Alexandrescu Vlad, Ngongang Christian, Vincent Gaetane, Ledent Gilles, Hubermont Gérard
Department of Surgery, Princesse Paola Hospital, Marche-en-Famenne, Belgium.
Cardiovasc Revasc Med. 2011 Jan-Feb;12(1):10-9. doi: 10.1016/j.carrev.2009.12.002. Epub 2010 Oct 20.
The study proposes to evaluate the limb salvage in diabetic ischemic limbs with foot wounds, where all types of common arterial reconstructions have previously failed or were impracticable, by using the "SAVES" technique (selective arterio-venous endoluminal switch) for deep calf veins arterialization upon an angiosomes model of distribution.
Since January 2001 until September 2009, a series of 26 limbs with threatening ischemic wounds in 25 diabetic patients at high risk for major amputation and no feasible conventional revascularizations, were treated by the hybrid (surgical and endovascular) SAVES technique and were retrospectively reviewed. The method consists in selective arterialization of the deep calf veins with synchronous endoluminal exclusion of the collaterals, guided by an angiosomes- model of vascularization. There were 12 limbs treated by preferential anterior tibial veins arterialization, 11 with revascularizations in the posterior tibial and three others targeting the peroneal-related territorial wound distribution.
The initial technical success was achieved in 21 of 26 limbs (80%) with 0% 30-day perioperative mortality rate. The cumulative primary and secondary patency were: 66%, 60% and 48%, at 12, 24 and 36 months, respectively. Limb salvage revealed 73% at one year and steady 73% afterwards, while the clinical success was: 68%, 60% and 60% at identical time intervals.
Selective deep calf venous arterialization oriented by an angiosome model for reperfusion may represent a complementary alternative for limb salvage in extreme situations, inoperable by direct arterial methods. Larger groups of study are needed to ascertain these preliminary observations.
本研究旨在评估在所有类型的常见动脉重建术先前均告失败或不可行的情况下，对于患有足部伤口的糖尿病缺血肢体，采用“挽救”技术（选择性动静脉腔内转换），依据血管体分布模型对小腿深部静脉进行动脉化，以实现肢体挽救。
自2001年1月至2009年9月，对25例有严重截肢高风险且无可行传统血管重建术的糖尿病患者的26条存在威胁性缺血伤口的肢体，采用（手术和血管腔内）混合“挽救”技术进行治疗，并进行回顾性分析。该方法包括在血管体血管化模型的引导下，对小腿深部静脉进行选择性动脉化，同时对侧支血管进行腔内封堵。其中12条肢体采用优先对胫前静脉进行动脉化，11条对胫后静脉进行血管重建，另外3条针对与腓骨相关的局部伤口分布进行治疗。
26条肢体中的21条（80%）实现了初始技术成功，围手术期30天死亡率为0%。12个月、24个月和36个月时的累计原发性和继发性通畅率分别为66%、60%和48%。1年后肢体挽救率为73%，此后保持稳定的73%，而相同时间间隔的临床成功率分别为68%、60%和60%。
以血管体模型为导向进行再灌注的选择性小腿深部静脉动脉化，可能是在直接动脉方法无法实施的极端情况下实现肢体挽救的一种补充替代方法。需要更大规模的研究组来确定这些初步观察结果。
