Intraoperative prebypass arteriography for infrageniculate revascularization

Background: Selection of the optimal distal target for infrageniculate arterial revascularization remains difficult in patients with multilevel occlusive disease due to poor visualization of the distal vasculature by preoperative arteriography. Prebypass, intraoperative arteriography (IOA) with direct injection of contrast into the infrageniculate arteries may improve distal arterial visualization and bypass target selection. Methods: One hundred fourteen extremities in 104 consecutive patients requiring infrageniculate bypass were prospectively studied. All patients underwent preoperative contrast arteriography (CA) of the aortoiliac and lower extremity arteries using iodinated and/or CO 2 contrast and digital subtraction techniques. IOAs were obtained at operation to confirm the adequacy of the distal runoff from the predicted bypass target and to identify potentially superior targets. The preoperative plan formulated from the CA was compared to the actual procedure performed based on the IOA. The CA and IOA were also independently reviewed postoperatively by two blinded vascular surgeons to determine the number of patent vessel segments visualized and the number of segments with