Articles: veins.
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In 79 patients in whom distal small vessel bypass with autogenous vein was used for revascularization because of gangrene, gangrenous ulceration or rest pain, 14 had femoroperoneal bypasses. Femorotibial or femoroperoneal bypasses were performed in those patients in whom no popliteal runoff was present on pre-operative arteriogram. Femoroperoneal bypass was performed in preference to primary amputation in each case. ⋯ Salvage of severely ischemic lower extremities was achieved in 5 of 14 (35.7%) patients after femoroperoneal bypass and in 46 of 65 (70.8%) patients after bypass to anterior tibial or posterior tibial arteries. Graft patency without limb salvage occurred in 4 of 9 (44.4%) patients with patent femoroperoneal bypasses and in only 2 of 48 (4.2%) of patients with femorotibial bypass. Although limb salvage rate is considerably less with femoroperoneal than femorotibial or femoropopliteal bypass, attempted limb revascularization by peroneal bypasses is preferable to primary amputation in patients with rest pain, gangrenous ulceration or gangrene.
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The study of the vascularization of the sternum allows to individualise the vascular pedicles, the anterior and posterior peripheral sternal networks and the intrasternal vascularization. 1. The numerous vascular pedicles of the sternum all come from the internal mammary arteries. The postero-superior and postero-inferior sternal arteries of one simple intercostal space or of contiguous spaces are anastomosed by systems of latero-sternal, retroarticular and retro-sternal arches. ⋯ The sub-cortical part is composed of a peripheral zone and a more central zone. The totality of the intramedullary network includes a few fine arteries, an interadipocytary network, which is very developed and is variable in form. It also include sinuses of increasing order connected into the venous system, into the network of the compact bone, or into the large trans-cortical veins, which are drained by the peripheral sternal networks or by the collateral veins or the internal mammary system.