Below-knee bypasses using venous “cuffs"

Abstract

Background/Aim. Although distal venous "patch" and cuff techniques are recommended to improve the patency of by-pass in the lower extremities, the advantage of these techniques remains unproven. Autovenous by-pass graft remains the method of choice but when there is no possibility of using a great saphenous vein the venous patch method may have an advantage. The aim of this work was to evaluate the results of femoro-popliteal bypass procedures with venous patch in critical lower extremity ischemia.Methods. The study described the results of this procedure after a follow-up period of 6 to 24 months. We followed 28 patients with distal composite anastomosis of femoro-distal arterial reconstruction. Indications for surgical treatment were set on the basis of the clinical exam and morphological criteria on the basis of multidetected computed angiography. Three types of distal graft-arterial anastomoses were applied: Miler?s cuff, Taylor?s patch, and St. Marry vein boot anastomosis. Results. After 6 months of surgery, all by-passes were passable. 2 (7%) patients had graft occlusion after one year and above-knee amputation, 8 (28%) patients dead after a period of one year. 18 (64%) patients had primary by-pass patency after 24 months. Conclusion. Femoro-popliteal by-pass procedures using a synthetic graft and venous patch have good long-term results. The optimal anstomosis is type St. Marry boot. A longer follow-up period and comparison with the autovenous bypass are necessary for a more detailed assessment of the final conclusion.