A flexible approach to infrapopliteal vein grafts in patients with diabetes mellitus
F. B. Pomposelli Jr, S. J. Jepsen, G. W. Gibbons, D. R. Campbell, D. V. Freeman, B. M. Gaughan, A. Miller and F. W. LoGerfo
Division of Vascular Surgery, New England Deaconess Hospital, Harvard Medical School, Boston, Mass.
From October 1985 to August 1989, we performed 156 dorsalis pedis artery
bypasses in 146 patients, 139 (95%) of whom had diabetes mellitus. A
variety of surgical techniques were used to shorten surgery, limit incision
length, and optimize size-matching between vein grafts and arteries
whenever possible. Arterial inflow was from the common femoral artery in 58
cases, from the distal superficial femoral or popliteal artery in 88 cases,
from a tibial artery in three cases, and from a preexisting bypass in seven
cases. In situ (75 cases), ex situ reversed- or nonreversed-vein (62),
composite vein (nine), and polytetrafluoroethylene (one) bypasses were
constructed. Four patients (2.7%) died, and seven grafts (4.5%) failed
within 30 days. Actuarial patency and limb salvage 6 to 52 months after
surgery were 87.1% and 91.6%, respectively. There were no significant
differences in patency between in situ and ex situ vein grafts (93.2% vs
89.7%) or between common femoral artery inflow site and distal superficial
femoral/popliteal artery inflow site (89.3% vs 88%).
