Distal venous arterialisation for salvage of critically ischaemic inoperable limbs

Amputation remains the only option in patients with extensive arterial disease in whom conventional bypass operations are not feasible. Up to 10000 amputations for vascular disease are estimated to be done annually. We investigated the use of venous perfusion as an alternative method of limb salvage.

Over 28 months, 18 patients with critical-limb ischaemia underwent bypass procedures to the venous bed of the foot with vein, synthetic graft, or a combination of these as the conduit. Various methods were used to destroy the valves of the venous system. We followed up patients for a mean of 17 months.

Three grafts failed immediately after surgery and necessitated major amputation, with one death. One late failure did not necessitate amputation. 15 patients had relief of symptoms and retained a useful pain-free limb with healing of ulcers and gangrene. Two patients with functioning grafts died at 5 months and 13 months, respectively. Three patients had successful further radiological intervention. The overall limb-salvage rate was 83% and the 1-year limb-salvage rate was 75%.

Distal venous arterialisation is a unique procedure that has exciting possibilities for limb salvage and merits further investigation. Increased use of this procedure may help to lower the number of limbs amputated for vascular disease.