Dorsalis pedis arterial bypass: Durable limb salvage for foot ischemia in patients with diabetes mellitus

Pomposelli, Frank B.; Marcaccio, Edward J.; Gibbons, G. W.; Campbell, David R.; Freeman, Dorothy V.; Burgess, Anne M.; Miller, Arnold; LoGerfo, Frank W.

doi:10.1016/s0741-5214(95)70279-2

Cited by 206 publications

(85 citation statements)

References 30 publications

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“…Patency of Paramalleolar Distal Bypass lar patency rates when they used a dorsalis pedis artery as a distal target vessel. 10 Dardik et al reported that even in angiographically unseen segments with sufficient outflow, most dorsalis pedis arteries could be successfully used for revascularization. 11 In the present series, the dorsalis pedis artery was the most frequently used distal target vessel.…”

Section: Discussionmentioning

confidence: 99%

Diabetes and Old Age Could Affect Long-Term Patency of Paramalleolar Distal Bypass for Peripheral Arterial Disease in Japanese Patients

Komai

Obitsu

Shigematsu

2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp istal bypass has been established as the most effective treatment for critical limb ischemia of peripheral arterial disease (PAD). In particular, bypass to the paramalleolar arteries is considered to enable complete revascularization through the pedal lesion. It is still a challenging procedure, however, because the long-term patency rate is not satisfactory, despite recent progress in surgical techniques and postoperative management. Early graft failure might be due to poor anastomotic technique, presence of inadequate run-off vessels, or marked calcification of the target artery and/or poor quality of the conduit vein. Although many papers have been published concerning the long-term patency of distal bypass, 1-3 the factors subsequently affecting the patency rate have not yet been elucidated. In the present report, data were reviewed and the factors affecting long-term patency were investigated. Patient background profile and technical factors involved in the distal bypass operation to the paramalleolar tibial artery were considerably similar in each patient due to the presence of similar risk factors of atherosclerosis and coexistent atherosclerotic vascular diseases. The extent of the disease was similar, variation in surgical techniques was limited, and surgical procedures and postoperative care were uniform in general. Thus, we believe that it would be beneficial to analyze the results of paramalleolar distal bypass to elucidate the risk factors of graft failure. In particular, Japanese subjects are very homogeneous genetically, 4,5 which favors determination of the substantial factors involved in graft failure. MethodsWe retrospectively studied 65 legs of 60 consecutively treated Japanese patients (49 men, 11 women; age range, 42-87 years; average, 70.5 years) with PAD who underwent distal bypass to the paramalleolar tibial artery (artery supplying the distal third of the calf) 6 for critical limb ischemia (Table 1). All the patients had lower extremity ischemic ulcer or necrosis. Ankle brachial pressure index, skin perfusion pressure and angiography showed the lesions to be of ischemic origin, and they met the criteria for critical limb ischemia in the Trans-Atlantic Inter-Society Consensus (TASC) guidelines. Comorbidity factors consisted of diabetes in 43 patients (66%), hypertension in 42 (65%), dyslipidemia in 12 (18%), chronic renal failure Background: The results of paramalleolar distal bypass for critical limb ischemia in patients with peripheral arterial disease were reviewed to determine the factors affecting the long-term patency of this procedure in Japanese subjects.

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Section: Discussionmentioning

confidence: 99%

Diabetes and Old Age Could Affect Long-Term Patency of Paramalleolar Distal Bypass for Peripheral Arterial Disease in Japanese Patients

Komai

Obitsu

Shigematsu

2011

Circ J

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“…Es posible que el puente de arterialización haya promovido la inducción de neocolaterales (arteriogénesis: Figuras 5 y 6) y de neoarteriolas (arteriogénesis) 16,17 responsables de la mejora de las lesiones isquémicas de los pies, incluso después de la oclusión del injerto puente. En los puentes clásicos, la conservación del miembro está estrechamente ligada a la duración del puente [18][19][20][21] .…”

