Proximalized Lateral Tunnel for the Bypass to the
Dorsalis Pedis Artery - a Safe Way to Go

Background: Wound complications associated with bypass grafting to the dorsalis pedis artery are frequent, and threaten the viability of the bypass and the limb. Methods: The long saphenous vein can be tunneled from its bed down the lateral side of the anterior margin of the tibia for subsequent anastomosis with the dorsalis pedis artery. Conclusion: The proximalized lateral tunnel for the bypass to the dorsalis pedis artery has the advantage of protecting the bypass graft from exposure if the patient develops wound breakdown.

Key words:

Dorsalis pedis artery - Bypass

References

• 1 Verhelst R, Bruneau M, Nicolas A L, Frangi R, El Khoury G, Noirhomme P, Dion R. Popliteal-to-distal bypass grafts for limb salvage.  Ann Vasc Surg. 1997;  11 505-509
• 2 Berceli S A, Chan A K, Pomposelli F B , Gibbons G W, Campbell D R, Akbari C M, Brophy D T, LoGerfo F W. Efficacy of dorsal pedal artery bypass: in limb salvage for ischemic heel ulcers.  J Vasc Surg. 1999;  30 499-508
• 3 Lermusiaux P, Laurent B, Richer de Forges M, Artru B. Infection-related exposure of the lower anastomosis of femorodistal bypass salvage through use of pedicle muscle flaps.  Ann Vasc Surg. 2000;  14 620-625
• 4 Piano G, Schwartz L B, Foster I, Bassiouny H S, McKinsey J F, Rosenthal D, Gewertz B L. Assessing outcomes, costs, and benefits of emerging technology for minimally invasive saphenous vein in situ distal arterial bypasses.  Arch Surg. 1988;  133 613-617
• 5 Gooden M A, Gentile A T, Demas C P, Berman S S, Mills J L. Salvage of femoropedal bypass graft complicated by interval gangrene and vein graft blowout using a flow-through radial forearm fasciocutaneous free flap.  J Vasc Surg. 1997;  26 711-714
• 6 Robison J G, Ross J P, Brothers T E, Elliott B M. Distal wound complications following pedal bypass: analysis of risk factors.  Ann Vasc Surg. 1995;  9 53-59
• 7 Wengrovitz M, Atnip R G, Gifford R R, Neumyer MM, Heitjan D F, Thiele B L. Wound complications of autogenous subcutaneous infraguinal arterial bypass surgery: predisposing factors and management.  J Vasc Surg. 1990;  11 156-161