MICROSCOPE-AIDED PEDAL BYPASS IS AN EFFECTIVE AND LOW-RISK OPERATION TO SALVAGE THE ISCHEMIC FOOT

BACKGROUND: The aim of this study was to determine the current operati ve licks of the pedal bypass procedure, its durability, and the factor s affecting long-term outcome. METHODS: We prospectively observed 96 p atients who consecutively underwent 100 pedal bypasses using autogenou s vein grafts for chronic critical ischemia. Of the 100 limbs, 91 had ischemic ulcers or gangrene, and 9 produced rest pain only. Sixty-four patients were diabetic, 21 had renal failure, and 36 had coronary art ery disease, Nonreversed saphenous vein grafts were used most frequent ly (68 translocated, 13 in situ), followed by composite (13) and rever sed vein grafts (6). Fifty-two long grafts originated from the iliac o r femoral arteries, and 48 short grafts originated from the popliteal or tibial arteries. For the 100 procedures, 102 distal anastomoses wer e performed-68 to the dorsalis pedis, 8 to the distal posterior tibial , 10 to the common plantar, 2 to the: medial plantar, 9 to the lateral plantar, 4 to the lateral tarsal, and 1 to the first dorsal metatarsa l arteries-with the aid of an operating microscope. RESULTS: No patien t died during the perioperative period. Two had hemodynamically insign ificant myocardial infarctions. Wound complications del eloped in 12 p atients-infection in I and hematoma in 5. There were 10 early graft fa ilures, 6 of which could be salvaged, and 96 grafts were patent at dis missal. Mean follow-up was 2.1 years (range 1 month to 6.4 years). Pos toperative surveillance identified 33 failed or failing grafts, 16 of which were successfully revised. At 3 years, cumulative primary and se condary patency rates were 60% and 69%, respectively. Factors correlat ing with increased secondary patency were intraoperative flow rate gre ater than or equal to 50 mL/min (P = 0.004) and diabetes (P <0.05). Ma jor amputations were performed on 17 limbs. The cumulative foot salvag e rate at 3 years was 79%. CONCLUSION: Pedal bypass is a safe, effecti ve, and durable procedure. It should be considered even for high-risk patients with critical limb ischemia before major amputation is contem plated.