Dorsalis pedis artery in bypass grafting

For many years, arterial reconstructive procedures designed to treat arterial occlusive disease involving the lower extremities were limited to the femoral and popliteal vessels. Arterial bypass procedures involving anastomoses below the knee were thought to be impossible because of the small size of the vessels involved and the limited runoff. However, as technics of vascular surgery have improved and as surgeons have become more familiar with the handling of smaller vessels, successful treatment of more distal arterial occlusions has been possible. Morris et al [I ] in 1959 described the first anastomosis of arterial grafts to the distal popliteal vessel below the knee. Two years later, McCaughan [2] described the first group of patients who had bypass grafts to vessels below the popliteal trifurcation. It soon became apparent that vessels distal to the popliteal artery would support inserted autogenous saphenous vein grafts [3-101. Thereafter, the frequency of arterial bypass grafting to the anterior tibial, posterior tibial, and peroneal arteries in the calf region increased rapidly. More recently, refinements in surgical technics for suturing vessels 2 mm in diameter have resulted in favorable patency rates for arterial anastomoses at the ankle and below [11-141. This report is an analysis of sixteen patients in whom the dorsalis pedis artery was utilized for the distal anastomosis in bypass grafting for arterial occlusive disease.