Abstract
BackgroundVenous arterialization has been adopted as a strategy for salvage of limbs in critical ischemia without the distal arterial bed, with successful outcomes, but the mechanisms by which irrigation of the extremities takes place are still unknown.ObjectivesTo develop an experimental model to test hypotheses that could explain the mechanisms of blood supply in venous arterialization.MethodsEleven pigs underwent a period of hind limb ischemia followed by reperfusion achieved by venous arterialization, after interposition of conduits filled with 10 ml (5 animals – group 1) or 1 ml (6 animals – group 2) of China Ink. After euthanasia, the limbs were amputated and underwent histological analysis.ResultsUnder optical microscopy, ink staining was observed in the arteriolar lumen of six (55%) of the eleven pigs used in the experiment; four (80%) out of five from group 1 and two (33%) out of six from group 2.ConclusionsThe experimental model was capable of testing the hypothesis. The presence of China Ink in the arteriolar lumen shows that it is possible to supply the arterial vessels by means of venous arterialization.
Highlights
Each year 1,000 new cases of critical limb ischemia (CLI) are identified in Europe and North America per population of one million inhabitants.[1]
Studies suggest that in developed countries about 25% of CLI patients undergo primary amputation, while in developing countries, where there is a lack of specialized programs to salvage the limb, amputation has been adopted as a first-line therapy.[2]
Venous arterialization has been adopted as a strategy for limb salvage in acute ischemia without the distal arterial bed
Summary
Each year 1,000 new cases of critical limb ischemia (CLI) are identified in Europe and North America per population of one million inhabitants.[1]. Great strides taken in development of techniques and devices have offered researchers the opportunity to disseminate endovascular revascularization procedures as a means to restore blood flow in CLI.[2] In acute ischemia, without the distal arterial bed, it is not possible to divert arterial blood to the extremity, but it may be possible to supply blood to the structure involved by diverting flow through venous circulation in the retrograde direction. Venous arterialization has been adopted as a strategy for salvage of limbs in critical ischemia without the distal arterial bed, with successful outcomes, but the mechanisms by which irrigation of the extremities takes place are still unknown.
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