Venous arterialization for treating lower limbs ischemia

TONG Xian-zhou; TONG Lin-long; CHEN Tao

doi:10.3969/j.issn.1674-3806.2013.10.19

Abstract：Objective To assess the clinical effectiveness of venous arterialization in the treatment of pa-tients with critical limb ischemia(CLI).Methods From January 2000 to December 2011,91 patients with CLI,in-cluding 70 cases with thromboangiitis obliterans and 21 artherosclerosis obliterans ,underwent venous arterializations . Ankle-brachial index(ABI) was 0~4.9(average 3.5) before operation.According to the different levels of the arteri-al occlusion ,3 kinds of venous arterialization were performed:high deep venous arterialization group ( n=30 ):rever-sal produced between the common or superficial femoral artery and superficial vein ;low deep venous arterialization group(n=32):reversal produced the popliteal artery and the tibiaperoneal venous trunk ;superficial venous arterial-ization group(n=29):reversal produced between the femoral or popliteal artery and the distal potion of the long sa -phenous vein.Results The technical success rate was 100%.All cases were followed up for 6~60 months,and 77 cases of them achieved satisfied results with disappearance of rest pain and absence of intermittent claudication or claudication distance >500 meters.In high deep venous arterializations group ,4 cases replapsed because of graft oc-clusion at 12 months after procedure and then underwent amputation .During the follow-up period,graft occlustion without recurrent symptom was observed in 10 patients.Overall limb salvage rate,effective rate and secondary graft patency rate was 95.6%,84.6%,84.6%,respectively.Conclusion When patients with CLI cannot be treated by any conventional treatment and require amputate ,venous arterialization may be considered as unconventionality alter-native to save limbs if indivcation was selected carefully and procedure was operated standardly .