Atraumatic vascular anastomoses using a tourniquet.

Because of the occurrence of stenoses just beyond the distal anastomosis, lower leg exsanguination and the use of a mid-thigh tourniquet was adapted. From July 1, 1988 until June 30, 1990, 75 primary operations and 18 secondary operations on failing bypasses were performed using this technique. The primary operations were to the below-knee popliteal (4), anterior tibial (19), posterior tibial (16), peroneal (26), and inframalleolar arteries (10). The proximal anastomoses were also done while the tourniquet was inflated in 11 cases (three tibio-tibial and eight from the popliteal below the knee). Of the secondary procedures, 15 were patch angioplasties and three were distal extensions. The cuff was inflated to 400 mmHg from 22 to 73 minutes. This technique offers numerous advantages: only enough arterial surface is dissected for the anastomoses to be performed. Veins and arterial branches are left intact, thus decreasing the risk of bleeding. The artery is left in its bed to preserve its vasa vasorum. The lumen is not obliterated by clamps assuring the best anastomosis. Since there are no clamps in the field, suturing is less difficult. The tourniquet facilitates a faster, drier operation. No stenoses have been noted in the arteries just distal to the anastomoses on follow-up showing the value of atraumatic occlusion, especially on small vessels. No inflow stenoses occurred in the area under the tourniquet if the artery was patent at the time of operation.