Abstract
CONTEXTO: O tratamento da isquemia crítica de membros inferiores sem leito arterial distal pode ser realizado por meio da inversão do fluxo no arco venoso do pé. OBJETIVO: O objetivo deste trabalho foi apresentar a técnica e os resultados obtidos com a arterialização do arco venoso do pé, mantendo a safena magna in situ. MÉTODOS: Dezoito pacientes, dos quais 11 com aterosclerose (AO), 6 com tromboangeíte obliterante (TO) e 1 com trombose de aneurisma de artéria poplítea (TA) foram submetidos ao método. A safena magna in situ foi anastomosada à melhor artéria doadora. O fluxo arterial derivado para o sistema venoso progride por meio da veia cujas válvulas são destruídas. As colaterais da veia safena magna são ligadas desde a anastomose até o maléolo medial, a partir do qual são preservadas. RESULTADOS: Dos pacientes, 10 (55,6%) mantiveram suas extremidades, 5 com AO e 5 com TO; 7 (38,9%) foram amputados, 5 com AO, 1 com TO e 1 com Ta; houve 1 óbito (5,5%). CONCLUSÃO: A inversão do fluxo arterial no sistema venoso do pé deve ser considerada para salvamento de extremidade com isquemia crítica sem leito arterial distal.
Highlights
In critical ischemia without arterial run-off, one of the ways to irrigate the ischemic limb is to turn the course of the flow reversely through the venous system to treat rest pain or to promote healing of ulcers and amputations.Atherosclerosis obliterans (AO), especially associated with diabetes mellitus, thromboangiitis obliterans (TO) in most cases, and popliteal artery aneurysms with distal bed thrombosis are conditions that justify the indication of this procedure.The first experiments of therapeutic arteriovenous fistulas were made on the proximal portion of the lower limbs, in the beginning of the past century, but no favorable results were obtained
The arterial flow into the venous system progressed through the vein whose valves had been destroyed by the Mills valvulotome (Otemac®), which was introduced through collateral veins until the medial malleolus (Figure 2)
Good surgical outcomes are related to precise indication, arterial and venous preoperative investigation of limb at risk, and details of the surgical technique
Summary
In critical ischemia without arterial run-off, one of the ways to irrigate the ischemic limb is to turn the course of the flow reversely through the venous system to treat rest pain or to promote healing of ulcers and amputations.Atherosclerosis obliterans (AO), especially associated with diabetes mellitus, thromboangiitis obliterans (TO) in most cases, and popliteal artery aneurysms with distal bed thrombosis are conditions that justify the indication of this procedure.The first experiments of therapeutic arteriovenous fistulas were made on the proximal portion of the lower limbs, in the beginning of the past century, but no favorable results were obtained. Critical lower limb ischemia in the absence of a distal arterial bed can be treated by arterialization of the venous arch of the foot. Objetive: The objective of this paper was to present the technique and the results of the arterialization of the venous arch of the foot with the in situ great saphenous vein. Methods: Eighteen patients, 11 with atherosclerosis (AO), 6 with thromboangiitis obliterans (TO) and 1 with popliteal artery aneurysm thrombosis (TA) were submitted to venous arch arterialization. Conclusion: Arterialization of the venous system of the foot should be considered for the salvage of limbs with critical ischemia in the absence of a distal arterial bed.
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