Amaç: İnfrapopliteal aterosklerotik tıkayıcı hastalığın tedavisinde popliteal arter, anterior tibial arter, tibioperoneal trunk, posterior tibial arter, peroneal arter ve plantar arterlere bypass uygulaması damar cerrahisi uygulamasında önemli yere sahiptir. Materyal ve Metod: Çalışmamızda, 1990-1999 yılları arasında kliniğimizde distal bypass uygulanan 95 hastanın takip ve sonuçları irdelenmiştir. İnflow bölgesi olarak en sık (%71.13) ana femoral arter eksplore edildi. Distal anastomoz, %68.42 ile en sık dizaltı popliteal artere uygulandı. Olguların %13.68'inde posterior tibial artere, %11.58 olguda tibioperoneal trunka ve %6.31 olguda anterior tibial artere distal anastomoz yapıldı. En sık kullanılan greft materyeli otojen safen ven grefti idi. Bulgular: Dizaltı popliteal artere bypass uygulanan hastalarda 1 ve 2 yıllık açık kalma oranı %88.7 ve %80.2 olarak saptandı. Bu sonuçlar anterior tibial artere, tibioperoneal trunk'a, posterior tibial artere bypass uygulanan olgularda sırasıyla %76.3 ve %67; %81.3 ve %76.6; %78.2 ve %62.3 idi. Ters çevrilmifl otojen safen ven grubunda bir ve iki yıllık açık kalma oranları %87.5 ve %79.4; in situ otojen safen ven grubunda ise %83 ve %75.6 idi. Polytetrafluoroethylene grubunda bu sonuçlar anlamlı olarak düşük idi (%59.5 ve %50.8; p < 0.001). Sonuç: Tibioperoneal arterlerin hepsi femorodistal bypass cerrahisinde outflow bölgesi olarak kullanılabilir. Otojen safen ven kullanılarak yapılan diz altı bypasslar kolay uygulanabilir ve sonuçları yüz güldürücüdür.
Background: Bypass procedures related to the popliteal, anterior tibial, posterior tibial, peroneal and plantar arteries and tibioperoneal trunk have a great importance in the treatment of infrapopliteal atherosclerotic occlusive diseases. Methods: In our study, 95 cases operated for infrapopliteal atherosclerotic disease between 1990-1999 were examined including follow up and results. The most common inflow site was the common femoral artery (71.13%). Distal anastomoses were performed on infrapopliteal artery in 68.42%, posterior tibial artery in 13.68%, the tibioperoneal trunk in 11.58% and the anterior tibial artery in 6.31% of the cases. The most commonly used graft material was the autogenous saphenous vein. Results: The first and the second year patency rates for below knee popliteal artery bypasses were 88.2% and 80.2%, respectively. It was 76.3% and 67% for anterior tibial artery, 81.3% and 76.6% for tibioperoneal trunk, 78.2% and 62.3% for posterior tibial artery bypasses. For the reversed autogenous saphenous vein group, the first and second year patency rates were 87.5% and 79.4%. For in situ autogenous saphenous vein group it was 83% and 75.6%. These rates were significantly higher compared to the polytetrafluoroethylene used group (59.5% and 50.8%). Conclusions: All infrapopliteal arteries can be used as outflow tract in femorodistal bypass surgery. Infrapopliteal bypasses can be performed easly using autogenous saphenous vein grafts and the results are better. ">
[PDF] İnfrapopliteal bypass uygulamalarımız | [PDF] Our infrapopliteal bypass applications
