Leg Ischemia and Aortoiliac Disease

Limb Salvage Using Bypass to the Perigeniculate Arteries

De Luccia N, Sassaki P, Durazzo A, et al (Hospital das Clínicas Faculdade de Medicina Universidade de São Paulo, Brazil; Hospital Guilherme Álvaro, Santos, Brazil; et al) Eur J Vasc Endovasc Surg 42:374–378, 2011^§

Abstract

Objective

To describe bypass to perigeniculate vessels for limb salvage.

Design

Retrospective cohort study.

Material and Methods

Between 1995 and 2009, 47 bypass procedures to perigeniculate collateral arteries were performed in 46 patients (15 women, 31 men; median age, 68 years). All patients presented with critical ischaemia (tissue loss in 87.5%, rest pain in 12.5%). Mean ankle brachial index was 0.27 ± 0.17. The site of distal anastomosis was the descending genicular artery (DGA) in 23 bypasses (1 bilateral) and the medial sural artery (MSA) in 24. Proximal anastomosis was to the external iliac artery in 2 cases, common femoral artery in 23 cases, superficial femoral artery in 8 cases, deep femoral artery in 8 cases, above-knee poplitaeal artery in 2 cases, and previous graft in 4 cases.

Results

There were four deaths during the immediate postoperative period. Mean follow-up duration was 27 months. Ten patients required major amputation. Mean ankle brachial index post-operatively was 0.60 ± 0.21. At 3 years, primary patency was 74.7 ± 7%, secondary patency was 83.4 ± 8%, and the limb salvage and survival rates were 73.5 ± 7% and 77.4 ± 7%, respectively.

Conclusion

Bypass to perigeniculate arteries is a viable treatment option for critical limb ischaemia in selected patients (Figs 1 and 4).

Figure 1 A: Pre-operative arteriography. B: Illustration shows a bypass (blue) to the descending genicular artery (red). C, D: Postoperative angioCT showing the bypass. For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article. (Reprinted from European Journal of Vascular and Endovascular Surgery, De Luccia N, Sassaki P, Durazzo A, et al. Limb salvage using bypass to the perigeniculate arteries. Eur J Vasc Endovasc Surg. 2011;42:374–378. Copyright 2011, with permission from the European Society for Vascular Surgery.)

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