[Comparative study of two methods of arterialization of foot veins in ischemic crisis]

Between February 1974 and December 1991, a total of 28 arterializations of the venous network of foot were performed in patients with stage IIIB or IV arteriopathies presenting disseminated femoropopliteal and more distal lesions excluding revascularization by conventional arterial shunt operations. Two groups of patients could be distinguished. The first group, of 8 patients, underwent arterialization by shunt operation with end to end fistula at the distal part of leg and return blood emptying at the dorsal surface of foot (3 cases). The procedure was successful in 50% of cases after a mean follow up of 76 months. The intervention in the second group, of 20 patients, was by end to side fistula of foot after preoperative countercurrent phlebography and the use of a material better adapted for the destruction of the valves. Results were evaluated as successful in 70% of cases at 31 month follow up. After spontaneous closure of the fistula, the collateral circulation provoked by it was sufficient to conserve the acquired benefit. No deaths or cases of cardiac overload were reported as a result of the intervention. Comparative analysis of results showed that the use of the second procedure allowed amputation to be avoided in more than 2/3rds of cases, provided relief from pain, provoked healing of necrosed areas and permitted renewal of walking. The results of this study have demonstrated that venous arterialization of the foot by this method represents an interesting alternative in the saving of a limb destined for amputation.