Amaç: İnfrapopliteal aterosklerotik tıkayıcı hastalığın tedavisinde popliteal arter, anterior tibial arter, tibioperoneal trunk, posterior tibial arter, peroneal arter ve plantar arterlere bypass uygulaması damar cerrahisi uygulamasında önemli yere sahiptir. Materyal ve Metod: Çalışmamızda, 1990-1999 yılları arasında kliniğimizde distal bypass uygulanan 95 hastanın takip ve sonuçları irdelenmiştir. İnflow bölgesi olarak en sık (%71.13) ana femoral arter eksplore edildi. Distal anastomoz, %68.42 ile en sık dizaltı popliteal artere uygulandı. Olguların %13.68'inde posterior tibial artere, %11.58 olguda tibioperoneal trunka ve %6.31 olguda anterior tibial artere distal anastomoz yapıldı. En sık kullanılan greft materyeli otojen safen ven grefti idi. Bulgular: Dizaltı popliteal artere bypass uygulanan hastalarda 1 ve 2 yıllık açık kalma oranı %88.7 ve %80.2 olarak saptandı. Bu sonuçlar anterior tibial artere, tibioperoneal trunk'a, posterior tibial artere bypass uygulanan olgularda sırasıyla %76.3 ve %67; %81.3 ve %76.6; %78.2 ve %62.3 idi. Ters çevrilmifl otojen safen ven grubunda bir ve iki yıllık açık kalma oranları %87.5 ve %79.4; in situ otojen safen ven grubunda ise %83 ve %75.6 idi. Polytetrafluoroethylene grubunda bu sonuçlar anlamlı olarak düşük idi (%59.5 ve %50.8; p < 0.001). Sonuç: Tibioperoneal arterlerin hepsi femorodistal bypass cerrahisinde outflow bölgesi olarak kullanılabilir. Otojen safen ven kullanılarak yapılan diz altı bypasslar kolay uygulanabilir ve sonuçları yüz güldürücüdür. ">
Amaç: İnfrapopliteal aterosklerotik tıkayıcı hastalığın tedavisinde popliteal arter, anterior tibial arter, tibioperoneal trunk, posterior tibial arter, peroneal arter ve plantar arterlere bypass uygulaması damar cerrahisi uygulamasında önemli yere sahiptir. Materyal ve Metod: Çalışmamızda, 1990-1999 yılları arasında kliniğimizde distal bypass uygulanan 95 hastanın takip ve sonuçları irdelenmiştir. İnflow bölgesi olarak en sık (%71.13) ana femoral arter eksplore edildi. Distal anastomoz, %68.42 ile en sık dizaltı popliteal artere uygulandı. Olguların %13.68'inde posterior tibial artere, %11.58 olguda tibioperoneal trunka ve %6.31 olguda anterior tibial artere distal anastomoz yapıldı. En sık kullanılan greft materyeli otojen safen ven grefti idi. Bulgular: Dizaltı popliteal artere bypass uygulanan hastalarda 1 ve 2 yıllık açık kalma oranı %88.7 ve %80.2 olarak saptandı. Bu sonuçlar anterior tibial artere, tibioperoneal trunk'a, posterior tibial artere bypass uygulanan olgularda sırasıyla %76.3 ve %67; %81.3 ve %76.6; %78.2 ve %62.3 idi. Ters çevrilmifl otojen safen ven grubunda bir ve iki yıllık açık kalma oranları %87.5 ve %79.4; in situ otojen safen ven grubunda ise %83 ve %75.6 idi. Polytetrafluoroethylene grubunda bu sonuçlar anlamlı olarak düşük idi (%59.5 ve %50.8; p < 0.001). Sonuç: Tibioperoneal arterlerin hepsi femorodistal bypass cerrahisinde outflow bölgesi olarak kullanılabilir. Otojen safen ven kullanılarak yapılan diz altı bypasslar kolay uygulanabilir ve sonuçları yüz güldürücüdür.
