Hidemaro Nakano

Operative arteriography: An indicator for infrainguinal bypass

Preceding infrainguinal artery bypass surgery, a complete arteriographic delineation of the recipient artery is not always feasible. For 13 out of 63 patients with occlusion of the infrainguinal arteries, distinct delineation could not be accomplished with preoperative angiography. However, prebypass operative arteriography was successful in 8 of the 13. In 5, we performed bypass surgery on vessels not visualized on the preoperative angiography. In the other 3, bypass was performed on vessels in which the status of the distal circulation had not been well defined, although the popliteal and infrapopliteal arteries were partially visualized on the preoperative angiography. Intraoperative arteriograms—a technique requiring operative exploration of the target vessel—can significantly improve the visualization of the recipient artery and the distal circulation. Therefore, prebypass operative arteriography may become another indicator for arterial bypass surgery.