The role of autologous ”distal-origin bypasses” in the treatment of isolated tibioperoneal arterial occlusive disease in diabetic patients with critical foot ischaemia

Objective: In a substantial number of diabetic patients, isolated tibioperoneal arterial occlusions are found to be the underlying cause for severe ischaemic foot lesions. To avoid limb loss under these conditions, short vein grafts have been being used to bypass the occluded crural arteries since the early 1980s. This presentation describes our nearly 12-year experience with this strategy. Patients and methods: Between 1 May 1986 and 31 December 1997, in 109 patients, 115 bypass grafts from the BK-popliteal artery or the proximal anterior tibial artery to malleolar vessels were performed in the presence of extended infrapopliteal arterial occlusions and critical foot ischaemia (rest pain 3, tissue loss 112). The mean age in this group was 70.1 years. Autologous vein was used in all cases (GSV rev. 79, GSV nonrev. 17, GSV in situ 15, LSV rev. 2, cephalic vein 2). Results: Using life-table analysis, primary and secondary patency rates for these bypasses with distal graft origination were 89% and 97% at 30 days, 76% and 83% at 1 year, and 60% and 62% at 6 years, respectively. The corresponding limb salvage rates amounted to 94%, 79%, and 70%. Conclusion: Our results suggest that short vein grafts represent an effective strategy for limb salvage in diabetic patients with infrapopliteal artery occlusions and critical foot ischaemia.