Background: Bypass procedures related to the popliteal, anterior tibial, posterior tibial, peroneal and plantar arteries and tibioperoneal trunk have a great importance in the treatment of infrapopliteal atherosclerotic occlusive diseases. Methods: In our study, 95 cases operated for infrapopliteal atherosclerotic disease between 1990-1999 were examined including follow up and results. The most common inflow site was the common femoral artery (71.13%). Distal anastomoses were performed on infrapopliteal artery in 68.42%, posterior tibial artery in 13.68%, the tibioperoneal trunk in 11.58% and the anterior tibial artery in 6.31% of the cases. The most commonly used graft material was the autogenous saphenous vein. Results: The first and the second year patency rates for below knee popliteal artery bypasses were 88.2% and 80.2%, respectively. It was 76.3% and 67% for anterior tibial artery, 81.3% and 76.6% for tibioperoneal trunk, 78.2% and 62.3% for posterior tibial artery bypasses. For the reversed autogenous saphenous vein group, the first and second year patency rates were 87.5% and 79.4%. For in situ autogenous saphenous vein group it was 83% and 75.6%. These rates were significantly higher compared to the polytetrafluoroethylene used group (59.5% and 50.8%). Conclusions: All infrapopliteal arteries can be used as outflow tract in femorodistal bypass surgery. Infrapopliteal bypasses can be performed easly using autogenous saphenous vein grafts and the results are better. ">
Amaç: İnfrapopliteal aterosklerotik tıkayıcı hastalığın tedavisinde popliteal arter, anterior tibial arter, tibioperoneal trunk, posterior tibial arter, peroneal arter ve plantar arterlere bypass uygulaması damar cerrahisi uygulamasında önemli yere sahiptir. Materyal ve Metod: Çalışmamızda, 1990-1999 yılları arasında kliniğimizde distal bypass uygulanan 95 hastanın takip ve sonuçları irdelenmiştir. İnflow bölgesi olarak en sık (%71.13) ana femoral arter eksplore edildi. Distal anastomoz, %68.42 ile en sık dizaltı popliteal artere uygulandı. Olguların %13.68'inde posterior tibial artere, %11.58 olguda tibioperoneal trunka ve %6.31 olguda anterior tibial artere distal anastomoz yapıldı. En sık kullanılan greft materyeli otojen safen ven grefti idi. Bulgular: Dizaltı popliteal artere bypass uygulanan hastalarda 1 ve 2 yıllık açık kalma oranı %88.7 ve %80.2 olarak saptandı. Bu sonuçlar anterior tibial artere, tibioperoneal trunk'a, posterior tibial artere bypass uygulanan olgularda sırasıyla %76.3 ve %67; %81.3 ve %76.6; %78.2 ve %62.3 idi. Ters çevrilmifl otojen safen ven grubunda bir ve iki yıllık açık kalma oranları %87.5 ve %79.4; in situ otojen safen ven grubunda ise %83 ve %75.6 idi. Polytetrafluoroethylene grubunda bu sonuçlar anlamlı olarak düşük idi (%59.5 ve %50.8; p < 0.001). Sonuç: Tibioperoneal arterlerin hepsi femorodistal bypass cerrahisinde outflow bölgesi olarak kullanılabilir. Otojen safen ven kullanılarak yapılan diz altı bypasslar kolay uygulanabilir ve sonuçları yüz güldürücüdür.
Our infrapopliteal bypass applications
Background: Bypass procedures related to the popliteal, anterior tibial, posterior tibial, peroneal and plantar arteries and tibioperoneal trunk have a great importance in the treatment of infrapopliteal atherosclerotic occlusive diseases. Methods: In our study, 95 cases operated for infrapopliteal atherosclerotic disease between 1990-1999 were examined including follow up and results. The most common inflow site was the common femoral artery (71.13%). Distal anastomoses were performed on infrapopliteal artery in 68.42%, posterior tibial artery in 13.68%, the tibioperoneal trunk in 11.58% and the anterior tibial artery in 6.31% of the cases. The most commonly used graft material was the autogenous saphenous vein. Results: The first and the second year patency rates for below knee popliteal artery bypasses were 88.2% and 80.2%, respectively. It was 76.3% and 67% for anterior tibial artery, 81.3% and 76.6% for tibioperoneal trunk, 78.2% and 62.3% for posterior tibial artery bypasses. For the reversed autogenous saphenous vein group, the first and second year patency rates were 87.5% and 79.4%. For in situ autogenous saphenous vein group it was 83% and 75.6%. These rates were significantly higher compared to the polytetrafluoroethylene used group (59.5% and 50.8%). Conclusions: All infrapopliteal arteries can be used as outflow tract in femorodistal bypass surgery. Infrapopliteal bypasses can be performed easly using autogenous saphenous vein grafts and the results are better.
