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Enrico Ascer, MD, Frank J. Veith, MD, Sushil K. Gupta, MD 

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Presentation on theme: "Enrico Ascer, MD, Frank J. Veith, MD, Sushil K. Gupta, MD "— Presentation transcript:

1 Bypasses to plantar arteries and other tibial branches: An extended approach to limb salvage 
Enrico Ascer, MD, Frank J. Veith, MD, Sushil K. Gupta, MD  Journal of Vascular Surgery  Volume 8, Issue 4, Pages (October 1988) DOI: / (88) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

2 Fig. 1 Positioning of the distal anastomosis for bypasses to branches of tibial arteries. A, Limiting the anastomosis to a short tibial segment may give rise to turbulence with subsequent graft thrombosis. B, Preferred technique of placing the distal anastomosis directly into the patent recipient branch. Journal of Vascular Surgery 1988 8, DOI: ( / (88) ) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

3 Fig. 2 Diagram shows the two major branches of the posterior tibial artery. The lateral plantar artery is usually the larger and forms the deep pedal arch. Journal of Vascular Surgery 1988 8, DOI: ( / (88) ) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

4 Fig. 3 Diagram shows exposure of the distal portion of the posterior tibial artery and the lateral and medial plantar branches. This can be accomplished by incision of the flexor retinaculum and the abductor hallucis muscle. The larger lateral plantar branch is usually inferior to the medial plantar branch when the foot is externally rotated in the supine position. Journal of Vascular Surgery 1988 8, DOI: ( / (88) ) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

5 Fig. 4 Diagram shows the deep plantar arch as the main terminal branch of the dorsalis pedis artery. Insert highlights the origin of the deep plantar branch and its downward course between the base of the first and second metatarsal bones. This exposure is facilitated by the lateral retraction of the extensor hallucis brevis muscle. Journal of Vascular Surgery 1988 8, DOI: ( / (88) ) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

6 Fig. 5 Diagram A illustrates the entire exposure of the deep plantar arch branch after partial resection of the second metatarsal bone. Placement of the distal anastomosis can be easily accomplished through this exposure (B). Journal of Vascular Surgery 1988 8, DOI: ( / (88) ) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

7 Fig. 6 Overall cumulative life-table primary graft patency rates for all 24 bypasses. Number of patients at risk and standard error are shown at each interval. Journal of Vascular Surgery 1988 8, DOI: ( / (88) ) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

8 Fig. 7 Management and outcomes of the 24 bypasses. Group 1, Lateral plantar branches; group 2, medial plantar branches; group 3, deep plantar branches; group 4, lateral tarsal branches; group 5, unnamed muscular branches. →, patent graft; x, occluded graft; ν viable with a closed graft; r, reoperation for closed graft; o, amputation with patent graft; †, death; BKA, below-knee amputation. Journal of Vascular Surgery 1988 8, DOI: ( / (88) ) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

9 Fig. 8 Cumulative life-table primary graft patency rates for the 20 bypasses to foot branches. Number of patients at risk and standard error are shown at each interval. Journal of Vascular Surgery 1988 8, DOI: ( / (88) ) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

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