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Frank W Logerfo - One of the best experts on this subject based on the ideXlab platform.

  • bypass to plantar and tarsal arteries an acceptable approach to limb salvage
    Journal of Vascular Surgery, 2004
    Co-Authors: Kakra Hughes, Christoph Domenig, Allen D Hamdan, Marc L Schermerhorn, Bernadette Aulivola, Seth B Blattman, David R Campbell, Sherry D Scovell, Frank W Logerfo, Frank B Pomposelli
    Abstract:

    Objective This study was undertaken to evaluate our experience with distal arterial bypass to the plantar Artery branches and the lateral tarsal Artery for ischemic limb salvage. Methods This was a retrospective analysis of data prospectively entered into our vascular surgery database from January 1990 to January 2003 for all consecutive patients undergoing bypass grafting to the plantar Artery branches or the lateral tarsal Artery. Median follow-up was 9 months (range, 1-112 months). Demographic data, indications for surgery, outcomes, and patency were recorded, and statistical analysis was performed to assess significance. Results Ninety-eight bypass procedures to either the medial plantar Artery, lateral plantar Artery, or lateral tarsal Artery were performed in 90 patients. Eighty-one patients (83%) were men. Mean age was 67.5 ± 11.6 years. Indications for operation were tissue loss in 93 patients (95%), rest pain in 3 patients (3%), and failing graft in 2 patients (2%). Eighteen patients (18%) had previously undergone vascular reconstruction, and 5 patients (5%) had undergone previous bypass to the Dorsalis Pedis Artery. Seventy-one grafts (72%) had inflow from the popliteal Artery, 25 grafts had inflow from a femoral Artery or graft (26%), and 2 grafts had inflow from a tibial Artery (2%). Conduits used were greater saphenous vein in 67 patients (69%), arm vein in 20 patients (20%), composite vein in 10 patients (10%), and polytetrafluoroethylene conduit in 1 patient (1%). There were 77 bypasses (79%) to plantar Artery branches, and 21 bypasses (21%) to the lateral tarsal Artery. Thirty-day mortality was 1% (1 of 98 procedures). Early graft failure within 30 days occurred in 11 patients (11%). In the subset of patients with a previous arterial reconstruction, there were 2 early graft failures within 30 days (11%). Both occurred in patients who had undergone previous bypass to the Dorsalis Pedis Artery. Primary patency, secondary patency, limb salvage, and patient survival were 67%, 70%, 75%, and 91%, respectively, at 12 months, and 41%, 50%, 69%, and 63%, respectively, at 5 years, as determined from Kaplan-Meier survival curves. Greater saphenous vein grafts performed better than all other conduits, with a secondary patency rate of 82% versus 47% at 1 year ( P = .009). Conclusion 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.

  • efficacy of dorsal pedal Artery bypass in limb salvage for ischemic heel ulcers
    Journal of Vascular Surgery, 1999
    Co-Authors: Scott A Berceli, David R Campbell, Frank B Pomposelli, Cameron M. Akbari, Allen K Chan, Gary W Gibbons, David T Brophy, Frank W Logerfo
    Abstract:

    Abstract Purpose: Although pedal Artery bypass has been established as an effective and durable limb salvage procedure, the utility of these bypass grafts in limb salvage, specifically for the difficult problem of heel ulceration, remains undefined. Methods: We retrospectively reviewed 432 pedal bypass grafts placed for indications of ischemic gangrene or ulceration isolated to either the forefoot (n = 336) or heel (n = 96). Lesion-healing rates and life-table analysis of survival, patency, and limb salvage were compared for forefoot versus heel lesions. Preoperative angiograms were reviewed to evaluate the influence of an intact pedal arch on heel lesion healing. Results: Complete healing rates for forefoot and heel lesions were similar (90.5% vs 86.5%, P = .26), with comparable rates of major lower extremity amputation (9.8% vs 9.3%, P = .87). Time to complete healing in the heel lesion group ranged from 13 to 716 days, with a mean of 139 days. Preoperative angiography demonstrated an intact pedal arch in 48.8% of the patients with heel lesions. Healing and graft patency rates in these patients with heel lesions were independent of the presence of an intact arch, with healing rates of 90.2% and 83.7% ( P = .38) and 2-year patency rates of 73.4% and 67.0% in complete and incomplete pedal arches, respectively. Comparison of 5-year primary and secondary patency rates between the forefoot and heel lesion groups were essentially identical, with primary rates of 56.9% versus 62.1% ( P = .57) and secondary rates of 67.2% versus 60.3% ( P = .50), respectively. Conclusion: Bypass grafts to the Dorsalis Pedis Artery provide substantial perfusion to the posterior foot such that the resulting limb salvage and healing rates for revascularized heel lesions is excellent and comparable with those observed for ischemic forefoot pathology. (J Vasc Surg 1999;30:499-508.)

