Use of an arteriovenous fistula for treatment of the severely ischemic extremity: experimental evaluation.

Experiments were performed on obligatory bipeds to study the effects of an arteriovenous fistula on a devascularized ischemic limb. Retrograde flow of arterial blood entering the venous system by way of an arteriovenous fistula was demonstrated. Venous valves appeared not to interfere with retrograde arterial flow. The data from these experiments indicate that a "Y" type arteriovenous fistula can lead to functional revascularization in the ischemic limb with arterial obstruction. The dual mechanism of retrograde arterial flow in venous channels and the stimulation of collateral flow adjacent to the fistula seemed to be critical factors. Since a peripheral arteriovenous fistula is a potent stimulus to arterial collateralization in the extremity, its application is worthy of consideration in certain selected patients with advanced and otherwise inoperable arterial occlusive disease.