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Assessing Therapeutic Angiogenesis in a Murine Model of Hindlimb Ischemia
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Revascularization options for terminal distal ischemia.

William C Pederson1

  • 1The Hand Center of San Antonio, University of Texas Health Science Center at San Antonio, 21 Spurs Lane, Suite 310, San Antonio, TX 78240, USA.

Hand Clinics
|December 3, 2014
PubMed
Summary

Direct arterial bypass is optimal for hand ischemia with suitable vessels. Alternative revascularization options like venous arterialization or omental transfer exist for specific patient groups, avoiding use in infected wounds.

Keywords:
BypassHandIn situIschemiaOmental transferVenous arterialization

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Area of Science:

  • Vascular Surgery
  • Reconstructive Surgery

Background:

  • Terminal ischemia of the hand presents a significant clinical challenge.
  • Identifying appropriate revascularization strategies is crucial for limb salvage.

Purpose of the Study:

  • To outline the optimal surgical approaches for revascularizing the ischemic hand.
  • To delineate the indications and contraindications for various bypass techniques.

Main Methods:

  • Review of direct arterial bypass, in situ bypass, venous arterialization, and microvascular omental transfer.
  • Evaluation of patient selection criteria based on distal vessel availability and wound status.

Main Results:

  • Direct arterial bypass is preferred when adequate distal targets exist.
  • In situ bypass is the primary choice for eligible arterial bypass candidates.
  • Venous arterialization serves as an alternative for poor arterial runoff but is contraindicated with significant wounds or infection.
  • Microvascular omental transfer is viable for select cases.

Conclusions:

  • Surgical strategy for hand ischemia depends on distal vessel patency and wound condition.
  • Direct arterial bypass and in situ bypass are primary options.
  • Venous arterialization and omental transfer provide alternative solutions for complex cases.