McGovern P J, Jain K M, Kerr J C, Swan K G, Rocko J M
Am J Surg. 1985 Mar;149(3):368-70. doi: 10.1016/s0002-9610(85)80109-4.
Various vascular surgical techniques have been employed to increase both graft patency and limb survival when the prognosis for limb salvage in arteriosclerotic patients is especially poor due to a diseased outflow tract. Ibrahim et al described the creation of an anastomotic arteriovenous fistula in distal tibial bypasses as the reconstructive procedure of choice in severely ischemic extremities unsalvageable by more conventional methods. This study presents the hemodynamics of an anastomotic arteriovenous fistula under such circumstances. Four adult mongrel dogs were anesthesized, and a femoral artery and vein were exposed from the groin to the knee. The femoral artery was ligated in midthigh, and the ligated segment was than bypassed using an umbilical vein graft. The distal anastomosis included an arteriovenous fistula. Flow was measured electromagnetically, and pressure was measured with intravascular catheters attached to strain gauges. The creation of an anastomotic arteriovenous fistula rapidly leads to a reversal of flow in the distal artery, distal arterial hypotension, and distal venous hypertension. Its clinical use in contraindicated as a result of our experimental observations.
当动脉硬化患者因流出道病变导致肢体挽救预后特别差时，已采用各种血管外科技术来提高移植物通畅率和肢体存活率。易卜拉欣等人描述了在胫后动脉旁路术中创建吻合性动静脉瘘，作为更传统方法无法挽救的严重缺血肢体的首选重建手术。本研究展示了在这种情况下吻合性动静脉瘘的血流动力学。对四只成年杂种犬进行麻醉，从腹股沟至膝关节暴露股动脉和静脉。在大腿中部结扎股动脉，然后用脐静脉移植物绕过结扎段。远端吻合包括一个动静脉瘘。用电磁法测量血流量，用连接应变仪的血管内导管测量压力。吻合性动静脉瘘的创建迅速导致远端动脉血流逆转、远端动脉低血压和远端静脉高血压。基于我们的实验观察结果，其临床应用是禁忌的。
