Аutogenous vein or graft used simultaneously for both a femoro-popliteal by-pass and profundoplasty
AbstractWe proposed our own method of combining a femoropopliteal bypass grafting with concurrent profundoplasty. We make a 4-6 cm longitudinal incision, which begins on the front aspect of the common femoral artery and continues on the same aspect of the profunda femoris artery. Then we form the proximal anastomosis along this incision with an autovein by means of continuous suture. In this way the graft lying on the whole length of the incision creates simultaneously anastomosis to the common femoral artery and dilates orifice and lumen of the profunda femoris artery, i.e. the profundoplasty. The S-like form of the graft is not inferior haemodynamics to the arch-shaped one. Between January 1991 and December 2003, 24 above-knee original femoropopliteal bypasses were performed. The indications for operation were severe claudication in 6 cases, rest pain in 11 cases, and ulceration in 7 cases. 22 reversed saphenous venous bypasses and 2 polytetrafluoroethylene bypasses were performed. Successful results in the early postoperative period were obtained with 23 patients. For a period of 5 to 15 years thrombosis has been registered in 4 cases - 2 ended with amputation; six patients died during the same period. We conclude after 5-16 years of follow-up that a bypass with saphenous vein and simultaneously profundoplsty have better patency rates at all intervals and needs fewer reoperations. This combination should be the graft material of choice for above-knee femoropopliteal bypasses and should not be preserved for reinterventions.
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