Pontage

Pontage is a surgical procedure that creates a bypass to restore blood flow around a blocked or narrowed segment of a vessel. The term is used in vascular and cardiovascular surgery, and in French-language medical literature it often appears in the form of pontage coronarien (coronary bypass) and other site-specific bypasses. The goal is to divert perfusion through a graft conduit that connects proximal and distal healthy vessels, bypassing the occluded segment.

Grafts used for pontage can be autologous channels such as the great saphenous vein or internal mammary and radial arteries, or prosthetic materials such as expanded polytetrafluoroethylene (ePTFE) or Dacron. The choice depends on the target territory, infection risk, prior surgeries, and patient factors. Procedures are typically performed under open surgery and may use cardiopulmonary bypass (on-pump) for cardiac bypass or be conducted off-pump. Anastomoses are usually end-to-end or end-to-side, depending on the anatomy and site of the bypass.

Indications vary by region but commonly include coronary artery disease with significant multivessel ischemia, where bypass grafting is pursued after or alongside angioplasty; peripheral arterial disease with critical limb ischemia or severe claudication; and selected cases of mesenteric or renal artery stenosis. Pontage aims to relieve symptoms, improve tissue perfusion, and reduce ischemic risk.

Outcomes depend on the conduit quality, anastomotic technique, and patient comorbidities. Graft patency rates are higher for arterial conduits in some sites, while prosthetic grafts are more common in others. Complications can include graft occlusion, bleeding, infection, thrombosis, and, in cardiac bypass, perioperative myocardial events or stroke.