Meta-analysis of the Clinical Effectiveness of Venous Arterialization for Salvage of Critically Ischaemic Limbs

Abstract

On the basis of limited evidence, venous arterialization may be considered as a viable alternative before major amputation is undertaken in patients with 'inoperable' chronic critical leg ischaemia.

Arterialização do arco venoso do pé para tratamento da tromboangeíte obliterante

“…Submetidos à metanálise, os estudos perfizeram um total de 228 pacientes com 231 extremidades e um percentual de salvamento de 71%, com cicatrização de lesões, pequenas amputações e melhora da dor em repouso. Do total de casos, 140 eram de aterosclerose e 91 de tromboangeíte obliterante 23 .…”

Is Limb Loss Always Inevitable for Critical Neuro-Ischemic Foot Wounds in Diabetic Patients with End Stage Renal Disease and Unfit for Vascular Reconstructions?

“…In Table I, are schematized the main features of the patients addressed for this technique. The majority of arterializations for "hopeless" CLI presentations intended for amputation were described in the literature using the available superficial venous system (Jacop et al, 1999;Lengua et al, 2001;Lu et al, 2006). A growing number of contemporary reports seem to provide rather encouraging (Lengua et al, 2001;Lu et al, 2006) than pessimistic results (Matzke et al, 1999) concerning this evolving technique.…”

“…4 and 5) to be reperfused (Alexandrescu et al, 2011). It may also fit selected extreme situations for limb salvage, despite irrecoverable occlusions of the arterial network (Alexandrescu et al, 2011;Lu et al, 2006). The concept of venous arterialization to treat advanced CLI presentations has emerged as an extreme therapeutic alternative in cases with impracticable conventional arterial reconstructions (Jacop et al, 1999;Lu et al, 2006).…”

“…Deep veins arterialization in ESRD and diabetic CLI patients may offer the advantage to direct flow in the deep calf venous conduits spared from typical type II calcifications (Irvin & Guzman, 2009) and extended chronic occlusions (Lu et al, 2006;Toursarkissian et al, 2002). This may enable to deliberately choose specific distal territories (Fig.…”

“…While some reports claim encouraging limb salvage results (Jacop et al, 1999;Lengua et al, 2001;Lu et al, 2006), others remain reserved (Matzke et al, 1999). Parallel efforts in CLI limb preservation were reported in the plastic reconstructive surgery field, by promoting the angiosomes model (AM) for reperfusion and tissue reconstruction upon specific arterial and venous bundles of blood supply (Attinger et al, 2001(Attinger et al, , 2006Taylor & Pan, 1998).…”