VENOUS ARTERIALIZATION FOR SOME PATIENTS WITH NO OPTION CRITICAL LIMB ISCHEMIA ! A DESPERATE ATTEMPT OR AN EXPERIENCE"PROVED SUCCESSFUL TECHNIQUE?
Introduction: Between 14–20% of patients with critical lower-limb ischemia (CLI) are not candidates for revascularization due to extensive occlusions in crural/pedal vessels. Frequently these patients are young and functionally active. In these cases, the concept of shunting blood through veins to...
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| Format: | Article |
| Language: | Portuguese |
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Sociedade Portuguesa de Angiologia e Cirurgia Vascular
2020-02-01
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| Series: | Angiologia e Cirurgia Vascular |
| Subjects: | |
| Online Access: | https://acvjournal.com/index.php/acv/article/view/242 |
| _version_ | 1797951913488023552 |
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| author | Inês Antunes Carlos Pereira Luís Loureiro Gabriela Teixeira Carlos Veiga Daniel Mendes Carlos Veterano Henrique Rocha João Castro Rui Almeida |
| author_facet | Inês Antunes Carlos Pereira Luís Loureiro Gabriela Teixeira Carlos Veiga Daniel Mendes Carlos Veterano Henrique Rocha João Castro Rui Almeida |
| author_sort | Inês Antunes |
| collection | DOAJ |
| description |
Introduction: Between 14–20% of patients with critical lower-limb ischemia (CLI) are not candidates for revascularization due to extensive occlusions in crural/pedal vessels. Frequently these patients are young and functionally active. In these cases, the concept of shunting blood through veins to get this reversed flow to reach the nutritive tissue capillary bed becomes attractive. Our aim is to report our very recent experience in venous arterialization.
Material/Methods: We retrospectively reviewed the cases of venous arterialization performed in our institution between April 2018–2019.
Results: Four patients were treated: 3 males/1 female with mean age of 58.5 years. All patients had PAD stage 4. All patients were studied with arteriography and ultrasound and were considerate no revascularizable (2 of them after an attempt of endovascular/surgical treatment). In one patient a trial with endovenous prostaglandin was performed, without clinical response. In all cases, the patients were facing a major amputation. Arterialization was performed as a last attempt to save the limb. Regarding the surgical procedures, the donor inflow artery was the infragenicular popliteal artery in 2 cases, distal femoral artery in 1 case and anterior tibial artery in 1 case. In 3 cases the bypass used the great saphenous vein (GSV) in situ to arterialize the medial marginal vein; in 1 case was used an inverted GSV bypass with the distal anastomosis at the posterior tibial vein. The venous valves were destroyed by combination of Fogarty catheter (proximally) and angioplasty balloon (distally). Collaterals were ligated to focalize the blood flow. In all patients marked improvement in foot perfusion was achieved. Two of them had excellent evolution in the postoperative period and healed foot lesions. One patient was amputated with permeable bypass. One patient presented good initial evolution but later had bypass thrombosis (presum- ably due to inadequate arterial inflow from the anterior tibial artery) and undergone major amputation.
Discussion/Conclusions: Despite advances in surgical and endovascular techniques, an important number of patients with CLI are not candidates to arterial revascularization and most patients with inoperable CLI will face a major amputation. In that setting, venous arterialization should be considered but not all patients are candidates to this procedure and a careful preoperative evaluation is required. Our preliminary experience is encouraging: the procedure was relatively straightforward, the resulting improve in foot perfusion was surprisingly good, the patency rate and limb salvage rate was 75 and 50%. In our opinion the major issues are selection of inflow artery and outflow vein and the learning curve in interpretation of the angiographic result to guide optimal focalization of the blood flow.
