NONDISSECTION METHOD FOR TIBIAL BYPASS-SURGERY USING ESMARCHS RUBBER BANDAGE OR AN AUTOMATIC SEQUENTIAL PNEUMATIC TOURNIQUET - LONG-TERM RESULTS

It is suspected that operative injury to the native arteries during a vascular bypass procedure causes periarterial fibrosis contributing to late graft failure. A a nondissection method for tibial artery bypass has been developed using Esmarch's rubber bandage or an automatic seq uential pneumatic tourniquet, This retrospective study examined patenc y and other late results in distal bypass operations using the nondiss ection method, Between June 1982 and July 1995, 78 tibial bypasses wer e performed using reversed autogenous saphenous vein grafts in 70 pati ents (57 men, 13 women: mean age 57.4 years). Craft patency was assess ed angiographically, When a stenotic lesion was recognized, the graft was revised and considered an assisted primary patency, Primary patenc y rates at 1, 3, 5, and 10 years were 82.8%, 75.3%, 63.4% and 63.4%, r espectively, by life-table analysis. Six grafts required revision for stenosis; one involved distal anastomotic stenosis, As a result, assis ted primary patency rates resembled secondary patency rates of 87.7%, 84.3%, 80.3%, and 80.3% at the same respective intervals. In conclusio n, the nondissection method improved long-term patency by preventing l ate distal anastomotic stenosis. (C) 1998 The International Society fo r Cardiovascular Surgery.