Entrar/Registro  
HOME SPANISH
 
Cirujano General
   
MENU

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board






>Journals >Cirujano General >Year 2009, Issue 4


Lengua AF, Madrid BA, Vargas DJ, Acosta RC
Countercurrent arterialization of foot veins as a treatment for critical ischemia
Cir Gen 2009; 31 (4)

Language: Español
References: 13
Page: 219-224
PDF: 4. Kb.


Full text




ABSTRACT

Objective: To demonstrate that, in critical ischemia, the old idea of substitution of the arterial net by the venous net, through the arterialization of foot veins, is possible and beneficial too. Place: Lima Police Hospital, Lima, Perú. Design: Prospective, longitudinal, observational, and descriptive study. Statistical analysis: Percentages as a summary measure for qualitative variables. Patients and methods: From January 2000 to July 2009, 80 arterializations were performed on 78 arthritic patients. Sixty of these patients were diabetic. There were 55 men and 23 women, and nine of them presented Stage IIIB and 69 had Stage IV of Leriche and Fontaine. Most of the cases have presented cardiac alterations and artery and other organs hypertension. The procedure consisted of the anastomosis of a venous bridge or by-pass proximally to an artery with a good blood flow (femoral or popliteal) and distally in a foot vein, generally in the internal marginal vein. Results: In 15 patients (19.2%), the procedure failed and they had to be subjected to amputation. Sixty-three cases (80.78%) succeeded: ten of short-term, 33 of medium-term, and 20 of long-term, with a follow-up period of two years and seven months, in average. Fifty-eight (92%) of these by-passes were occluded by late thrombosis. There were four cases of relapses due to stenosis of the distal anastomosis. One of these patients died at 5 ½ years after the surgery, due to septicemia. The total amount of dead patients was of 13 (16.6%) due to comorbidity. There was no member amputation after the by-pass occlusion, and there were neither heart overload nor varices. Conclusion: Foot arterialization of veins in arthritic and diabetic patients at critical ischemia is an efficient and lasting method in the long-term because of neo-arteriogenesis and neo-angiogenesis that keep the benefits even after the by-pass occlusion.


Key words: Diabetic foot, critical ischemia, venous arterialization.


REFERENCIAS

  1. Nunez AA, Veith FJ, Collier P, Ascer E, Flores SW, Gupta SK. Direct approaches to the distal portions of the deep femoral artery for limb salvage bypasses. J Vasc Surg 1988; 8: 576-81.

  2. Lengua F. Arterialization technic of the venous net work in the foot. Nouv Presse Med 1975; 4: 1309-42.

  3. Pokrovski- AV, Dan VN, Khorovets AG, Chupin AV. Arterialization of venous blood flow in the foot in the treatment of severe ischemia in patients with crural arterial occlusions and non-functioning plantar arch. Khirurgiia (Mosk) 1990; 5: 35-42.

  4. Taylor RS, Belli AM, Jacob S. Distal venous arterialization for salvage of critically ischaemic inoperable limbs. Lancet 1999; 354(9194): 1962-5.

  5. Rowe VL, Hood DB, Liphan J, Terramini T, Torres G, Katz S, et al. Initial experience with dorsal venous arterialization for limb salvage. Ann Vasc Surg 2002; 16: 187-92.

  6. Lengua F. Can distal vein arterialization be beneficial for the diabetic foot with necrosis? Chirurgie 1994-1995; 120: 143-52.

  7. Lengua F, Nuss JM, Lechner R, Kunlin J. Arterialization of the venous network of the foot through a bypass in severe arteriopathic ischemia. J Cardiovasc Surg (Torino) 1984; 25: 357-60.

  8. Veith FJ, Weiser RK, Gupta SK, Ascer E, Scher LA, Samson RH, et al. Diagnosis and management of failing lower extremity arterial reconstructions prior to graft occlusion. J Cardiovasc Surg (Torino) 1984; 25: 381-4.

  9. Isaksson L, Lundgren F. Vein surgery to the foot in patients with diabetes in critical ischaemia. Br J Surg 1994; 81: 517-20.

  10. Panayiotopoulos YP, Reidy JF, Taylor PR. The concept of knee salvage: why does a failed femorocrural/pedal arterial bypass not affect the amputation level? Eur J Vasc Endovasc Surg 1997; 13: 477-85.

  11. Busato CR, Utrabo CAL, Housome JK, Gomes RZ. Arterialização do arcovenoso do pé para tratamento da isquemia crítica sem leito distal. Cir Vasc Angiol 1999; 15: 117-21.

  12. Busato CR, Lima-Utrabo CA, Zanetti-Gomes R, Kengi-Housome J, Hoeldtke E, Teixeira-Pinto C, et al. Arterialization of the venous arch of the foot for the treatment of thromboangeiitis obliterans. J Vasc Bras 2008; 7: 267-271.

  13. Ramos HG, Mar CHR, Reman PA, Pacheco GC, Garibaldi IM. Salvamento del pie diabético isquémico con la arterialización de las venas del pie (técnica Dr. Lengua). Nuestra experiencia inicial en el Hospital General de Tampico SSa. Cir Gral 2007; 29: S135.






>Journals >Cirujano General >Year 2009, Issue 4
 

· Journal Index 
· Links 






       
Copyright 2019