Revascularization of Severely Ischemic Limbs by Staged Arteriovenous Reversal / 日本心臓血管外科学会雑誌

ABSTRACT

<i>Purpose</i> To apply staged arteriovenous reversal in the treatment of extensive and diffuse arterial occlusive disease of the limb. To avoid amputation of the limb or to limit it to necrosed segments.<br><i>Methods</i> Exactly 138 patients (a total of 153 severely ischemic limbs) were applied staged arteriovenous reversal (AVR) from January 1984 to December 1995. Generic-specific involvement totaled 106 men and 32 women. Their ages ranged from 24 to 71, averaging 48.7 years. The duration of symptoms ranged from 15 days to 17 years. A total of 112 patients were diagnosed as having Buerger's disease, and 25 had arteriosclerosis. In one patient, the popliteal artery was completely obstructed by acute emboli of atheromatous plaques. Three patients with Buerger's disease had not benefited from lumbar sympathectomy or partial adrenalectomy done several years ago. According to different levels of extensive and diffuse arterial occlusion, arteriovenous reversal was formed at three different sites (1) high-deep reversal, produced between the external iliac, common femoral, or superficial femoral artery and the superficial femoral vein; (2) low-deep reversal between the distal popliteal artery and tibioperoneal venous trunk; (3) superficial reversal, established between the distal popliteal artery and distal portion of the long saphenous vein.<br><i>Results</i> Until June 1996, a total of 132 patients were followed up for 0.5-12 years, averaging 6.5 years. The postoperative results of all limbs except 12 in this series are excellent or good. Cardiac dysfunction does not occur, nor does the marked elevation of venous pressure of the limb.<br><i>Conclusion</i> We consider that if the deep venous trunks are patent, the limbs with extensive arterial occlusion are indicated for staged AVR if severe ischemia is present and all other therapeutic methods have failed. Even with necrotic limbs, this operation may lower the level of amputation. The authors suggest that staged arteriovenous reversal is a new and effective approach in the treatment of extensive arterial occlusive disease of the limb.