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's rubber bandage or a sequential pneu- matic 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 cumula- tive 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-dissec- tion method is useful to achieve an acceptable outcome in tibial bypass surgery.