ARTERIOVENOUS REVASCULARIZATION FOR LOWER -LIMB SALVAGE IN UNRECONSTRUCTIBLE ARTERIAL OCCLUSIVE DISEASE (LONG-TERM OUTCOME)

Between February 1983 and June 1994 we attempted surgically to salvage twenty-six legs in twenty-five patients with insufficient distal run- off and severely ischemic feet; all of them had resting pain, and 23 h ad tissue necrosis. A saphenous venous graft was interposed between an artery of the lower extremity (femoral or popliteal) and the veins of the foot with obligatory end-to-side distal anastomosis. The patency of the venous circulation of the ischemic foot was ascertained by retr ograde phlebography. Patients were followed from 3 months to 11 years (an average of 3 years and 5 months). In 19 legs (73 %), surgery succe eded in preventing extensive gangrene of the foot, and allowed postpon ing or avoiding major amputation. The purpose of this paper is to anal yze this experience, and stimulate further interest and study of the r eversed microcirculation in critical ischemia.