J.Jpn. Surg. Soc.. 89(3): 443-451, 1988

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Original article

USEFULNESS OF SEQUENTIAL BYPASS TECHNIQUE IN ARTERIAL RECONSTRUCTION

Although sequential bypass grafting has been recommended for surgical treatment of lower limb ischemia in patients with complex multisegmental arterial occlusion, hemodynamic evaluation of the sequential bypass procedure remains to be resolved. The present study was undertaken to evaluate the sequential bypass operation to assess its usefulness from the standpoint of hemodynamics.
A model was made simulating a sequential bypass in the mongrel dogs, and blood flow through the sequential bypass graft much more increased than through the standard one, measured by an electromagnetic flowmeter.
By flow visualization in a glass tube model, type of flow separation and stagnation region in case of a side-to-side anastomosis was similar to those in case of an end-to-side one. The stagnation area at the anastomotic site was widened when the vascular resistance increased in the ramified vessel which corresponded to the host distal artery.
It was considered reasonable to blockade the retrograde blood flow through the anastomotic site by ligating the host artery proximal to the anastomotic point when the retrograde blood perfusion was unnecessary.
Clinical results of 21 cases with the sequential bypass grafting were presented and the usefulness of the technique was discussed from a hemodynamic viewpont.

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