Mutirangura Pramook, Ruangsetakit Chanean, Wongwanit Chumpol, Sermsathanasawadi Nuttawut, Chinsakchai Khamin
Department of Surgery, Mahidol University, Bangkok, Thailand.
Vascular. 2011 Dec;19(6):313-9. doi: 10.1258/vasc.2010.oa0278. Epub 2011 Oct 18.
Heavily calcified and severely stenotic distal arteries defined as unreconstructable, precludes the possibility of revascularization, resulting in major amputation in patients with critical limb ischemia. However, providing blood supply to the ischemic foot through the venous system instead of the arterial system may improve the circulation adequately for the healing process in the vascular compromised distal tissue. This study aimed to assess the safety and efficacy of pedal bypass with deep venous arterialization, one of the possible procedures to improve the circulation through the venous system in critically ischemic limbs and unreconstructable distal arteries. Twenty-six patients with critical limb ischemia and an unreconstructable distal artery of the lower extremities were included for the surgical procedure. Arterial bypass with distal anastomosis at the paramalleolar deep vein was carried out through a composite graft combined with adequate destruction of valve competency in the distal vein. The primary endpoint was complete healing of ischemic ulcer with amelioration of rest pain within six months. The secondary endpoints were the outcomes of survival, limb salvage and primary graft patency rate at six-month intervals to 24 months. Nineteen patients (73.1%) had complete healing of ischemic ulcer and disappearance of rest pain within six months. Six patients (23.1%) underwent major amputation. Perioperative mortality was 3.8%. After 24 months of follow-up study, the survival rate was 87.5%, whereas the limb salvage and graft patency rates were 76.02 and 49.17%, respectively. Pedal bypass with deep venous arterialization may be another therapeutic option to enhance the healing of ischemic ulcer and limb salvageability in patients with critical limb ischemia and unreconstructable distal artery.
严重钙化且严重狭窄的远端动脉被定义为不可重建，这排除了血管再通的可能性，导致严重肢体缺血患者进行大截肢。然而，通过静脉系统而非动脉系统为缺血足部供血，可能足以改善血管受损远端组织愈合过程中的血液循环。本研究旨在评估经深静脉动脉化的足部旁路手术的安全性和有效性，这是改善严重缺血肢体和不可重建远端动脉的静脉系统血液循环的一种可能方法。26例严重肢体缺血且下肢远端动脉不可重建的患者纳入手术。通过复合移植物进行动脉旁路手术，远端吻合至内踝深静脉，并充分破坏远端静脉的瓣膜功能。主要终点是缺血性溃疡在6个月内完全愈合且静息痛缓解。次要终点是6个月至24个月期间每隔6个月的生存、保肢和移植物原发性通畅率结果。19例患者（73.1%）在6个月内缺血性溃疡完全愈合且静息痛消失。6例患者（23.1%）接受了大截肢。围手术期死亡率为3.8%。经过24个月的随访研究，生存率为87.5%，而保肢率和移植物通畅率分别为76.02%和49.17%。经深静脉动脉化的足部旁路手术可能是另一种治疗选择，可促进严重肢体缺血且远端动脉不可重建患者的缺血性溃疡愈合和提高保肢能力。
