Emergency Pedal Artery Bypass Grafting

OBJECTIVES: To determine the value of emergency pedal artery bypass. MATERIAL AND METHODS: Data were drawn from a prospective vascular database. Inclusion criteria were: acute onset of critical forefoot ischemia, emergency surgery, no pre-operative angiographic imaging of the pedal vasculature and attempted revascularisation of a pedal vessel. Follow-up was obtained from outpatient records. The grafts were considered patent if a pedal pulse was palpable. RESULTS: Eight out of 208 pedal vascular procedures performed between January 1996 and June 2002 were entered into the study. This cohort consisted of 3 women and 5 men (age 23-85 years, median 71). Operations were performed because of thrombo-embolic occlusion of the tibial vasculature (5 patients), severe tibial embolism following a percutaneous angioplasty of the superficial femoral artery, trash foot following aortic reconstruction and acute occlusion of tibial run-off vessels following a crural reconstruction. Two patients suffered an early graft occlusion, one of them resulting in major amputation. At a median follow up of 17 months (10-52 months) the remaining 6 grafts were patent. CONCLUSIONS: If catheter directed methods (local lysis, aspiration embolectomy) or surgical procedures (embolectomy, tibial bypass) fail to treat critical foot ischemia, pedal probatorial dissection and pedal bypass is worthwhile.