In situ femoropopliteal and infrapopliteal bypass. Two-year experience
W. I. Carney Jr, A. Balko and M. S. Barrett
We describe 83 in situ femoropopliteal and infrapopliteal artery bypass
grafts. The in situ technique involved the valve incision method using
scissors, the valvulotome (Leather), and a modified valve cutter (Hall).
Arteriovenous fistulae were detected intraoperatively by angiography and/or
the Doppler method and ligated. The operative indications were rest pain,
ulcer, and gangrene in 88% of cases, and claudication in 7.2%. The mean
preoperative ankle pressure was 61.3 mm Hg and the ankle-brachial index was
0.43. The mean postoperative ankle pressure was 125.3 mm Hg and the
ankle-brachial index was 0.97. The vein utilization rate was 96%. One-year
patency for popliteal anastomoses was 85.7%, for peroneal anastomoses it
was 100%, and for infrapopliteal anastomoses it was 89.6%. The data suggest
that the practicing vascular surgeon can adopt the in situ technique and
can expect high graft patency rates even in limb salvage situations with
poor distal outflow.
