The use of operative prebypass arteriography and Doppler ultrasound recordings to select patients for extended femoro-distal bypass.

Of 113 preoperative arteriograms analyzed, 46 (40%) were unsatisfactory to determine operability for femoral-distal bypass. In 23 of these 46 arteriograms, there was complete nonvisualization of calf vessels (Group A) and in the remaining 23, there was limited visualization (Group B). Both prebypass, on-table operative arteriography and Doppler ultrasound recordings were helpful in predicting the best available artery for bypass in all but one patient (4%) in Group A. In Group B, 7 of 23 patients had the site of distal anastomosis altered after prebypass, ontable arteriography. There was no statistical difference in the patency rates of grafts in patients with inadequate visualization (Groups A and B) and those with adequate visualization (67 patients, Group C). Prebypass, on-table operative arteriography, supplemented by preoperative Doppler ultrasound recordings, helps to extend operability and to avoid unnecessary amputation.