Arteriovenous fistula for revascularization of the ischemic extremity

The basic considerations in the use of an arterio-venous fistula for revascularization of the ischemic extremity have been summarized. Retrograde flow of arterial blood entering the venous system by way of an arteriovenous fistula has been demonstrated in acute and chronic animal experiments. While evidence of significant reversed flow in humans has been shown in a few small series, its occurrence is still controversial. The significance of venous valves in impending retrograde flow is not yet adequately investigated. Since a peripheral arteriovenous fistula is one of the most potent stimuli to arterial vessel formation in the extremity, its application may be worthy of consideration in certain selected patients with advanced and otherwise "inoperable" arterial occlusive disease.