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Órgano Oficial de la Sociedad Mexicana de Angiología y Cirugía Vascular

2008, Number 3

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Rev Mex Angiol 2008; 36 (3)

Cirugía de salvamento de miembros inferiores con isquemia crítica

Rodríguez TJM, Escotto SI, Rodríguez RN, Morales GLG, Marquina RM, Espinosa AA

Language: Spanish
References: 24
Page: 88-97
PDF size: 279.08 Kb.


ABSTRACT

Objective: To evaluate the arterial reconstruction in critical limb ischemia, using reverse safenous vein technique. Design. Prospectiue study.
Material and methods: Between January 1994 and October 2003, we performed 365 limb arterial reconstructions in 330 patients. 194 male and 132 female, with a median age of 70 years, range 45 to 94 years. Initial clinical evaluation included Ankle brachial index. According to the Fontaine and Rutherford classification. Risks factors were history of smoking (80%), diabetes mellitus (80%), high blood pressure (70%), myocardial infarction (26%), previous hear surgery (15%), cerebrovascular disease (3%), and renal failure (2%). Procedures included 147 femoropopliteal bypass (Group 1), 32 femoropopliteal with sequential distal by pass (Group 11), 117 popliteal distal (Group 111), nine extra anatomic by pass (Group IV).
Results: Technical success was 97%, primary patency at 12 months was 90%, 77% at 18 months. Follow up clinical evaluation and Doppler waveform. Amputation rate at 18 months above knee was 10%, postoperative complications ischemia skin 30% and swelling leg 80% Perioperative death in one patient (0.3%) of myocardial infarction and ten during one year (3%).
Discussion: Our results in the patency rates are similar to other reports in the international literature, the prevalence of diabetic patients is higher in our population with more multisegmentary arterial distal lesions in limbs; genetic and anatomical differences can probably explain this.
Conclusion: Infrainguinal bypass with reverse safenous vein technique is a good alternative in patients with critical limb ischemia even in diabetics patients.


REFERENCES

  1. Criqui MG, Froneck A, Barret Connor E, Klauber MR, Gabriel S, Goodman D. The prevalen ce of perpheral arte rial disease in a defined population. Circulation 1985; 71: 510 15.

  2. Fowkes FG, Housley E , Cawood EH, Macintyre CC, Ruc kley CV, Prescott RJ. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial di sease in the general population. lnt J Epidt,ni<>l 1991; 20: 348 92.

  3. Weitz JI, Byrne J , Clagett GP, et al. Diagnosis and treat ment of chronic arterial, insufficiency of the lower extremi ties: a critical review. Cü-cu/atic>n 1996; 94: 3026 49.

  4. Management of peripheral arterial Disease (PAD) Trans Atlantic InterSociety Consensus European. J V ase Endouas" Surg 2000; 19(Suppl. A).

  5. Rodríguez TJ, Escot to SI, Cobo JF, Rodríguez RN. Enfer m edad arterial periférica oclusiva. Re u Mex Angiol 2001; 29: 117 29.

  6. Lambert G. Alternativas terapéuticas de la obliteración por at eroesclerosis infrainguinal en pacientes de edad avanza da. Clfnicas Qui rúrgicas de Norte América 1986; 2: 305 15.

  7. Rojas GA, Cervantes J, Flores C, Rodríguez J . Revasculari zación arterial distal en el diabético. Reu Mex Angiol1998; 26(1): 22 6.

  8. Dos Santos CS, Quoted by Eastcott HHG. Presidencial ar des. Internacional Vascular Symposium, London, Sept. 1981.

  9. Norgren L, Hiatt W, Dormandy D, et al. In ter Society Con sensus for the Management of Peripheral Arterial Disease (TASC II). J Va.~<: Surg 2007; 45: lSl 67.

  10. Informe Epidemiológico de Mortalidad 1998. DGE, SSA; 1999.

  11. LoGerfo W. The Diabetic Foot. In: Dean RH, Yaoj ST, Brewsler DC. Current Diagnosis and Tratment in Vascular Surgery. Appleton and Lange Connecticul, U. S.A.; 1995.

  12. Vieth FJ, Gupta SK, Wengerter KR, et al. Changing arte rioesclerotic disease patterns and management strategies in lower limb threatening ischemia. Ann Surg 1990; 212: 402 12.

  13. Ballard JI, Malone JM. Amputation in the diabetic. Semi.n Vasc Surg 1992; 5: 257 63.

  14. Kunlin J . Le traitment de I 'arteriti obliteran te par la greffe veineusse. Arch Mal C<>Cur 1949; 42: 371.

  15. Linton RR, Darling RC. Autogenous saphenous vein bypass grafts in femoropopliteal obliterative arterial disease. Surgery 1962; 51: 62 73.

  16. Taylor LM, Edwards JM, Porter JM. Present status of re versed vein bypass grafting: five years results of a moderm series. J V ose Surg 1990; 11: 193 206.

  17. Andros G, Harris RW, Salles Cinha SX, et al. Bypass grafts to the ankle and foot. J V ase Surg 1988; 7: 785 94.

  18. Rodríguez TJ, Rodríguez RN, Escotto SI. Anatomía vascu lar patológica Reu Mex Angiol 2001; 29: 83 9.

  19. Brewster D. Clinical and anatomical considerations for sur gery in aortoiliac desease and results of surgical treatment. Circulation 1991; 83(Suppl. 1): 142 5.

  20. Galino A, Mahler F, Probst P. Percutaneous transluminal angioplasty of the arteries of the lower limbs: a 5 years fo llow u p. Cü-culation 1984; 70: 619 23.

  21. Landry G, et al. Long term outcome of reversed lower ex tremity bypass grafts. J V ase Surg 2002; 35(1): 56 63.

  22. Rodríguez TJM, Rodríguez R, Escotto S. Alternativa Qui rúrgica en derivación femoropoplítea fallida. Re u M ex An· giol 2003; 31: 47 54.

  23. Huitgren R, Olofsson P, Wahlberg E. Gender differences in patients treated for critical limb ischemia. Eur J Vasc Envasc Surg 2005; 9: 295 300.

  24. Rodríguez TJM. Revascularización de la arteria peronea. Reu M ex Angiol 2000; 28: 60 7.




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