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Two-Year Experience

Wilfred I. Carney, Jr, MD; Alexander Balko, MD; Michael S. Barrett, MD

Arch Surg. 1985;120(7):812-816.

Abstract
• 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.

(Arch Surg 1985;120:812-816)

Author Affiliations
From the Departments of Surgery, Rhode Island Hospital (Dr Carney), Veterans Administration Medical Center (Dr Balko), and St Joseph's Hospital and Roger Williams Hospital (Dr Barrett), Providence, RI.

Footnotes
Accepted for publication March 14, 1985.

Read before the 11th annual meeting of the New England Society for Vascular Surgery, Dixville Notch, NH, Oct 12, 1984.

Reprint requests to 120 Dudley St, Providence, RI 02905 (Dr Carney).

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