Arterialización venosa temporal del pie diabético

Lengua, F; Madrid, Andrés La; Acosta, Carlos Alberto Palacio; Vargas, Jorge Zelada

doi:10.1590/s1677-54492010005000007

Cited by 8 publications

(9 citation statements)

References 14 publications

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“…This technique was first used in 1974 in three diabetic patients with promising results, but it was not well received and it was only 20 years later that it began to be adopted because of publications about its successful use by other vascular surgery teams. 9 …”

Section: Discussionmentioning

confidence: 99%

“…However, all over the world, amputations continue to be performed of lower limbs with critical ischemia and no distal arterial run-off, mainly in diabetic patients. 6 , 9 …”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Arterialization of the foot is possible, effective and long-lasting, probably thanks to induction of neo-arteriogenesis and neo-angiogenesis that maintain the benefits even after the bypass has occluded (temporary function). 9 This mechanism is based on the assumption that there should be a positive pressure gradient between the arterialized venous blood and arterial network which supply adequate oxygenation until these mechanisms can meet. 3 , 4 …”

Section: Discussionmentioning

confidence: 99%

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Experimental model for the study of retrograde flow

et al. 2016

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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.

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Section: Discussionmentioning

confidence: 99%

“…However, all over the world, amputations continue to be performed of lower limbs with critical ischemia and no distal arterial run-off, mainly in diabetic patients. 6 , 9 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Experimental model for the study of retrograde flow

et al. 2016

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“…Diverting flow in a retrograde direction through the venous circulation is a feasible alternative that is supported by evidence from countless published studies. [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.…”

Section: Introductionmentioning

confidence: 99%

Isquemia e reperfusão por circulação retrógrada: estudo comparativo experimental

et al. 2017

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Background: There are few options for treating critical ischemia in limbs with no distal patency. Diverting flow through the venous circulation is an option supported by evidence from numerous published studies. Objectives: To compare the behavior of clinical and laboratory variables between the hind limbs of pigs subjected to ischemia and to ischemia with reperfusion by retrograde circulation and between these intervention groups and a control group. Methods: Ten pigs were divided into 2 groups. In group 1 (n=5), controls, patterns of physiological variables such as flow according to Doppler ultrasound, temperature, blood gas analysis results, lactate, creatine kinase, and blood pressure were evaluated. In group 2 (n=5), after an initial ischemia period with mean duration of 27 minutes and 30 seconds, provoked by interrupting flow through the femoral arteries, the animals were subjected to venous arterialization of the left hind limb while the right hind limb was maintained in ischemia. Variables were analyzed separately for each hind leg at 0, 2, 3, 4, and 6 hours after reperfusion and compared against each other and the control group. Results: Analysis of variables from both procedures showed decreases in BE and PO 2 and significant increases in lactate and creatine kinase, in relation to the control group. In arterialized ischemic limbs, we observed flow on Doppler ultrasound, and arterial pressures and temperatures were higher than in the ischemic limbs. Conclusions: Comparative analysis of the extremities in ischemia and arterialized ischemia showed, in relation to the control group, metabolic acidosis with significant increases in lactate and creatine kinase, suggesting cellular damage, and there were signs of retrograde reperfusion in arterialized extremities.

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A New Modified Surgical Technique of In Situ Reverse Arterialization: Leaving the Distal Saphenous Side Branches Open of Nonreconstructable Ischemic Leg Leads to Full Recovery

Chayen

Lorber

Malic

et al. 2019

Annals of Vascular Surgery

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Background: Arterialization of the foot veins in patients with ischemic foot usually result in excessive foot edema, wound infection, venous gangrene, long hospitalization duration, and a high rate of amputation. We herein present an improved method of foot revascularization via the superficial venous system by in situ reverse arterialization (ISRA) of the foot venous bed, leaving the distal saphenous side branches open. Methods: A 69-year-old patient with toe wet gangrene and end-stage peripheral vascular disease with absence of foot target arteries underwent ISRA procedure, using the great saphenous vein, which was anastomosed end-to-side to the proximal superficial femoral artery. Only proximal saphenous tributaries were ligated until arterial flow reached the pedal superficial veins. Results: Postoperatively, the foot regained normal pulsation over the superficial venous system. The patient did not experience foot edema. On-table subtraction angiography demonstrated arterial flow through the long saphenous and dorsal foot veins, with returned venous flow through the anterior and posterior tibial veins. Methoxyisobutylisonitrile scan conducted 4 weeks postoperatively demonstrated positive oxygen uptake of the pedal muscles, which was absent before surgery. Electron microscopy of the muscles at the level of the transmetatarsal amputation demonstrated regeneration of muscle tissue with mitosis 6 weeks postoperatively. During 1,000 days of follow-up postsurgery, the flow was reduced and the transcutaneous pO 2 level of the foot increased up to 76 mm Hg. Conclusions: This new modified surgical technique of ISRA, in which only proximal saphenous tributaries were ligated in order to prevent high systemic pressure in the foot venous low pressure system, resulted in increased levels of transcutaneous pO 2 and reduced flow, leading to full recovery of the ischemic foot.

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Arterialización venosa temporal del pie diabético

Cited by 8 publications

References 14 publications

Experimental model for the study of retrograde flow

Experimental model for the study of retrograde flow

Isquemia e reperfusão por circulação retrógrada: estudo comparativo experimental

A New Modified Surgical Technique of In Situ Reverse Arterialization: Leaving the Distal Saphenous Side Branches Open of Nonreconstructable Ischemic Leg Leads to Full Recovery

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