  • Dorsalis Pedis arterial bypass durable limb salvage for foot ischemia in patients with diabetes mellitus
    Journal of Vascular Surgery, 1995
    Co-Authors: Frank B Pomposelli, David R Campbell, Gary W Gibbons, Edward J Marcaccio, Dorothy V Freeman, Anne M Burgess, Arnold Miller, Frank W Logerfo
    Abstract:

    Abstract Purpose: Although the technical feasibility of pedal Artery bypass for limb salvage is now well established, questions remain about its most appropriate use and its long-term durability. Methods: We reviewed our experience over an 8-year period in 367 consecutive patients undergoing 384 vein bypass grafts to the Dorsalis Pedis for limb salvage. Results: Ninety-five percent of the patients had diabetes mellitus. Infection complicated ischemia at initial presentation in 55.2% of patients. The preoperative arteriogram demonstrated a patent Dorsalis Pedis in 362 extremities (92.8%). Four hundred two patients underwent exploration for bypass, including 29 patients without demonstrated arteries on the arteriogram but audible pedal Doppler signals. Successful bypasses were carried out in 357 of 362 cases, where preoperative arteriography demonstrated a patent Dorsalis Pedis Artery (98.6%), 16 of 28 cases explored on the basis of a Doppler signal alone (57%), and 11 of 12 patients where angiographic status was unknown. All procedures were performed with vein: in situ 38.5%, reversed 29%, onreversed 18%, arm vein 7%, and composite vein 8%. Inflow was taken from the common femoral Artery in 34%, superficial femoral or popliteal arteries in 60%, a previously placed graft in 5%, and a tibial Artery in 1%. There were seven erioperative deaths (1.8%) and 21 myocardial infarctions (5.4%). Twenty-nine grafts failed within 30 days (7.5%), but 19 were successfully revised. Eight of the 10 failed grafts resulted in major amputation (80%). Over the remaining study period, there were 39 additional graft failures, of which 17 were successfully revised, and 17 additional major amputations. Actuarial primary and secondary patency and limb salvage rates were 68%, 82%, and 87%, respectively, at 5 years' followup. The actuarial patient survival rate was 57% at 5 years. Patency rates were similar for in situ and translocated saphenous vein grafts. Conclusions: Dorsalis Pedis arterial bypass is an effective limb salvage procedure with long-term durability comparable to distal vein grafts placed into more proximal arteries. (J VASC SURG 1995;21:375-84.)

Barker Helen - One of the best experts on this subject based on the ideXlab platform.

Frank B Pomposelli - One of the best experts on this subject based on the ideXlab platform.

  • bypass to plantar and tarsal arteries an acceptable approach to limb salvage
    Journal of Vascular Surgery, 2004
    Co-Authors: Kakra Hughes, Christoph Domenig, Allen D Hamdan, Marc L Schermerhorn, Bernadette Aulivola, Seth B Blattman, David R Campbell, Sherry D Scovell, Frank W Logerfo, Frank B Pomposelli
    Abstract:

