| Popis: |
The surgical technique of the arterial reconstructions to the leg vessels is of critical importance for the outcome of those delicate procedures. The anatomic surgical exposures to the potentially target leg arteries are described. Infrapopliteal reconstructions are performed when popliteal artery is unsuitable for a distal anastomosis. Posterior tibial artery is exposed through a medial approach as an extension of the bellow knee popliteal artery exposure. Anterior tibial artery is accessible through the medial approach only in its ostial section, distal segments of it can be exposed using antero-lateral approach between tibia and fibula. Peroneal artery can also be exposed using medial approach in its proximal third, and for distal exposure resection of the fibula is required. All patients receive venous antibiotic, and Heparin 100 IU/kg or the corresponding doses low-molecular Heparin. All patients with thrombosed by-passes within 30 days undergo reoperation. Suggested is treatment of skin and soft tissue foot lesions. "Failing graft" should be diagnosed and treated properly, since assisted primary patency is higher than secondary patency. Intraoperative fluoroscopy has the potential to provide valuable information before, during and at completion of the procedure. Mortality is mainly due to myocardial infarction. |
