Management of chronic critical lower limb ischemia with no distal run off

Abstract

Despite advances in vascular and endovascular techniques, 14-20% of patients with chronic lower limb ischemia are not suitable for distal arterial reconstruction due to occlusion of crural and pedal arteries. The aim of this study was to evaluate the outcome of distal venous arterialization (DVA) in treatment of those patients in whom major amputations were decided.This study was conducted in Tanta University Hospital; in the period from April], 2008 to March 31, 2010 on 27 patients with chronic critical/ower limb ischemia with no distal run off. Arteriogram and coloured Duplex were mandatory investigations. Great saphenous vein (GSV) was anastomosed to the superficial femoral artery in 15 patients (55.5%), to the popliteal artery in 9 patients (33.3%) and to the common femoral artery in three patients (11.1%).All DVA procedures were peiformed in situ with destruction of the valves of the GSV using Mills valvulotome. After the first year, limb salvage was achieved in 17 patients (65.4%) with healing of wounds, marked improvement of the rest pain and increased pain free walking distance. Nine patients (34.6%) ended with major amputation. As a conclusion, DVA could be considered as a promising method in treatment of chronic critically ischemic limb with no distal run off before jumping to major amputation.