    Objective This study was undertaken to evaluate our experience with distal arterial bypass to the plantar Artery branches and the lateral tarsal Artery for ischemic limb salvage. Methods This was a retrospective analysis of data prospectively entered into our vascular surgery database from January 1990 to January 2003 for all consecutive patients undergoing bypass grafting to the plantar Artery branches or the lateral tarsal Artery. Median follow-up was 9 months (range, 1-112 months). Demographic data, indications for surgery, outcomes, and patency were recorded, and statistical analysis was performed to assess significance. Results Ninety-eight bypass procedures to either the medial plantar Artery, lateral plantar Artery, or lateral tarsal Artery were performed in 90 patients. Eighty-one patients (83%) were men. Mean age was 67.5 ± 11.6 years. Indications for operation were tissue loss in 93 patients (95%), rest pain in 3 patients (3%), and failing graft in 2 patients (2%). Eighteen patients (18%) had previously undergone vascular reconstruction, and 5 patients (5%) had undergone previous bypass to the Dorsalis Pedis Artery. Seventy-one grafts (72%) had inflow from the popliteal Artery, 25 grafts had inflow from a femoral Artery or graft (26%), and 2 grafts had inflow from a tibial Artery (2%). Conduits used were greater saphenous vein in 67 patients (69%), arm vein in 20 patients (20%), composite vein in 10 patients (10%), and polytetrafluoroethylene conduit in 1 patient (1%). There were 77 bypasses (79%) to plantar Artery branches, and 21 bypasses (21%) to the lateral tarsal Artery. Thirty-day mortality was 1% (1 of 98 procedures). Early graft failure within 30 days occurred in 11 patients (11%). In the subset of patients with a previous arterial reconstruction, there were 2 early graft failures within 30 days (11%). Both occurred in patients who had undergone previous bypass to the Dorsalis Pedis Artery. Primary patency, secondary patency, limb salvage, and patient survival were 67%, 70%, 75%, and 91%, respectively, at 12 months, and 41%, 50%, 69%, and 63%, respectively, at 5 years, as determined from Kaplan-Meier survival curves. Greater saphenous vein grafts performed better than all other conduits, with a secondary patency rate of 82% versus 47% at 1 year ( P = .009). Conclusion 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.

  • efficacy of dorsal pedal Artery bypass in limb salvage for ischemic heel ulcers
    Journal of Vascular Surgery, 1999
    Co-Authors: Scott A Berceli, David R Campbell, Frank B Pomposelli, Cameron M. Akbari, Allen K Chan, Gary W Gibbons, David T Brophy, Frank W Logerfo
    Abstract:

    Abstract Purpose: Although pedal Artery bypass has been established as an effective and durable limb salvage procedure, the utility of these bypass grafts in limb salvage, specifically for the difficult problem of heel ulceration, remains undefined. Methods: We retrospectively reviewed 432 pedal bypass grafts placed for indications of ischemic gangrene or ulceration isolated to either the forefoot (n = 336) or heel (n = 96). Lesion-healing rates and life-table analysis of survival, patency, and limb salvage were compared for forefoot versus heel lesions. Preoperative angiograms were reviewed to evaluate the influence of an intact pedal arch on heel lesion healing. Results: Complete healing rates for forefoot and heel lesions were similar (90.5% vs 86.5%, P = .26), with comparable rates of major lower extremity amputation (9.8% vs 9.3%, P = .87). Time to complete healing in the heel lesion group ranged from 13 to 716 days, with a mean of 139 days. Preoperative angiography demonstrated an intact pedal arch in 48.8% of the patients with heel lesions. Healing and graft patency rates in these patients with heel lesions were independent of the presence of an intact arch, with healing rates of 90.2% and 83.7% ( P = .38) and 2-year patency rates of 73.4% and 67.0% in complete and incomplete pedal arches, respectively. Comparison of 5-year primary and secondary patency rates between the forefoot and heel lesion groups were essentially identical, with primary rates of 56.9% versus 62.1% ( P = .57) and secondary rates of 67.2% versus 60.3% ( P = .50), respectively. Conclusion: Bypass grafts to the Dorsalis Pedis Artery provide substantial perfusion to the posterior foot such that the resulting limb salvage and healing rates for revascularized heel lesions is excellent and comparable with those observed for ischemic forefoot pathology. (J Vasc Surg 1999;30:499-508.)

