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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES VASCULAR SECTION
The Journal of Cardiovascular Surgery 2004 Auguste;45(4):375-79
In-situ bypass surgery on arteriographically invisible vessels detected by Doppler-ultrasound for limb salvage
Eiberg J. P., M. Hansen A., Jørgensen L. G., Rasmussen J. B. G., Jensen F., Schroeder T. V.
1 Department of Vascular Surgery Rigshospitalet, Copenhagen, Denmark
2 Department of Radiology Rigshospitalet, Copenhagen, Denmark
Aim. The aim of this paper was to evaluate our primary experience with bypass surgery on arteries only visible on Doppler-ultrasound in patients suffering from critical lower limb ischemia.
Methods. During a study period of 10 months, Doppler-ultrasound routinely supplemented digital subtraction arteriography (DSA) whenever it failed to reveal patent runoff vessels suitable for in-situ saphenous vein bypass surgery. If an arteriographically invisible runoff artery was detected on Doppler-ultrasound and the patient was eligible for surgery, a bypass procedure was performed. All patients were facing a lower limb amputation due to critical limb ischemia (tissue loss, SVS/ISCV-category 5). Postoperatively the patients were followed according to a standard graft surveillance program, including clinical examination, ankle pressure measurements and a color Doppler-ultrasound at discharge and after 1, 6 and 12 months.
Results. Fifty-one in-situ saphenous vein bypasses were performed, 5 (10%) on arteriographically occult runoff vessels detected only on Doppler-ultrasound. After a 12-month follow-up, 3 bypasses were still patent and only one patient had an amputation. One bypass occluded after 6 months but the patient stayed asymptomatic.
Conclusion. Doppler-ultrasound permits in-situ by-pass surgery on arteriographically invisible vessels reducing the proportion of inoperable patients by 10%.