J.Jpn. Surg. Soc.. 97(7): 557-562, 1996

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Feature topic

RECONSTRUCTION OF THE CRURAL ARTERY IN ATHEROSCLEROTIC OCCLUSIVE ARTERIAL DISEASE

Limb threatening ischemia in patients with atherosclerotic occlusive disease is frequently induced by the association of crural artery occlusion. To improve the patency of distal bypass grafts, we developed a “non-dissection method” for reconstruction of these lesions. This method involves following procedures ; an adventitial dissection limited to the frontal surface of the artery at the anastomotic site, complete evacuation of blood from the lower leg using a Esmarch’s rubber bandage or a pneumatic tourniquet under systemic heparinization, and distal anastomosis with vein graft in end to side fashion with long arteriotomy (20 mm in length) without use of vascular clamps. This method has several advantages to the conventional method, such as easiness of suturing for accurate anastomosis, preservation of the rnuscular branches around the anastomosis, avoidance of surgery-induced injury to the artery and prevention of postoperative cicatrization around the anastomosis which may affect natural enlargement of the bypassed native artery. The technical details are described.
Since 1982, 76 tibial bypass surgeries were performed using this method. Whenever stenotic lesions were recognized, the grafts were revised and counted as a primary occlusion. The primary patency rates at 1 year, 3 years, 5 years and 10 years are 82.2％, 75.8％, 63.9％ and 63.9％ respectively. The secondary patency rates are 89.1％, 84.8％, 80.8％ and 80.8％ respectively at the same term.

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