Optimal Methods for Autogenous Bypass to the Anterior Tibial Artery

: Autogenous bypass to the anterior tibial artery (AT) has been increasingly used for infrageniculate revascularization. The conduit may be routed through the interosseous membrane, a pretibial tunnel, or through a lateral thigh and calf tunnel. This study reviewed results of AT bypass to determine the optimal routing method. : One hundred thirty consecutive vein grafts to the AT were analyzed retrospectively to compare the experience with the interosseous (group I; N = 50), pretibial (group II; N = 51), and lateral (group III; N = 29) routing alterantives. : Indications were claudication in 16 (12.3%) and critical ischemia in 114 (87.8%) procedures with no differences among routing subgroups. Ectopic nonreversed and composite conduits were more common in group III. Major operative morbidity occurred after 7 procedures (5.4%) with no differences in early graft failure (7.7% overall) among the three routing subgroups. Wound infections were more common among group I patients, but without predilection to the interosseous tunnel. During a mean follow-up of 24.9 months (0 to 111.2) overall 5-year secondary patency was 70% with no difference among routing technique. : Optimal routing choice depends on the location of suitable AT, the length of adequate vein conduit, and the surgeonʹs preference rather than on factors inherent to the method used.