Significance of pedal arch for femoropopliteal vein bypass patency.

There are different opinions about the usefulness of preoperative arteriography. Therefore we resolved to show its importance for the distal runoff evaluation as well as for the indication and results of femoropopliteal vein bypasses. There were controlled 149 patients 1-5 years after femoropopliteal vein bypass implantations. Seventy six vein bypasses proved to be patent and seventy three were closed. The findings of preoperative arteriographies visualizating the whole arterial periphery, including the pedal arch arteries, were compared in both groups of patients. It was proved that the evaluation of the distal runoff by means of preoperative arteriography may be reliable and correct under condition of tibial and pedal arch arteries visualization. According to our experience, the preoperative arteriography can be performed in such a way to fulfil this indispensable condition. In rare case of preoperative arteriography repeated failure, it is the peroperative prebypass arteriography, which always is successful. In evaluating the distal runoff, there must be taken into consideration the whole arterial complex: tibial + pedal arch arteries. The patency of pedal arch seems to be more important than the number of patent tibial arteries. According to preoperative arteriographic findings, there is possible to distinguish three main types of distal runoff: (1) Sufficient runoff: whole pedal arch and 1-3 tibial arteries patent; (2) satisfactory runoff: partial pedal arch patency and 1-3 tibial arteries patent; (3) Unsufficient runoff: total pedal arch obliterations and 1-3 tibial arteries patency.