Direct approaches to the distal portions of the deep femoral artery for limb salvage bypasses.

This study describes a technique that facilitates lower extremity "redo" revascularizations and that may increase the number of patients who can be revascularized. By using the distal deep femoral artery for bypass outflow or inflow, we were able to revascularize patients with no other accessible patent major thigh artery, to increase the use of autologous vein for infrapopliteal bypasses, and to avoid difficult groin reoperations. Thirty-seven patients (23 men) had various distal deep femoral revascularizations for limb salvage indications only (rest pain, ischemic ulcers, and/or gangrene). Techniques to expose the distal deep femoral artery directly are described and their uses discussed. We found that the type of bypass performed (e.g., axillofemoral or aortofemoral) determined the patency rate of the reconstruction. Placement of the origin or termination of the graft in the deep femoral artery did not appear to affect the results adversely.