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Totally Autogenous Venovenous Composite Bypass GraftsSalvage of the Almost Irretrievable Extremity
Robert W. Harris, MD;
George Andros, MD;
Sergio X. Salles-Cunha, PhD;
Leopoldo B. Dulawa, MD;
Robert W. Oblath, MD;
Roseanne L. Apyan, RN
Arch Surg. 1986;121(10):1128-1132.
Abstract
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• When a suitable single length of saphenous or arm vein is unavailable, the elderly patient with a profoundly ischemic extremity, poor runoff, and a distal outflow vessel frequently undergoes amputation. Rather than performing primary amputation or resorting to nonautogenous conduits, we used 21 different combinations of available vein segments of ipsilateral or contralateral greater saphenous, lesser saphenous, cephalic, and basilic veins as composite autogenous bypass grafts. Fifty-four extremities, of which 21 (39%) had one or more failed previous bypasses, were revascularized. Tissue necrosis necessitated operation in 74% (40 instances) and rest pain in 19% (ten instances). All grafts extended below the knee, 22% (12 grafts) to the infrageniculate popliteal artery, 78% (42 grafts) to an infrapopliteal runoff vessel, and 28% (15 grafts) to the ankle or foot. The patency rate at one month was 81%. Thrombectomy alone or with local graft repair increased the one-month patency rate to 96%. At one year, the patency and limb salvage rates were 74% and 82%, respectively.
(Arch Surg 1986;121:1128-1132)
Author Affiliations
From St Joseph Medical Center, Burbank, Calif.
Footnotes
Accepted for publication July 21, 1986.
Read before the Annual Meeting of the Southern California Chapter of the American College of Surgeons, Palm Springs, Calif, Jan 17, 1986.
Reprint requests to Vascular Laboratory, St Joseph Medical Center, Buena Vista and Alameda, Burbank, CA 91505 (Dr Harris).
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