Addendum to a report on a special investigation of the Iowa Department of Transportation for the period January 29, 1994 through June 30, 2013

Addendum to a report on a special investigation of the Iowa Department of Transportation for the period January 29, 1994 through June 30, 2013

Examination report on the City of Walcott, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Walcott, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Glidden, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Glidden, Iowa for the period July 1, 2012 through June 30, 2013

Reaudit report on the City of Remsen and the Remsen Municipal Utilities for the period July 1, 2010 through June 30, 2011

Reaudit report on the City of Remsen and the Remsen Municipal Utilities for the period July 1, 2010 through June 30, 2011

Report on a review of the operations of the Poweshiek County Sheriff’s Office for the period January 1, 2010 through March 31, 2013

Report on a review of the operations of the Poweshiek County Sheriff’s Office for the period January 1, 2010 through March 31, 2013

Report on a special investigation of Remsen-Union Family Connections for the period July 1, 2011 through October 31, 2012

Report on a special investigation of Remsen-Union Family Connections for the period July 1, 2011 through October 31, 2012

Report on a review of selected general and application controls over the Iowa Department of Workforce Development’s MyIowaUI and Unemployment Insurance Benefits systems for the period April 29, 2013 through May 10, 2013

Report on a review of selected general and application controls over the Iowa Department of Workforce Development’s MyIowaUI and Unemployment Insurance Benefits systems for the period April 29, 2013 through May 10, 2013

Report on a review of selected general and application controls over the State University of Iowa ePost and Effort Reporting systems for the period May 29, 2013 through July 19, 2013

Report on a review of selected general and application controls over the State University of Iowa ePost and Effort Reporting systems for the period May 29, 2013 through July 19, 2013

Examination report on the City of Morning Sun, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Morning Sun, Iowa for the period July 1, 2012 through June 30, 2013

Report on applying agreed-upon procedures to the Fayette County Engineer’s Office for the period July 1, 2012 through June 30, 2013

Report on applying agreed-upon procedures to the Fayette County Engineer’s Office for the period July 1, 2012 through June 30, 2013

Report on a special investigation of the City of Sloan for the period May 19, 2009 through March 31, 2013

Report on a special investigation of the City of Sloan for the period May 19, 2009 through March 31, 2013

Examination report on the City of Sidney, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Sidney, Iowa for the period July 1, 2012 through June 30, 2013

Reaudit report on the North Central Iowa Regional Solid Waste Agency for the period July 1, 2011 through June 30, 2012

Reaudit report on the North Central Iowa Regional Solid Waste Agency for the period July 1, 2011 through June 30, 2012

Special investigation of the Garner Volunteer Ambulance Service for the period July 1, 2011 through June 30, 2012

Special investigation of the Garner Volunteer Ambulance Service for the period July 1, 2011 through June 30, 2012

Clinical results of autologous infrainguinal revascularization using grafts originating distal to the femoral bifurcation in patients with mild inflow disease.

AIM: Chronic critical limb ischemia (CLI) often requires venous bypass grafting to distal arterial segments. However, graft patency is influenced by the length and quality of the graft and occasionally patients may have limited suitable veins. We investigated short distal bypass grafting from the superficial femoral or popliteal artery to the infrapopliteal, ankle or foot arteries, despite angiographic alterations of inflow vessels, providing that invasive pressure measurement at the site of the planned proximal anastomosis revealed an inflow-brachial pressure difference of <or=10 mmHg. METHODS: Four hundred and twenty-three consecutive infrainguinal bypass grafts were performed for CLI between June, 1999 and November, 2002 at our institution. All patients underwent preoperative clinical examination, arteriography and assessment of the veins by duplex ultrasound. The study group are patients in whom the proximal and distal anastomoses of the bypass are below the femoral bifurcation and the popliteal artery, respectively. Invasive arterial pressure measurements were recorded at the level of the planned proximal anastomosis which was performed at that level if the difference of the inflow-brachial pressure was <or=10 mmHg, irrespective of angiographic alterations of the inflow vessels proximal to the planned anastomosis. All patients had a clinical follow-up included a duplex examination of their graft, at 1 week, 3, 9 and 12 months and, thereafter, annually. No patient was lost to follow-up. RESULTS: Sixty-seven patients underwent 71 short distal bypass grafts in 71 limbs with reversed saphenous vein grafts in 52, in situ saphenous veins in 11, reversed cephalic vein in 1 and composite veins in 7, respectively. Surgical or endovascular interventions to improve inflow were required in 4 limbs (5.6%). The mean follow-up time was 22.5 months and the two-year survival was 92.5%. Primary and secondary patency rates at 2 years were 73% and 93%, respectively, and the limb salvage rate was 98.5%. CONCLUSION: In appropriately selected patients, short distal venous bypass grafts can be performed with satisfactory patency and limb salvage rates even in the presence of morphologic alterations of the inflow vessels providing that these are not hemodynamically significant, or can be corrected intraoperatively.