VASCULAR SURGERY

1. Limb salvage in patients with femoropopliteal
occlusive disease by infra genicular bypass
revascularization – A retrospective analytical study.
Dr.V.Arul
Madurai Medical College

2. Introduction
• Femoro-popliteal occlusive disease frequently
presents with critical limb ischemia in later stages
• It usually doesn’t respond to early conservative
management and eventually leads to amputation of
the limb.
• Limb salvage requires revascularization procedures
• But only in 7% of the symptomatic PAOD,
revascularization procedures are done, according to
literature.

3. Why this study?
• Revascular procedures are not performed routinely for
the below knee occlusive diseases due to the
• Technical difficulty to perform anastamosis in
low caliber vessels below knee
• Poor outcome after the infra genicular
bypasses as per literature
• Surgical treatment for TAO is limited
• Our aim is to evaluate the role of revascularisation
procedures below knee in limb salvage
• And analyse their outcome in cases of femoropopliteal
occlusion.

4. Inclusion & Exclusion criteria
Inclusion Exclusion
• Patients proven of peripheral
arterial occlusive disease (by
CT angiogram)
•TAO
•Atherosclerotic Occlusion
• Patients with critical limb
ischemia (ABI <0.9)
• Arterial occlusion above the
level of knee joint

5. Materials and Methods
• Study was carried out in the Department of
Vascular surgery, Govt Rajaji Hospital, Madurai
, between Feb 2014 to Jan 2015.
• 82 patients, proven of femoro popliteal
occlusive disease (by CT angiogram) , with
critical limb ischemia were taken in to study.
• Initial presentation, Preop pain score, Preop
ABI, Co morbid conditions, Level of occlusion in
CT angiogram were noted. Preop Diagnosis was
made.

6. Materials & Methods
• Inflow vessel & Level of anastamosis (target
artery) during surgery were recorded.
• Patient was followed up after 6 months, and
improvements in rest pain (Postop pain score),
time taken for ulcer healing, post procedure ABI,
duplex doppler are noted.
• The results are evaluated using SPSS software.

7. Surgery – Femoropoleteal Bypass
• Inflow vessel :
•common femoral artery
• superficial femoral artery
•popliteal artery
• Target vessel :
•Anterior tibial artery
•Peroneal artery
•Mid posterior tibial artery
•Distal posterior tibial
•Distal popliteal artery

8. COMMON FEMORAL
DEEP FEMORAL
SUPERFICIAL FEMORAL
POPLITEAL ARTERY
POSTERIOR TIBIAL
ANTERIOR TIBIAL
PERONEAL ARTERY

9. RESULTS

14. Inflow vessel