Nguyen P-S-A, Legré R, Gay A-M
Service de chirurgie de la main, hôpital de la Conception, Marseille, France.
Ann Chir Plast Esthet. 2011 Jun;56(3):200-6. doi: 10.1016/j.anplas.2010.12.005. Epub 2011 Feb 5.
Hand ischemia is a rare phenomenom of various etiologies among which can be found Raynaud's phenomenon and autoimmune arteritis. The limitations of symptomatic medical treatment and the frequent plurisegmental and distal affection of arteries make the management of chronic hand ischemia difficult. The arterialization of the superficial venous system, which consists in redirecting the arterial flow to the fingertip through the dorsal venous system, could be an interesting alternative to the disappointing results of medical therapy and surgical sympathectomy. The authors present here the preliminary results of this technique.
We carried out a retrospective study analyzing the indications, the operative technique and results of three hands operated on two patients. An arteriography was carried out on each patient prior to perform the arterialization of the superficial venous system, in order to make sure that none of the patients was eligible for a technique of direct re-vascularization.
Postoperatively, for each patient, the following points were evaluated: pain reduction, ulcer healing, and then we tried to obtain a more objective assessment by performing angio-MRI.
This last resort technique in management of critical ischemia of the fingers led to an immediate and lasting improvement of symptoms in all the patients treated. This technique seems reliable and reproducible in selected cases aiming to re-vascularize hands that have reached the stage of critical ischemia. This treatment option should be known by hand surgeons, and distributed to internists who usually manage these patients.
手部缺血是一种病因多样的罕见现象，其中包括雷诺现象和自身免疫性动脉炎。对症药物治疗的局限性以及动脉多节段和远端受累的频繁发生，使得慢性手部缺血的治疗变得困难。浅表静脉系统动脉化，即通过背静脉系统将动脉血流重新导向指尖，可能是药物治疗和手术交感神经切除术效果不佳的一种有趣替代方法。作者在此介绍该技术的初步结果。
我们进行了一项回顾性研究，分析了两名患者三只手的手术适应症、手术技术及结果。在进行浅表静脉系统动脉化之前，对每位患者进行了血管造影，以确保没有患者适合直接血管重建技术。
术后，对每位患者评估了以下几点：疼痛减轻、溃疡愈合，然后我们通过进行血管磁共振成像试图获得更客观的评估。
这种手指严重缺血管理的最后手段技术在所有接受治疗的患者中均导致症状立即且持久改善。在旨在为已达到严重缺血阶段的手部进行血管重建的特定病例中，该技术似乎可靠且可重复。手部外科医生应了解这种治疗选择，并将其告知通常负责管理这些患者的内科医生。
