Bypass to plantar and tarsal arteries: An acceptable approach to limb salvage

Abstract

Inframalleolar bypass to plantar artery branches and the lateral tarsal artery, even in patients with a previously failed revascularization, can be undertaken with acceptable patency and limb salvage rates. Early graft failure, however, is higher, whereas patency and limb salvage rates are lower, compared with bypass to the dorsalis pedis artery. The use of saphenous vein as a conduit results in the best patency for plantar or lateral tarsal bypass procedures.

Evaluation of the Paramalleolar Bypass for Critical Limb Ischemia Patients on Hemodialysis with Diabetes Mellitus and Chronic Renal Failure

“…7) According to other reports, also, the survival rate was low in patients on hemodialysis, but the graft patency rate was not inferior, and the results of bypass surgery for limb salvage were reasonable, encouraging aggressive revascularization. [8][9][10][11][12] In patients with DM and those undergoing HD, the obstructive lesion is often located in a lower leg artery and is accompanied by marked calcification. Therefore, a sufficient blood supply to the foot by dorsalis pedis, posterior tibial, or plantar artery bypass surgery using a venous graft, which is obtained primarily from the greater saphenous vein, is necessary.…”

Ischemic Ulcer Healing: Does Appropriate Flow Reconstruction Stand for All That We Need?

“…High-skill distal vein bypasses to the tibial [72], to the pedal [77], and up to the plantar or tarsal foot arteries [78] equally by targeting remote branches of pedal arteries in some particular cases [1,76] were successfully documented. We now know that both surgical and endovascular techniques are more likely complementary than competitive techniques since each of them holds major advantages and inherent drawbacks [1,29,30,79].…”

“…Endovascular techniques essentially provide minimal invasiveness, great accessibility, and reproducibility for one or multiple below-the-knee CTO recanalizations [1,29,[73][74][75]. Alternatively, bypass offers a higher pressure on targeted arteries and more physiological and pulsatile flow inside collaterals around the wound zone [35,53,[77][78][79]. This particularity heightens arterial-arterial collateral shear stress and enhances rising arteriogenesis [58][59][60] toward further tissue cicatrization [1,29,35,60,72].…”

“…Beyond striking surgical arterial reconstructions [76][77][78][79], new tapered nitinol [81], drug-eluting stents (DES) [82], and original drugeluting balloon, (DEB) [83] were imagined. Novel or redesigned directional or rotational atherectomy devices [84], together with latest "bioresorbable scaffolds" technologies [85], represent few additional of numerous achievements that challenge today ancient technical barriers [1,29,75,[81][82][83][84][85][86].…”

“…Beyond high-performance techniques in reconstructing arterial flow [72][73][74][75][76][77][78][79][80][81][82][83][84][85][86], new strategies about "when" and "where" to perform appropriate revascularization emerge today [1,27,30,35]. Contemporary practitioners equally avail key data on the molecular mechanisms generating ischemic threat and tissue regeneration [59][60][61].…”