Nondissection method in distal arterial bypass surgery.
One of the most conspicuous advances in vascular surgery during the past two decades has been the improvement of the patency of distal bypasses. The nondissection method, in particular, has made a great contribution to better the tibioperoneal bypass patency. This review describes the operative procedure and background of the method, in which only the vascular sheath of the recipient artery is exposed and circumferential dissection of the artery avoided. The limb is exsanguinated with an Esmarch's bandage, and haemostasis is maintained with a pneumatic tourniquet. Vascular clamps are not applied to the artery at the distal anastomotic site. In a series of 42 tibial bypasses, a primary revised patency of 84% has been achieved after five years with this method.