A new revascularization procedure for extensive arterial occlusions of lower extremity. A.V shunt procedure

A revascularization procedure for extensive arterial occlusive lesions of the lower extremity, namely "A-V shunt procedure" was devised. The occluded popliteal artery is recanalized by open endarterectomy in association with E-PTFE bypass for occlusion of the superficial femoral artery, and the patency of reconstructed arterial segments is ensured by an arterio-venous shunt created at the distal end of the recanalized tibio-peroneal trunk. The branches of the genicular arterial network are also reopened by a technique of thrombectomy. Numerous collaterals develop through the reopened genicular network increasing blood flow to the ischemic distal areas. From 1967 to 1980, 63 extremities in 57 patients, which had extensive arterial occlusions of lower extremities with impending ulcer and/or severe rest pain in their feet or toes, underwent this procedure. Remarkable improvement of ischemic symptoms resulted in 76.2% of extremities at the time of the hospital discharge and 57.1% in follow-up.