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KMID : 0371319770190100037
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Journal of the Korean Surgical Society
1977 Volume.19 No. 10 p.37 ~ p.47
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Clinical Experience of Autogenous Saphenous Vein By-pass Grafts in Buerger´s Disease of Lower Exterimities
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고용복/Koh, Yong Bok
김인철/이용각/김응국/김옥길/Kim, In Chul/Lee, Yong Kak/Kim, Eung Kuk/Kim, Ok Kil
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Abstract
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Buerger´s disease is not uncommon in Korea and we have experienced 292 patients during the past 15 years. During the first 10 years of our series our surgical modalities were comprised of various form of vascular surgery such as endarterectomy, patch graft and by-Pass vein graft with concomitant lumbar sympathectomy.
But our results were not satisfactory in many cases.
Recently, during the latter 5 years of our series, we developed new technique of microvascular surgery which enabled us to revascularize those small arteries such as anterior and posterior tibial or peroneal arteries.
This series is comprised of 31 cases. All of them received lumbar sympathectomy in conjunction to the vascular surgery.
It is our present policy to explore all the distal legs whenever we confirm visualization of run-off vessels of tibial trifurcation no matter how diseased it appears or how, short a segment it is.
A long length of autogenous saphenous vein was harvested from the ipsilateral leg or from the- contralateral leg when the ipsilateral vein is diseased and hence unsuitable for grafting.
Break down of the 31 cases is as follows;
Common femoral to popliteal 1 case, superficial femoral to popliteal 19 cases, superficial fe-moral to posterior tibial 3 cases, superficial femoral to anterior tibial 5 cases, superficial femoral to peroneal 1 case, superficial femoral to anterior tibial ´and to posterior tibial (double, by-pass) 2 cases.
Results;
In almost of all the cases one or both pedal pulse reappeared immediately after the operation. Graft pulsation could be palpated at popliteal fossa or could be confirmed with Doppler or by direct femoral arteriography. 23 caess (74.2%); retained patent graft in more than 6 month
follow up. 8 cases (25.8%) showed graft failure within 6 months. E Functional rehabilitation was excellent in success cases. Those graft failure cases were no worse off than the preoperative condition because they were benefited by sympathectomy and the vascular collateral were not interrupted by the by-pass operation per se.
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