  • Dorsalis Pedis arterial bypass durable limb salvage for foot ischemia in patients with diabetes mellitus
    Journal of Vascular Surgery, 1995
    Co-Authors: Frank B Pomposelli, David R Campbell, Gary W Gibbons, Edward J Marcaccio, Dorothy V Freeman, Anne M Burgess, Arnold Miller, Frank W Logerfo
    Abstract:

    Abstract Purpose: Although the technical feasibility of pedal Artery bypass for limb salvage is now well established, questions remain about its most appropriate use and its long-term durability. Methods: We reviewed our experience over an 8-year period in 367 consecutive patients undergoing 384 vein bypass grafts to the Dorsalis Pedis for limb salvage. Results: Ninety-five percent of the patients had diabetes mellitus. Infection complicated ischemia at initial presentation in 55.2% of patients. The preoperative arteriogram demonstrated a patent Dorsalis Pedis in 362 extremities (92.8%). Four hundred two patients underwent exploration for bypass, including 29 patients without demonstrated arteries on the arteriogram but audible pedal Doppler signals. Successful bypasses were carried out in 357 of 362 cases, where preoperative arteriography demonstrated a patent Dorsalis Pedis Artery (98.6%), 16 of 28 cases explored on the basis of a Doppler signal alone (57%), and 11 of 12 patients where angiographic status was unknown. All procedures were performed with vein: in situ 38.5%, reversed 29%, onreversed 18%, arm vein 7%, and composite vein 8%. Inflow was taken from the common femoral Artery in 34%, superficial femoral or popliteal arteries in 60%, a previously placed graft in 5%, and a tibial Artery in 1%. There were seven erioperative deaths (1.8%) and 21 myocardial infarctions (5.4%). Twenty-nine grafts failed within 30 days (7.5%), but 19 were successfully revised. Eight of the 10 failed grafts resulted in major amputation (80%). Over the remaining study period, there were 39 additional graft failures, of which 17 were successfully revised, and 17 additional major amputations. Actuarial primary and secondary patency and limb salvage rates were 68%, 82%, and 87%, respectively, at 5 years' followup. The actuarial patient survival rate was 57% at 5 years. Patency rates were similar for in situ and translocated saphenous vein grafts. Conclusions: Dorsalis Pedis arterial bypass is an effective limb salvage procedure with long-term durability comparable to distal vein grafts placed into more proximal arteries. (J VASC SURG 1995;21:375-84.)

Matthew B Dobbs - One of the best experts on this subject based on the ideXlab platform.

  • magnetic resonance angiography in clubfoot and vertical talus a feasibility study
    Clinical Orthopaedics and Related Research, 2009
    Co-Authors: Lisa M Kruse, Christina A Gurnett, David R Hootnick, Matthew B Dobbs
    Abstract:

    Congenital vascular alterations of the normal adult arterial pattern have been associated with multiple congenital limb deformities including clubfoot and vertical talus. Investigators have observed absence of the anterior tibial Artery and Dorsalis Pedis Artery in most patients with clubfoot, and absence of the posterior tibial Artery in all patients with vertical talus. We used magnetic resonance angiography to define the lower extremity vascular anatomy of two patients with left-sided vertical talus and right-sided clubfoot and one patient with bilateral vertical talus and cartilage-derived morphogenetic protein-1 (CDMP-1) gene mutation. Of the three patients, one had bilateral posterior tibial Artery deficiencies while the other had bilateral anterior tibial Artery deficiencies. The third patient with bilateral vertical talus and CDMP-1 mutation had normal arterial structure bilaterally. Though clubfoot and vertical talus have distinctly different clinical phenotypes, the association of each with arterial abnormalities suggests a common etiology during development. The presence of normal arterial structure in our patient with vertical talus and CDMP-1 mutation suggests that other nonvascular etiologies may be responsible for some cases of foot deformities.

Rehman Irving - One of the best experts on this subject based on the ideXlab platform.