Arterialisation of the distal veins of the foot for limb salvage in patients with obliterative arterial disease. Technique and results.

Study aim: The aim of this retrospective study was to report the long term results with arterialisation of the veins of the foot as the final attempt to save an ischaemic limb when classical techniques have proved ineffective or impossible. Patients and method. From January 1974 to July 2000, 60 arterialisations of the distal veins of the foot were performed in 59 patients with arteritis, associated in 25 of them with diabetes mellitus. There were 41 men and 18 women, their mean age was 72 years (range from 49 to 95 years). There were 50 stage IV patients and 9 stage III patients. The arterialisation was perf ormed by a reversed venous bypass between the femoral or popliteal artery a nd an internal vein of the foot, after destruction of the valvulas of the f orefoot veins. The distal anastomosis was made termino lateral in order to provide tissular nutrition and to avoid blood congestion. Results: The result was considered good when a major amputation was avoided during one year at least, with a bypass permeability longer than one month . Among the 60 arterialisations, 36 were successful (60%), 7 in the short t erm (between one month and one year), 15 in the medium term (between one an d five years), 14 in the long term (more than 5 years). Among the 15 medium -term good results, the mean time of bypass permeability was one year; thre e patients died, six were lost of follow-up, and six were still alive, four of them with a permeable bypass, at the time of the study. Among the 14 lo ng term results, spontaneous bypass occlusion occurred after a 26-month mea n time; despite this occlusion, the favourable result persisted till the de ath of the patient after a mean delay of 9 years (range from 5 to 15 years) . The 24 other patients had a poor result followed by a major amputation. T here were no deaths in relation with the reversed circulation. Conclusion: These results suggest that the arterialisation of the distal ve ins of the foot may be considered a useful revascularization technique for limb salvage when all the classical methods have failed or are impossible. (C) 2001 Editions scientifiques et medicales Elsevier SAS.