Infrainguinal bypass for critical limb ischemia: tips and tricks.

Abstract

A thoughtful but aggressive approach to care of patients with critical limb ischemia (CLI) is required to alleviate lower-extremity pain/tissue injury and achieve durable limb salvage. Specific subsets of CLI patients have been identified to clearly benefit from open surgical revascularization based on presenting signs (extensive tissue loss), multi-level, long-segment arterial occlusive disease, healthy saphenous conduit, and nondiseased tibial artery target vessel with continuous patency to the pedal arch. When other clinical scenarios exist, the treatment strategy requires consideration of patient's medical and surgical risk factors, anatomic distribution of atherosclerotic disease, and the clinical status of the limb affected by CLI. Infrainguinal saphenous vein bypass is the most durable technique for limb salvage and when properly performed is associated with excellent wound healing rates and improvement in quality of life. In this review, we detail our approach to infrainguinal arterial vein bypass in patients with CLI, including patient selection criteria, surgical planning based on arterial imaging studies, and operative technical requirements required for successful open lower-extremity bypass procedures.

• Authors: Marlin Wayne Causey, Charles Eichler
• Journal: Seminars in vascular surgery (Semin Vasc Surg) Vol. 27 Issue 1 Pg. 59-67 (Mar 2014) ISSN: 1558-4518 [Electronic] United States
• PMID: 25812759 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Topics

• Critical Illness
• Extremities (blood supply)
• Humans
• Ischemia (diagnosis, physiopathology, surgery)
• Patient Selection
• Risk Factors
• Treatment Outcome
• Vascular Grafting (adverse effects, methods)
• Vascular Patency