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[Clinical effects of revascularization in lower limb ischemia]
1Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University Medical Sciences, Guangzhou Guangdong, P.R. China 510080. lix2@21cn.com
Insights
Revascularization effectively treats severe lower extremity ischemia using bypass grafts, endarterectomy, or venous arterialization. Surgical options should be individualized based on arteriography to optimize limb salvage and patency rates.
Area of Science:
- Vascular Surgery
- Peripheral Artery Disease
- Ischemia Management
Context:
- Severe lower extremity ischemia poses significant risks, including limb loss.
- Surgical revascularization aims to restore blood flow and prevent amputation.
- Arteriography is crucial for diagnosing occlusive disease patterns.
Purpose:
- To evaluate the clinical outcomes of various revascularization techniques for severe lower extremity ischemia.
- To compare the effectiveness of artificial vascular grafts, endarterectomy with patch profundaplasty, and arterialization of the femoral venous system.
- To determine limb survival and patency rates associated with different surgical approaches.
Summary:
- A retrospective study analyzed 56 lower limbs in 49 patients undergoing surgical intervention for severe ischemia.
- Revascularization procedures included artificial vascular grafts (33 limbs), endarterectomy with patch profundaplasty (5 limbs), and arterialization of the femoral venous system (14 limbs).
- Average follow-up was 38 months, with an overall accumulated amputation rate of 14.3% for revascularized limbs.
Impact:
- Artificial vascular bypass, endarterectomy, and venous arterialization are effective treatments for severe lower extremity ischemia.
- Limb survival rates were high: 94.7% for grafts/endarterectomy and 85.7% for venous arterialization.
- Individualized surgical planning based on arteriography is essential for successful revascularization and limb salvage.
Objective:
To investigate the clinical effects of revascularization in lower extremity for severe ischemia.
Methods:
Fifty-six lower limbs with severe ischemia in 49 patients were evaluated retrospectively, who underwent surgical intervention from January of 1995 to December of 2000. By arteriography, the actual anatomic distributions of occlusive disease included infrarenal aorta-bicommon iliac arteries, abdominal aorta-bicommon iliac arteries, iliac artery, and femoral artery or femoropopliteal artery. The indication for surgery was disabling claudication, rest pain and gangrene. Fourteen limbs in 12 cases received arterialization of femoral venous system by artificial venous-arterial fistula. Artificial vascular grafts were implanted in 33 limbs of 28 cases, endarterectomy and patch profundaplasty were performed in 5 limbs of 5 cases, and primary amputation was carried out in 4 cases.
Results:
During 38 months follow-up in average, 4 limbs were amputated within 52 revascularizated limbs, and accumulated amputation rate was 14.3%. Patency rate was 68.4% in arterial revascularization limbs (26/38 limbs), and limb survival rate was 94.7%(36/38 limbs) by procedure of artificial vascular grafts, endarterectomy and patch profundaplasty. Limb survival rate in procedure of artificial venous-arterial fistula was 85.7%(12/14 limbs).
Conclusion:
In treatment of severe lower extremity ischemia, the effective revascularization can be achieved by artificial vascular bypass, endarterectomy and patch profundaplasty, or arterialization of femoral venous system. Options in the surgical management should depend on individual. Arteriography is essential for revascularization and properly planning a practicable surgical approach.