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Tochikubo A, Koya A, Uchida D, Tada Y, Kikuchi S, Azuma N. Collateral artery bypass in the infrapopliteal segment. J Vasc Surg Cases Innov Tech 2021; 7:30-34. [PMID: 33665528 PMCID: PMC7902279 DOI: 10.1016/j.jvscit.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/09/2020] [Indexed: 11/26/2022] Open
Abstract
A 74-year-old man with diabetes and end-stage renal failure on regular dialysis required revascularization for gangrene of multiple toes and a heel ulcer on the right foot with chronic limb-threatening ischemia. However, the anterior tibial artery, posterior tibial artery, and peroneal artery, which are the usual targets below the knee, showed obstruction or calcification and were considered inappropriate bypass targets. Instead, a collateral artery developed along the area of the posterior tibial artery, and bypass surgery was performed with this artery. This is a case report showing successful collateral artery bypass grafting in the distal infrapopliteal segment.
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Affiliation(s)
- Ai Tochikubo
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Atsuhiro Koya
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Daiki Uchida
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yuki Tada
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Shinsuke Kikuchi
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
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Gomes Giusti JC, Neves Beraldo JP, Rossi FH, Trento AF, Barbosa de Sousa LC, Linardi Piccoli RS, Hayashi MT, Brochado Neto FC. The Descending Genicular Artery as a Recipient Vessel in Chronic Limb-Threatening Ischemia—A Case Report and Literature Review. Ann Vasc Surg 2020; 69:450.e23-450.e28. [DOI: 10.1016/j.avsg.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 11/25/2022]
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Houlind K. Surgical revascularization and reconstruction procedures in diabetic foot ulceration. Diabetes Metab Res Rev 2020; 36 Suppl 1:e3256. [PMID: 31840931 DOI: 10.1002/dmrr.3256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/25/2019] [Indexed: 11/08/2022]
Abstract
This article summarizes surgical procedures for preservation of the foot in diabetic patients with peripheral artery disease. Distal bypass surgery performed to perigeniculate arteries and to an isolated 'blind' popliteal segment with visible collaterals can be performed with limb salvage rates close to what can be achieved with standard bypass to crural arteries. This is also the case when performing bypass to the dorsalis pedis artery. Bypass to the medial or lateral plantar artery or to the lateral tarsal artery is associated with a relatively high rate of early occlusion, but in the patients who have persistently open grafts, limb salvage is common. The use of an arteriovenous fistula as an adjunct to distal bypass surgery does not improve prognosis. Venous arterialization, either creating retrograde perfusion of the superficial or of the deep veins of the foot has been successful in several cases although it is difficult to predict which patients will benefit. Reconstructive surgery is often performed in a multidisciplinary team including plastic surgeons. In patients with need of more extensive cover of defects, the transplant of muscular or fasciocutaneous free flaps has provided good results in the few centres that have applied this technique. This procedure can be combined with a revascularization in the same session or at a later stage. A majority of the described techniques can be implemented in most vascular centres and they should be considered in complicated cases when standard methods of revascularization and reconstruction do not suffice.
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Affiliation(s)
- Kim Houlind
- Kolding Hospital, University Hospitals of Southern Denmark, Department of Regional Health Research, University of Southern Denmark, Kolding, Denmark
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Giusti JCG, Fernandes JR, Soares SP, Dos Santos KR, Rossi FH, Beraldo JPN, Brochado FC. Alternative iliofemoral revascularization in extensive aortoiliac occlusive disease. J Vasc Bras 2019; 18:e20180083. [PMID: 31360150 PMCID: PMC6637000 DOI: 10.1590/1677-5449.180083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Over recent decades, there has been a considerable increase in use of endovascular methods to treat aortoiliac occlusive disease. It has been demonstrated that this approach offers many benefits, primarily for non-complex arterial lesions of the iliac axis, but difficulties persist with achieving adequate results over the medium and long term when treating extensive occlusive disease. Arterial bypasses to alternative vicarious arteries of the femoral-genicular complex for limb salvage are well known in the literature describing cases that are not favorable for conventional or endovascular surgery. We describe the case of a patient with extensive aortoiliac occlusive disease treated with an arterial bypass in the iliofemoral territory, using an alternative autologous substitute and the descending lateral femoral artery as recipient artery. Alternative bypasses and substitutes that are normally reserved for exceptional cases can and should be part of the vascular therapeutic arsenal and have a contribution to make in cases in which endovascular surgery does not yet enable us to achieve good results.
