Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/S1677-54492010000300004
Jornal Vascular Brasileiro
Original Article

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

The great saphenous vein in situ for the arterialization of the venous arch of the foot

Cesar Roberto Busato; Carlos Alberto Lima Utrabo; Ricardo Zanetti Gomes; Eliziane Hoeldtke; Joel Kengi Housome; Dieyson Martins de Melo Costa; Cintia Doná Busato

http://dx.doi.org/10.1590/S1677-54492010000300004 J Vasc Bras, vol.9, n3, p.119-123, 2010
PDF Português
PDF English
SciELO
Downloads: 1
Views: 1263

Resumo

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.

Palavras-chave

Tromboangeíte obliterante, salvamento de membro, arterialização temporal, amputação de membro

Abstract

BACKGROUND: Critical lower limb ischemia in the absence of a distal arterial bed can be treated by arterialization of the venous arch of the foot. OBJETIVE: The objective of this paper was to present the technique and the results of the arterialization of the venous arch of the foot with the in situ great saphenous vein. METHODS: Eighteen patients, 11 with atherosclerosis (AO), 6 with thromboangiitis obliterans (TO) and 1 with popliteal artery aneurysm thrombosis were submitted to venous arch arterialization. The in situ great saphenous vein was anastomosed to the best donor artery. Arterial flow derived from the venous system progresses through the vein whose valves were destroyed. The collateral vessels of the great saphenous vein are linked from the anastomosis to the medial malleolus and preserved from this point onward. RESULTS: Limb salvage was achieved in 10 (55.6%) patients, 5 with AO and 5 with TO. Seven (38.9%) patients were amputated, 5 with AO, 1 with TO and 1 with Ta. One (5.5%) patient died. CONCLUSION: Arterialization of the venous system of the foot should be considered for the salvage of limbs with critical ischemia in the absence of a distal arterial bed.

Keywords

Thromboangiitis obliterans, limb salvation, temporal arterialization, limb amputation

References

Lengua F, Herrera EZ, Kunlin J. Nuevos documentos experimentales de inversion circulatoria em miembro isquemico y de inyeccion retrograda em piezas anatomicas. Diagnostico.. 1984;13:77-86.

Lengua F, Helfner L. Técnica de arterialization de l ares venosa del pie. Rev Sand Polic.. 1984;35:203-10.

Lengua F, Nuss JM, Lechner R, Kunlin J. Arterialization of the venous network of the foot through a bypass in severe arteriopathic ischemia. J Cardiovasc Surg.. 1984;25:357-60.

Lengua F, Nuss JM, Buffet JM, Lechner R. Etude comparative de deux modalités d'arterialisation des veines du pied en ischémie critique. J Chir. 1993;130:12-9.

Lengua F. Le pontage d'artérialisation veineuse distale peut-il être bénéfique au pied diabétique avec nécrose?. Chirurgie. 1994;120:143-52.

Lengua F, Cohen R, Huillier BL, Buffet JM. Arteriovenous revascularization for lower limb salvage in unreconstructible arterial occlusive disease (long term outcome). Vasa. 1995;24:261-9.

Lengua F, Madrid A La, Acosta C. L'arterialisation des veines du pied pour sauvetage de membre chez l'artéritique. Technique et resultats. Ann Chir. 2001;126:629-38.

Pokrovski AV, Dan VN, Khorovets AG, Chupin AV. Arterialization of venous blood flow in the foot in the treatment of severe ischaemia in patients with crural arterial occlusions and non-functioning plantar arch. Khirurgiia. 1990;5:35-42.

Pokrovski AV, Dan VN, Khorovets AG, Chupin AV. Arterialization of the foot venous system in the treatment of the critical lower limb ischaemia and distal arterial bed occlusion. An Vasc Surg. 1996;4:73-93.

Chen XS, Lin T, Chen DL, Guan YB. Venous arterialization in the treatment of extensive arterial occlusion of lower extremities. J Surg Concepts Pract. 1998;3:219-21.

Taylor RS, Belli AM, Jacob S. Salvage of critically ischaemic limbs. Lancet. 1999;354:1962-.

Engelke C, Morgan RA, Quarmby JW, Taylor RS, Belli AM. Distal venous arterialization for lower limb salvage: angiographic appearances and interventional procedures. Radiographics. 2001;21:1239-50.

Rowe VL, Hood DB, Liphan J. Initial experience with dorsal venous arch arterialization for limb salvage. Ann of Vasc Surg. 2002;16:187-92.

Ozbeck C, Kestelli M, Emrecan B. A novel approach: ascending venous arterialization for atherosclerosis obliterans. Eur J Vasc Endovas Surg. 2005;29:47-51.

Gavrilenko AV, Skrylev SI. Long-term results of venous blood flow arterialization of the leg and foot in patients with critical lower limb ischemia. Angiol Sosud Khir. 2007;13:95-103.

Keshelawa G, Gigilashvili K, Chkholaria A, Pagava G, Janashia G, Beselia K. Foot venous system arterialization for salvage of nonreconstructable acute ischemic limb: a case report. J Vasc Nurs. 2009;27:13-6.

Busato CR, Utrabo CAL, Housome JK, Gomes RZ. Arterialização do arco venoso do pé para tratamento da isquemia crítica sem leito distal. Cir Vasc & Angiol. 1999;15:117-21.

Busato CR, Utrabo CAL, Gomes RZ. Arterialização do arco venoso do pé para tratamento da tromboangeíte obliterante. J Vasc Bras. 2008;7:267-71.

Gasparis AP, Noor S, Da Silva MS, Tassiopoulos AK, Semel L. Distal venous arterialization for limb salvage: a case report. Vasc Endovasc Surg. 2002;36:469-72.

Lozano A, Melon J, Ruiz-Grande F. Arterialización venosa distal en cirugía de salvación de extremidad: Resultados preliminaries. Angiologia. 2002;54:204-26.

Root HD, Cruz AB. Effects of an arteriovenous fistula on the devascularized limb. JAMA. 1965;191:645-8.

Matolo NM, Cohen SE, Wolfmann EF Jr. Use of an arteriovenous fistula for treatment of the severely ischemic extremity: experimental evaluation. Ann Surg. 1976;5.

Lofgren EP, Myers TT, Lofgren KA, Kuste G. The venous valves of the foot and ankle. Surg Gynecol Obstet. .

Garrido MBM. Anatomia médico-cirúrgica do sistema venoso dos membros inferiores. Doenças vasculares periféricas. 2002;1:133-67.

Kauffman P. Tromboangeíte obliterante. Doenças vasculares periféricas. 2002;2:1271-9.

Lu XW, Idu , Ubbink DT, Legemate DA. Meta-analysis of the clinical effectiveness of venous arterialization for salvage of critically ischaemic limbs. Eur J Vasc Endovasc Surg. 2006;31.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5dded1b40e8825b5497279a4 jvb Articles
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections