<Clinical Study> Technical Improvement in Tibial Bypass Surgery: Non-Dissection Method with the Tourniquet Occlusion Technique

We have used the non-dissection method for tibial artery bypass surgery since 1992 to improve outcomes in small artery bypass surgery. An Esmarchﾕs rubber bandage or a sequential pneumatic tourniquet was used in combination with an air tourniquet for arterial clamping. A total of 74 tibial bypasses were performed in 66 patients for lower extremity ischemia. Over a mean follow-up of 27.7 months, there were 14 graft occlusions or stenoses. One aneurysm was also noted. The cumulative primary patency rates were 89.5% at 1 year, 72.8% at 3 years, and 63.4% at 5 years. A total of 6 grafts were revised, 2 of which became re-occluded. The cumulative secondary patency rates were 89.6% at 1 year, 83.4% at 3 years and 73.8% at 5 years. Before 1992, the tibial bypass surgeries were performed with regular vascular clamps, resulting in poor patency rates (64.7% at 1 year). The tourniquet occlusion technique appears to prevent anastomotic intimal hyperplasia. The non-dissection method is useful to achieve an acceptable outcome in tibial bypass surgery.