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Affiliation(s)
- Júlio César Gomes Giusti
- Hospital Municipal Carmino Caricchio - HMCC, Departamento de Cirurgia Vascular, São Paulo, SP, Brasil
| | | | - Samara Pontes Soares
- Hospital Municipal Carmino Caricchio - HMCC, Departamento de Cirurgia Vascular, São Paulo, SP, Brasil
| | | | - Fabio Henrique Rossi
- Instituto Dante Pazzanese de Cardiologia - IDPC-SP, Departamento de Cirurgia Vascular, São Paulo, SP, Brasil
| | - João Paulo Neves Beraldo
- Hospital Municipal Carmino Caricchio - HMCC, Departamento de Cirurgia Vascular, São Paulo, SP, Brasil
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The Impact of Geniculate Artery Collateral Circulation on Lower Limb Salvage Rates in Injured Patients. Ann Vasc Surg 2015; 30:258-62. [PMID: 26541964 DOI: 10.1016/j.avsg.2015.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/03/2015] [Accepted: 07/19/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study aimed to determine the association between geniculate artery flow on admission computed tomography (CT) angiography and limb salvage outcomes in patients with lower extremity arterial injury. METHODS All injured patients at a level I trauma center with CT angiogram (CTA) confirmed limited or no flow to the tibial vessels were included. Demographics, injury severity score (ISS), mechanism of injury, physiological parameters, the presence of geniculate artery collateral circulation (superior medial, superior lateral, medial, inferior medial, inferior lateral), and 30-day limb salvage outcome were recorded. Statistical analysis was completed using descriptive statistics and the chi-squared tests. RESULTS From 2009 to 2012, a total of 84 patients with lower extremity arterial injury underwent diagnostic evaluation with CTA on admission that confirmed limited or no flow to the tibial vessels. A total of 10 patients (12%) underwent amputation. Primary amputation was performed in 3 (4%) patients, and secondary amputation was performed in 7 (8%) patients. There was no difference in age, gender, ISS, extremity abbreviated injury score, mechanism of injury, admission systolic blood pressure, heart rate, respiratory rate, transfusion volume, or type of vascular interventions between patients who had successful limb salvage and those who received an amputation. The number of patent geniculate arterial vessels was inversely associated with amputation with 3.3 patent geniculate arteries in the limb salvage group compared to 2.1 in the amputation group (P < 0.05). The 2 geniculate artery vessels that were significantly associated with limb salvage were the superior lateral geniculate and the inferior medial geniculate arteries (P < 0.05). CONCLUSIONS Geniculate collateral circulation may have an important role in limb salvage after lower extremity vascular injury. The geniculate arteries that are associated with the highest rates of limb salvage appear to be the superior lateral geniculate and the inferior medical geniculate artery.
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Georgakarakos E, Kapoulas K, Koukoumtzis D, Mantatzis M, Lazarides MK. An uncommon clinical presentation of acute limb ischemia: underscoring the role of perigenicular collaterals. Vascular 2012; 20:174-7. [PMID: 22416262 DOI: 10.1258/vasc.2011.cr0300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present a case of atypical acute limb ischemia in a non-diabetic patient, with ankle-brachial pressure index of 0.6 and rest pain localized exclusively over the gastrocnemius muscle, sparing the foot. This uncommon presentation was attributed to an impaired perigenicular collateral network. Thrombolysis restored adequate perfusion only temporarily and was followed by thromboembolectomy. The ischemia presentation in our case underscores the importance of the adequacy of the perigeniculate collateral network for the perfusion of the tibial muscles and, especially, the gastrocnemius muscle.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, Demokritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
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Matsumoto H, Yamamoto E, Kamiya C, Miura E, Kitaoka T, Suzuki J, Yamamoto K, Deguchi J, Higashi M, Tamaru JI, Sato O. Sural Artery Bypass in Buerger's Disease: Report of a Case. Ann Vasc Dis 2012; 5:199-203. [PMID: 23555511 DOI: 10.3400/avd.cr.11.00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 01/21/2012] [Indexed: 11/13/2022] Open
Abstract
A 72 year-old man was admitted to the hospital to receive treatment for resting pain and an ulcer, which had developed on an amputation stump, 4 months after he had undergone a thrombectomy, below-the-knee popliteal-dorsal pedis artery bypass of his left leg, and digital amputation of his 2nd toe. Angiography demonstrated diffuse arterial and bypass occlusion in his left leg that did not include a sural artery, which was the main collateral. Therefore, the patient underwent reversed saphenous vein bypass from the common femoral artery to the medial sural artery. His leg pain disappeared, and the ulcer healed promptly.
