Surgical Management of Critical Limb Ischemia

Jeffrey L. Ballard, Joseph L. Mills

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


At the present time, infrainguinal bypass using autogenous vein is the most effective and durable treatment for chronic limb ischemia caused by long-segment, diffuse, atherosclerotic occlusive disease. Quality of the vein conduit is the most important factor that determines operative success. Preoperative vein mapping is useful to identify an optimal vein conduit as well as to suggest vein segments that should not be explored due to occlusion, significant calcification, poor caliber, or sclerosis. Reversed, nonreversed, and in situ vein bypass grafts all perform equally well, and the choice of technique depends on anatomic considerations and surgeon preference. Bypass grafts originating from inflow sources distal to the common femoral artery may be appropriate in selected cases without compromising graft patency. All vein graft patients should be followed by postoperative, duplex-based graft surveillance. Antiplatelet therapy is indicated in all infrainguinal bypass patients; oral anticoagulation may be worthwhile in selected, high-risk patients, but hemorrhagic risks are significantly increased.

Original languageEnglish (US)
Pages (from-to)169-174
Number of pages6
JournalTechniques in Vascular and Interventional Radiology
Issue number4
StatePublished - Dec 2005
Externally publishedYes


  • critical limb ischemia
  • surgical management

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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