Utilização da safena magna in situ para arterialização do arco venoso do pé

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.

Experimental model for the study of retrograde flow

“…Conditions that justify indicating this procedure are atherosclerosis obliterans, especially when associated with diabetes mellitus, thromboangiitis obliterans in most cases and popliteal artery aneurysms with distal bed thrombosis. 3 , 8…”

“…Inverted venous graft, 9 , 12 great saphenous vein in situ 3 and endoluminal selective deep calf venous arterialization oriented by an angiosome model 5 have all been used. The results depend more on the characteristics of the patient than on the technique itself.…”

“…This technique is based on the theory that in the absence of primary arterial pressure in the arterioles, blood supplied through the venous system by means of arterial pressure is able to feed peripheral tissues and supply adequate oxygenation. 3 , 4 Venous arterialization has been adopted as a strategy for limb salvage in acute ischemia without the distal arterial bed. Studies 3 - 14 have reported successful outcomes, all evidence-based.…”

“… 3 , 4 Venous arterialization has been adopted as a strategy for limb salvage in acute ischemia without the distal arterial bed. Studies 3 - 14 have reported successful outcomes, all evidence-based. Nevertheless, the mechanisms through which irrigation of the extremities takes place are still unknown.…”

Isquemia e reperfusão por circulação retrógrada: estudo comparativo experimental

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] The concept is based on the theory that in the absence of primary arterial blood pressure in arterioles, blood supplied by arterialization of the distal venous system is capable of supplying the peripheral tissues and providing adequate oxygenation. [3][4][5]13 Many different variables have been used to evaluate tissue hypoxia in animal models, such as assessment of arterial flow using Doppler ultrasound (US), 14,15 temperature measurements, 16 blood gas analysis, 17 lactate 18 and creatine phosphokinase (CP) assays, 19 and measurements of arterial blood pressure at extremities. 20 The objective of this study is to compare the behavior of these clinical and laboratory variables in pigs' hind limbs after induction of ischemia, with and without reperfusion via retrograde circulation, against each other and in relation to a control group.…”