1. Edwards WH, Mulherin JL. The role of graft material in femorotibial bypass grafts. Ann Surg1980;191:721-6. 2. Taylor LM, Edwards JM, Phinney ES, Porter JN. Reversed vein bypass to infrapoliteal arteries. Ann Surg 1987;205:90-7.
3. Veith FJ, Gupta SK, Samson RS, Flores SW, Janko G, Scher LA. Superficial femoral and popliteal as inflow sites for distal bypasses. Surgery 1981;90:980-90.
4. Reichle FA, Martinson MW, Rankin KP. Infrapopliteal arterial reconstruction in the severely ischemic lower extremity. Ann Surg 1980;191:59-65.
5. Sidawy AN, Menzoian JO, Cantelmo NL, LoGerfo FW. E ffect of inflow and outflow sites on the results of tibioperoneal vein grafts. Am J Surg 1986;152:211-4.
6. Mannick JA, Whittemore AD, Donaldson Mc. Clinical and anatomic considerations for surgery in tibial disease and the results of surgery. Circulation 1991;83:181-5.
7. Jensen LP, Nielsen OM, Schroeder TV. The importance of complete follow-up for results after femoro-infrapopliteal vascular surgery. Eur J Vasc Endovasc Surg 1996;12:282-6.
8. Leather RP, Shah DM, Karmody AM. Infrapopliteal arterial bypass for limb salvage: Increased patency and utilization of the saphenous vein used Òin situÓ. Surgey 1981;90:1000-7.
9. Wengerter KR, Veith FJ, Gupta SK, et al. Prospective randomized multicenter comparison of in situ and reversed vein infrapopliteal bypasses. J Vasc Surg 1991;13:189-97.
10. Calligaro KD, Syrek JR, Dougherty MJ, et al. Use of arm and lesser saphenous vein compared with prosthetic grafts for infrapopliteal arterial bypass: Are they worth the effort? J Vasc Surg 1997;26:919-24.
11. Simone ST, Dubner B, Safi AR, et al. Comparative review of early and intermediate patency rates of polytetrafluoroethylene and autogenous saphenous vein grafts for lower extremity ischemia. Surgery 1981;90:991-9.
12. Gentile AT, Lee RW, Moneta Gl, et al. Results of bypass to the popliteal and tibial arteries with alternative sources of autogenous vein. J Vasc Surg 1996;23:272-9.
13. Ascer B, Gennaro M, Pollina RM, et al. Complementary distal arteriovenous fistula and deep vein interposition: A five year experience with a new technique to improve infrapopliteal prosthetic bypass patency. J Vasc Surg 1996;24:140-3.
14. Schuler JJ, Flanigan DP, Williams LR, Ryan TJ, Castronuovo JJ. Early experience with popliteal to infrapopliteal bypass for limb salvage. Arch Surg 1983;118:472-6.
15. Ascer E, Kirwin J, Mohan C, Gennaro M. The preferential use of the external iliac artery as an inflow redo femoropopliteal and infrapopliteal bypass. J Vasc Surg 1993;18:239-41.
16. Shah DM, Darling RC, Chang BB, et al. Is long vein bypass from groin to ankle a durable procedure? An analysis of a ten-year experience. J Vasc Surg 1992;15:402-7.
17. Davidson JT, Callis JT. Artreial reconstruction of vessels in the foot and ankle. Ann Surg1993;217:699-710.
18. Rosen RC, Johnson WC, Bush HL, et al. Staged infrainguinal revascularization: Initial prosthetic aboveknee bypass followed by a distal vein bypass for recuurent ischemia. Am J Surg 1986;152:224-30.
19. Cook TA, Davies AH, Horrocks M, Baird RN. Amputation level is not adversely affected by previous femorodistal bypass surgery. Eur J Vasc Surg 1992;6:599-601.
20. Brothers TE, Robison JG, Elliott BM, Arens C. Is infrapopliteal bypass compromised by distal origin of the proximal anastomosis? Ann Vasc Surg 1995;9:172-8.
21. Biancari F, Kantonen I, Alback A, Matzke S, Luther M, Lepantalo. Limits of infrapopliteal bypass surgery for critical leg ischemia: When not to reconstruct. World J Surg 2000;24:727-33.