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Affiliation(s)
- Harunobu Matsumoto
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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De Luccia N, Sassaki P, Durazzo A, Sandri G, Kikuchi M, Hirata C, Romiti M, Sacilotto R, Brochado-Neto FC. Limb salvage using bypass to the perigeniculate arteries. Eur J Vasc Endovasc Surg 2011; 42:374-8. [PMID: 21632264 DOI: 10.1016/j.ejvs.2011.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe bypass to perigeniculate vessels for limb salvage. DESIGN Retrospective cohort study. MATERIAL AND METHODS Between 1995 and 2009, 47 bypass procedures to perigeniculate collateral arteries were performed in 46 patients (15 women, 31 men; median age, 68 years). All patients presented with critical ischaemia (tissue loss in 87.5%, rest pain in 12.5%). Mean ankle brachial index was 0.27 ± 0.17. The site of distal anastomosis was the descending genicular artery (DGA) in 23 bypasses (1 bilateral) and the medial sural artery (MSA) in 24. Proximal anastomosis was to the external iliac artery in 2 cases, common femoral artery in 23 cases, superficial femoral artery in 8 cases, deep femoral artery in 8 cases, above-knee poplitaeal artery in 2 cases, and previous graft in 4 cases. RESULTS There were four deaths during the immediate postoperative period. Mean follow-up duration was 27 months. Ten patients required major amputation. Mean ankle brachial index post-operatively was 0.60 ± 0.21. At 3 years, primary patency was 74.7 ± 7%, secondary patency was 83.4 ± 8%, and the limb salvage and survival rates were 73.5 ± 7% and 77.4 ± 7%, respectively. CONCLUSION Bypass to perigeniculate arteries is a viable treatment option for critical limb ischaemia in selected patients.
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Affiliation(s)
- N De Luccia
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
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Moxey PW, Hofman D, Hinchliffe RJ, Jones K, Thompson MM, Holt PJE. Trends and outcomes after surgical lower limb revascularization in England. Br J Surg 2011; 98:1373-82. [DOI: 10.1002/bjs.7547] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2011] [Indexed: 11/07/2022]
Abstract
Abstract
Background
The aim was to analyse contemporary data on the number of surgical revascularization procedures performed each year in England, and their outcome.
Methods
Hospital Episode Statistics and Office for National Statistics data were used to quantify numbers and identify factors associated with outcome after all femoropopliteal and femorodistal bypass procedures performed between 2002 and 2006. Outcome measures were repeat bypass, major amputation, death and a composite measure. Single-level multivariable logistic regression modelling was used to quantify the effect of these variables on outcome.
Results
A total of 21 675 femoropopliteal and 3458 femorodistal bypass procedures were performed. Mean in-hospital mortality rates were 6·7 and 8·0 per cent respectively. One-year survival rates were 82·8 and 79·1 per cent; both increased over the study interval. The mean 1-year major amputation rate after femoropopliteal bypass was 10·4 per cent, which decreased significantly over the 5 years (P < 0·001); after distal bypass the rate of 20·8 per cent remained unchanged (P = 0·456). Diabetes mellitus and chronic kidney disease were significant predictors of adverse outcome for both procedures: odds ratio (OR) at 1 year 1·56 (95 per cent confidence interval 1·46 to 1·67; P < 0·001) and 2·15 (1·88 to 2·45; P < 0·001) respectively for femoropopliteal bypass. Previous femoral angioplasty was associated with an increased rate of major amputation 1 year after proximal bypass (OR 1·18, 1·05 to 1·33; P = 0·004).
Conclusion
Although all mortality rates are improving, the major amputation rate remains high after femorodistal bypass. Adverse events occurred after 37·6 per cent of femoropopliteal and 49·7 per cent of femorodistal bypasses; diabetes and chronic renal failure were the main predictors of poor outcome.
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Affiliation(s)
- P W Moxey
- Department of Outcomes Research, St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK
| | - D Hofman
- Department of Outcomes Research, Community Health Sciences, St George's University of London, London, UK
| | - R J Hinchliffe
- Department of Outcomes Research, St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK
| | - K Jones
- Department of Outcomes Research, St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK
| | - M M Thompson
- Department of Outcomes Research, St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK
| | - P J E Holt
- Department of Outcomes Research, St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK
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De Luccia N, Appolonio F, Santo FRE. Vascular images. Arm vein bypass from distal deep femoral to superior medial genicular artery for limb salvage. J Vasc Surg 2009; 50:1196. [PMID: 19375268 DOI: 10.1016/j.jvs.2009.02.239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 02/24/2009] [Accepted: 02/24/2009] [Indexed: 10/20/2022]
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Ballotta E, Da Giau G, Gruppo M, Mazzalai F, Martella B, Militello C, Toniato A. Revascularization to an isolated (“blind”) popliteal artery segment: A viable procedure for critical limb ischemia. Surgery 2009; 145:426-34. [DOI: 10.1016/j.surg.2008.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 12/05/2008] [Indexed: 11/26/2022]
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