Abstract
Background: The aim of this study was to evaluate graft patency and limb salvage rates of popliteal-to-distal bypass for patients with critical limb ischemia. Patients and Methods: Between 2003 and 2008, 10 patients with toe gangrene underwent popliteal-to-distal bypass. The mean age at operation was 72.7 years; 7 were men, 8 (80%) had diabetes, and 1 (10%) had end-stage renal failure with hemodialysis. The inflow source in 7 patients was the supragenicular popliteal artery and the infragenicular popliteal artery in 3 pataients. Distal outflow was to the posterior tibial artery in 6 patients and to the dorsalis pedis artery in 4 patients. In 2 cases, percutaneous balloon angioplasty was perioperatively added for multiple short stenoses in the superficial femoral artery. Results: Initial success was obtained in all cases, and skin perfusion pressure elevated from 20.5 ± 9.3 mmHg to 67.5 ± 23.9 mmHg postoperatively. Minor amputation was necessary in 6 but none required major amputation. With an average follow-up period of 15.9 months, secondary patency was obtained in all cases and 9 out of 10 patients survived with complete healing of their toe gangrene. There was no new lesion or restenosis in the superficial femoral artery during the follow-up period. Conclusions: Popliteal-to-distal bypass, with or without an additional angioplasty, for lesions of the superficial femoral artery can yield good long-term results for appropriately selected patients with critical limb ischemia.
