Radial artery flow-through graft: A new conduit for limb salvage

• Published in: Journal of vascular surgery 2003-04, Vol.37 (4), p.816-820
• Main Authors: Teodorescu, Victoria J., Chun, Jin K., Morrisey, Nicholas J., Faries, Peter L., Hollier, Larry H., Marin, Michael L.
• Format: Article
• Language: English
• Subjects: Aged; Amputation; Arterial Occlusive Diseases - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Humans; Ischemia - surgery; Limb Salvage - methods; Lower Extremity - blood supply; Male; Medical sciences; Radial Artery - surgery; Surgical Flaps - adverse effects; Surgical Flaps - blood supply; Surgical Flaps - trends; Thrombosis - etiology; Thrombosis - surgery; Wound Healing
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1067/mva.2003.199

Objective Patients with severe peripheral occlusive disease may present especially challenging problems because of previous bypass surgery, location of ulcers, or extremely poor runoff. We used the radial artery with its overlying skin flap as a bypass conduit, called the radial artery flow-through (RAFT) graft in 10 such patients. Methods From November 1999 to January 2002, 10 patients had limb-threatening ischemia at presentation. All had severe inframalleolar vascular occlusive disease. Four patients had undergone previous conventional bypass procedures. Two grafts remained patent, but distal ulcers failed to heal. Eight patients were men. Seven patients had diabetes mellitus. All patients but one had nonhealing ulcers. In most cases, a composite femoral-tibial bypass graft was constructed by sewing the RAFT graft end-to-end to either the greater saphenous vein or, in one patient, to a polytetrafluoroethylene graft. In all cases, the radial venous comitans were sewn to a nearby superficial vein. In 5 patients the skin paddle was positioned to cover the ulcer; in the remaining patients the skin paddle was used to close the foot incision over the distal anastamosis. Postoperative graft surveillance was performed with Duplex scanning or contrast medium-enhanced angiography. Results Thromboses developed in 2 grafts during follow-up. In 1 of these patients below-knee amputation was performed. Another patient required below-knee amputation because of continuing infection in the foot despite a patent RAFT graft. In 1 patient thrombosis developed in the vein graft, but the RAFT graft extension remained patent. All other RAFT grafts were patent in their entirety at 15 (±6) months. Conclusions The RAFT graft is a new option for treating limb-threatening ischemia. The skin paddle may be useful in selected patients for wound coverage. (J Vasc Surg 2003;37:816-20.)