Distal venous arterialization for non-reconstructable arterial disease

Abstract

Abstract Background Despite advances in vascular surgical and interventional radiological techniques, 14–20 per cent of patients with critical lower limb ischaemia will not be suitable for distal arterial reconstruction owing to occlusion of crural and pedal vessels. Following investigation into the venous anatomy of the foot, the disease-free venous bed was used as an alternative conduit for perfusion of peripheral tissues. Methods For 22 months, venous arterialization was performed for all patients with non-reconstructable disease but potentially salvageable feet. There were 15 patients; 14 had surgery for chronic ischaemia and one for acute embolization from a popliteal aneurysm after unsuccessful thrombolysis. The inflow vessel was the common femoral artery in 12 and the popliteal artery in three patients. Reversed contralateral long saphenous vein was used in five, a composite graft in three and a polytetrafluoroethylene graft with vein patch in the remaining seven. The distal anastomosis was to the dorsal venous arch (13 cases) and in two to vena comitantes of the posterior tibial vein owing to extensive tissue loss. Various techniques were employed to destroy the valve. Results Three procedures failed immediately after operation and major amputation was required. The remaining 12 patent grafts were monitored by duplex scan; two required intervention to correct distal anastomotic stenosis by angioplasty and atherectomy (one patient each). The limb salvage rate at 2–22 months of follow-up was 80 per cent. Conclusion Distal venous arterialization is a unique and promising operation which merits further evaluation.