Early Individual Experience with Distal Venous Arterialization as a Lower Limb Salvage Procedure

Abstract

This prospective randomized study reported early results of the treatment of 36 unreconstructable patients with critical lower limb ischemia. The patients were divided into two groups: 12 were treated with distal venous arterialization (DVA) and 24 were conservatively (CT) using antiplatelet drugs. There were seven men and five women with an average age 64.3 ± 9.9 in DVA and 13 men and 11 women with a average age 67.1 ± 10.8 in CT groups of patients. The aim of this study was to estimate the validity of DVA as the limb salvage procedure. During the period of monitoring, morbidity and mortality rates were 50 and 0 per cent at DVA versus a mortality rate in the CT group of 33.3 per cent ( P < 0.05). The mean follow-up period for DVA was 4.8 ± 3.9 months (range, 1 to 14 months) versus 4.9 ± 2.4 months (range, 1 to 9 months) for the CT group ( P > 0.05). Graft patency was 83.3 per cent with two early graft thromboses. There were significant differences between the two groups in limb salvage (91.7% DVA vs 12.5% CT, P < 0.001), pain relief (75% DVA vs 8.3% CT, P < 0.001), and wound healing rates (77.8% DVA vs 0% CT, P < 0.001). Lactate level in the blood of deep venous system after repeated measuring was significantly decreased after the multivariate analysis of variance method was applied (F = 7.691, P < 0.01). Hemodynamic parameters such as systolic digital pressure and digitobrachial systolic pressure index were increased after revascularization using Student's t test ( P < 0.001). The DVA may improve the outcome of the treatment of the patients for whom the conventional bypass procedure mainly was not possible.