2009, Number 4
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ABSTRACTObjective: 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.
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