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| first_indexed | 2024-04-10T22:38:06Z |
| format | Article |
| id | doaj.art-1c3042ef067d49fbaa521716f19268df |
| institution | Directory Open Access Journal |
| issn | 1646-706X 2183-0096 |
| language | Portuguese |
| last_indexed | 2024-04-10T22:38:06Z |
| publishDate | 2020-02-01 |
| publisher | Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
| record_format | Article |
| series | Angiologia e Cirurgia Vascular |
| spelling | doaj.art-1c3042ef067d49fbaa521716f19268df2023-01-16T09:09:12ZporSociedade Portuguesa de Angiologia e Cirurgia VascularAngiologia e Cirurgia Vascular1646-706X2183-00962020-02-0115410.48750/acv.242VENOUS ARTERIALIZATION FOR SOME PATIENTS WITH NO OPTION CRITICAL LIMB ISCHEMIA ! A DESPERATE ATTEMPT OR AN EXPERIENCE"PROVED SUCCESSFUL TECHNIQUE?Inês Antunes0Carlos Pereira1Luís Loureiro2Gabriela Teixeira3Carlos Veiga4Daniel Mendes5Carlos Veterano6Henrique Rocha7João Castro8Rui Almeida9Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, PortugalServiço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, PortugalServiço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, PortugalServiço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, PortugalServiço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, PortugalServiço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, PortugalServiço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, PortugalServiço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, PortugalServiço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, PortugalServiço de Angiologia e Cirurgia Vascular, Centro Hospitalar do Porto, Porto, Portugal Introduction: Between 14–20% of patients with critical lower-limb ischemia (CLI) are not candidates for revascularization due to extensive occlusions in crural/pedal vessels. Frequently these patients are young and functionally active. In these cases, the concept of shunting blood through veins to get this reversed flow to reach the nutritive tissue capillary bed becomes attractive. Our aim is to report our very recent experience in venous arterialization. Material/Methods: We retrospectively reviewed the cases of venous arterialization performed in our institution between April 2018–2019. Results: Four patients were treated: 3 males/1 female with mean age of 58.5 years. All patients had PAD stage 4. All patients were studied with arteriography and ultrasound and were considerate no revascularizable (2 of them after an attempt of endovascular/surgical treatment). In one patient a trial with endovenous prostaglandin was performed, without clinical response. In all cases, the patients were facing a major amputation. Arterialization was performed as a last attempt to save the limb. Regarding the surgical procedures, the donor inflow artery was the infragenicular popliteal artery in 2 cases, distal femoral artery in 1 case and anterior tibial artery in 1 case. In 3 cases the bypass used the great saphenous vein (GSV) in situ to arterialize the medial marginal vein; in 1 case was used an inverted GSV bypass with the distal anastomosis at the posterior tibial vein. The venous valves were destroyed by combination of Fogarty catheter (proximally) and angioplasty balloon (distally). Collaterals were ligated to focalize the blood flow. In all patients marked improvement in foot perfusion was achieved. Two of them had excellent evolution in the postoperative period and healed foot lesions. One patient was amputated with permeable bypass. One patient presented good initial evolution but later had bypass thrombosis (presum- ably due to inadequate arterial inflow from the anterior tibial artery) and undergone major amputation. Discussion/Conclusions: Despite advances in surgical and endovascular techniques, an important number of patients with CLI are not candidates to arterial revascularization and most patients with inoperable CLI will face a major amputation. In that setting, venous arterialization should be considered but not all patients are candidates to this procedure and a careful preoperative evaluation is required. Our preliminary experience is encouraging: the procedure was relatively straightforward, the resulting improve in foot perfusion was surprisingly good, the patency rate and limb salvage rate was 75 and 50%. In our opinion the major issues are selection of inflow artery and outflow vein and the learning curve in interpretation of the angiographic result to guide optimal focalization of the blood flow. https://acvjournal.com/index.php/acv/article/view/242venous arterializationcritical limb ischemiamajor amputationrevascularization procedures |
| spellingShingle | Inês Antunes Carlos Pereira Luís Loureiro Gabriela Teixeira Carlos Veiga Daniel Mendes Carlos Veterano Henrique Rocha João Castro Rui Almeida VENOUS ARTERIALIZATION FOR SOME PATIENTS WITH NO OPTION CRITICAL LIMB ISCHEMIA ! A DESPERATE ATTEMPT OR AN EXPERIENCE"PROVED SUCCESSFUL TECHNIQUE? Angiologia e Cirurgia Vascular venous arterialization critical limb ischemia major amputation revascularization procedures |
| title | VENOUS ARTERIALIZATION FOR SOME PATIENTS WITH NO OPTION CRITICAL LIMB ISCHEMIA ! A DESPERATE ATTEMPT OR AN EXPERIENCE"PROVED SUCCESSFUL TECHNIQUE? |
| title_full | VENOUS ARTERIALIZATION FOR SOME PATIENTS WITH NO OPTION CRITICAL LIMB ISCHEMIA ! A DESPERATE ATTEMPT OR AN EXPERIENCE"PROVED SUCCESSFUL TECHNIQUE? |
| title_fullStr | VENOUS ARTERIALIZATION FOR SOME PATIENTS WITH NO OPTION CRITICAL LIMB ISCHEMIA ! A DESPERATE ATTEMPT OR AN EXPERIENCE"PROVED SUCCESSFUL TECHNIQUE? |
| title_full_unstemmed | VENOUS ARTERIALIZATION FOR SOME PATIENTS WITH NO OPTION CRITICAL LIMB ISCHEMIA ! A DESPERATE ATTEMPT OR AN EXPERIENCE"PROVED SUCCESSFUL TECHNIQUE? |
| title_short | VENOUS ARTERIALIZATION FOR SOME PATIENTS WITH NO OPTION CRITICAL LIMB ISCHEMIA ! A DESPERATE ATTEMPT OR AN EXPERIENCE"PROVED SUCCESSFUL TECHNIQUE? |
| title_sort | venous arterialization for some patients with no option critical limb ischemia a desperate attempt or an experience proved successful technique |
| topic | venous arterialization critical limb ischemia major amputation revascularization procedures |
| url | https://acvjournal.com/index.php/acv/article/view/242 |
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