Section: Discussionunclassified

Arterialización venosa temporal del pie diabético

Lengua¹,

Madrid²,

Acosta³

et al. 2010

J. vasc. bras.

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IntroducciónA comienzos del siglo XX, la primera idea que tuvieron los cirujanos (San Martín, 1902, España, y Jaboulay, 1902 para evitar amputaciones por isquemia, fue la de derivar la sangre arterial al sistema venoso mediante una fístula entre vasos adyacentes. Posteriormente, dicha técnica ha sido empleada por diversos cirujanos de diferentes países pero, por lo general, ha sido abandonada de- No se declararon conflictos de intereses asociados a la publicación de este artículo. Artículo recibido el 06.04.09, aceptado el 13.01.10. 14 ARTÍCULO ORIGINAL ResumenContexto: La primera idea que tuvieron los cirujanos (1902) para evitar amputaciones por isquemia fue la de desviar el flujo arterial al sistema venoso por intermedio de una fístula arteriovenosa entre vasos adyacentes, pero con resultados inciertos. Desde entonces se han inventado las simpatecomias, las endarteriectomias y los injertos puentes o bypass y, últimamente, otros avances médicos, quirúrgicos y endovasculares. Sin embargo, en el mundo se siguen haciendo amputaciones, sobre todo en diabéticos. La arterialización de las venas del pie, basada en la vieja idea de la circulación invertida, constituye una esperanza más para estos pacientes ya condenados a la pérdida del miembro.Objetivo: Demostrar que la arterialización de las venas del pie en diabéticos con lesiones neuroisquémicas, generalmente infectadas (pie diabético), es un método eficaz y durable, aunque el puente solo funcione temporalmente. Pacientes y método:De enero de 2000 a febrero de 2009, 59 pacientes con pie diabético fueron tratados por arterialización de las venas del pie. Un deceso precoz no ha sido contabilizado. De los 58 pacientes restantes, 44 fueron hombres y 14 mujeres, con edad promedio de 71 años: (53-91 años), 54 en estado IV de Fontaine y cuatro en estado IIIB. La arterialización fue hecha con un injerto venoso invertido anastomosado, proximalmente en una arteria con buen flujo (ilíaca externa, femorales o poplítea) distalmente en la vena marginal interna del pie, con destrucción de las válvulas de las venas del dorso. Resultados:De los 58 arterializados, 12 fueron fracasos por trombosis precoz, siendo amputados, y 46 fueron éxitos (79%): seis de corto, 12 de mediano y 28 de largo plazo. En los grupos que se ajustan a la definición de éxito (dos) hubo 38 trombosis tardías del puente (95%) y cuatro recidivas de la sintomatología isquémica. No ha habido ningún caso de sobrecarga cardíaca ni de várices.Conclusión: La arterialización en el pie diabético es posible, eficaz y durable, gracias, posiblemente, a la inducción de una neoarteriogénesis y neoangiogénesis, que mantiene los beneficios aun después de que el puente se haya ocluido (función temporal).Palabras clave: Salvataje de miembro, pie diabético, arterialización temporal, amputación de miembro. AbstractBackground: The first idea of surgeons (1902) to avoid amputations due to ischemia was to deviate the arterial flow to the venous system using an arteriovenous fistula between adjacent vessels; however, the results wer...

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“…Considered together,these may suggest poorer outcome in treated patients or,even worse, may completely discourage any aggressive vascular surgical treatment in these patients (22). however, despite decreased surdespite decreased survival among diabetics (19,23,24) therei se vidence that bypass grafting to the leg is worthwhile (19)(20)(21)(22)(23)(24). In anation-wide analysis of diabetes as arisk factor for postoperative major mortality and morbidity after surgery for CLI in Finland during 1991-1999, diabetes was found to be an independent risk factor for postoperative BK amputation (37).…”

Section: Methodsmentioning

confidence: 99%

“…Several studies have shown an inverse correlation between the incidence of infrainguinal bypass reconstruction and that of amputation (5, [14][15][16][17][18]. Equal patency and limb salvage rates after infrainguinal revascularization for diabetic and nondiabetic patients have been reported (19)(20)(21)(22)(23)(24). Furthermore, implementation of am ultidisciplinary team implementationo fam ultidisciplinary team approach for prevention and treatment of diabetic foot ulcers has reported to be effective means of preventing amputations (25)(26)(27)(28)(29)(30)(31).…”

mentioning

confidence: 99%

Major Amputation Incidence Decreases Both in Non-Diabetic and in Diabetic Patients in Helsinki

Eskelinen

Albäck

et al. 2006

Scand J Surg

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Background andAims: The aim of the study was to assess the changes in diabetes-related lower extremity amputationsand to compare it with the development of amputations for criticalleg ischaemia in patients without diabetes.Material and Methods: Clinical records of 1094 patients undergoing major lower limb amputations for vascular disease in the town of Helsinki during 13 years from 1990 to 2002 were analyzed retrospectively. Data concerning patientfactors,diagnosis,existence of diabetes and amputation level were recorded. The studyperiod was divided into three parts (1990-1994, 1995-1998 and 1999-2002) and results were compared between diabetic and nondiabetic vascular amputees during these time periods.Results: From 1990 through 2002, 561 of patients undergoing major lower limb amputation had diabetes mellitus. The overall incidenceo fm ajor amputations of diabetics reduced from the first time period to the last period by 23%. At the same time, the incidence of amputations in non-diabetic patient group decreased 40%. If the incidence rate fora mputations is expressed per million individuals with diabetes, 33% decrease was observedduring the study period.Conclusions: The decrease in majora mputation rates among diabetic as well as nondiabetic patients can be attributed to the increasedi nterest in amputation prevention, with acontribution by vascular surgeonsbeing made in both groups.

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Dorsalis pedis arterial bypass: Durable limb salvage for foot ischemia in patients with diabetes mellitus

Abstract: Dorsalis pedis arterial bypass is an effective limb salvage procedure with long-term durability comparable to distal vein grafts placed into more proximal arteries.

Cited by 206 publications

References 30 publications

Diabetes and Old Age Could Affect Long-Term Patency of Paramalleolar Distal Bypass for Peripheral Arterial Disease in Japanese Patients

Diabetes and Old Age Could Affect Long-Term Patency of Paramalleolar Distal Bypass for Peripheral Arterial Disease in Japanese Patients

Arterialización venosa temporal del pie diabético

Major Amputation Incidence Decreases Both in Non-Diabetic and in Diabetic Patients in Helsinki

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