Genesis of Crural Revascularization

Background The purpose of this study is to recognize those investigators responsible for initiating progress in limb salvage where runoff beyond the arterial blockage was limited to the crural vasculature and to also describe how crural bypass has evolved into the contemporary setting where endovascular options have become increasingly prominent. Methods An extensive literature review of articles published from 1960 to 1979 was the basis for selecting and recognizing surgeons who pioneered infrageniculate revascularization. Documentation of patency and amputation rates were tabulated for these early series of distal limb bypass. Cases performed in the decade of interest, but not published until the 1980s, are also recognized and recorded separately. Results Subsequent to the first tibial bypass performed in 1961 by McCaughan, a total of 746 crural bypasses were defined in the decades of interest, where possible, with overall 6-, 12-, and 36-month patencies of 76%, 59%, and 48%, respectively. There was an overall amputation rate of 17%. Life table analysis and other statistical methods were also adopted during this time. Conclusions Performance of crural bypass from 1960 to 1979 was analyzed in groups according to the distal anastomosis site. These results confirm the satisfactory early progress leading to further refinement in subsequent decades. It is essential that the current generation of vascular surgeons recognize the value of these early open procedures as a stable force for securing limb salvage in conjunction with evolving endovascular techniques.