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An Aggressive Strategy for Foot Salvage

Hobart W. Harris, MD, MPH; Joseph H. Rapp, MD; Linda M. Reilly, MD; Peggy A. Orlando, RN; William C. Krupski, MD; Jerry Goldstone, MD

Arch Surg. 1989;124(10):1232-1236.

Abstract
• Patients with forefoot ischemia and severe tibial artery disease present a major challenge to revascularization and foot preservation. Encouraged by the success of saphenous vein bypass to the more proximal arteries of the lower leg, we extended this technique to the pedal arteries. Between February 1986 and September 1988, we performed 26 bypasses in 24 men (mean age, 66 years) with critical foot ischemia. Sixty-three percent of the patients had diabetes mellitus, 50% had hypertension, and 71% were actively smoking. Angiography invariably revealed multiple tibial artery occlusions with reconstitution of the pedal arteries. The foot salvage rate was 83% (mean survival, 14 months), primary patency was 83% (mean survival, 9 months), and survival was 86% (mean, 12 months). There were 11 wound complications (42%); two resulted in disruptions of the distal anastomosis and eventual graft failure. Bypass to the pedal arteries yields a high rate of foot salvage and is comparable with more proximal bypass procedures; however, wound complications are common and require special technical considerations.

(Arch Surg. 1989;124:1232-1236)

Author Affiliations
From the Surgical Service, Veterans Administration Medical Center, Department of Surgery and Division of Vascular Surgery, University of California, San Francisco.

Footnotes
Accepted for publication June 22, 1989.

Read before the 60th Annual Meeting of the Pacific Coast Surgical Association, Vancouver, Canada, February 22, 1989.

Reprint requests to Surgical Service 112, Veterans Administration Medical Center, San Francisco, CA 94121 (Dr Harris).

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