The bridge graft: A new concept for infrapopliteal surgery

Background: the long-term results of ePTFE grafts are particularly poor in crural reconstructions. We report on a novel surgical technique, whereby bo th run-off and anastomotic mismatches are concomitantly addressed. Patients and methods: short segments of vein grafts (5-15 cm in length) wer e used to bridge two crural artery segments. Subsequently, a femoro-distal ePTFE graft was anastomosed to the bridge graft. Venous valves were made in competent to allow bi-directional flow. In a retrospective series of 45 pat ients with crural bridge grafts, 12 patients were in stage III and 33 in st age IV. In 18 patients the reconstruction was the first procedure and in th e remaining 28 patients it was the first or second re-operation. Results: the primary patency rate at 1, 2, 3 and 4 years was 53, 44, 35 and 26% respectively. The secondary patency rate was 67, 53, 49 and 39% respec tively. The corresponding limb salvage rate was 70, 61, 56 and 45%. In a sm all subgroup of patients, in which the crural bridge was the first reconstr uctive procedure, the primary patency was 76 at 1 year and 64 at 4 years. Conclusion: convincing long-term crural bridge grafts should be considered in those patients who have more than one crural or pedal artery available f or grafting and an insufficient length of saphenous vein.