Author/Editor		Jacobs, Michael J; Gregorič, Igor D; Reul, George J
Title		Prosthetic graft placement and creation of a distal arteriovenous fistula for secondary vascular reconstruction in patients with severe limb ischemia
Type		članek
Source		J Vasc Surg
Vol. and No.		Letnik 15, št. 4
Publication year		1992
Volume		str. 612-8
Language		eng
Abstract		Patients with lower limb ischemia who require reoperation for failed vascular reconstructive surgery can benefit from a surgical technique in which an artificial graft is used and an arteriovenous fistula is created at the site of the distal anastomosis, followed by ligation of the proximal vein. This technique was used in 30 patients who had undergone vascular reconstruction with bypasses from the femoral to the distal tibial, peroneal, or dorsal pedal arteries. Angiography showed occlusion of the superficial femoral and popliteal arteries in all patients with reconstitution of only one small segment in the anterior tibial (n = 12), posterior tibial (n = 11), peroneal (n = 5), or dorsal pedal artery (n = 2). All patients had rest pain and necrosis. Artificial grafts were required because of the absence of autogenous vein. Immediate postoperative graft patency was achieved in all 30 patients. The mean ankle/arm pressure index increased from 0.30 +/- 0.24 to 0.79 +/- 0.31 (p less than 0.01). Graft patency computed by the life-table method was 71% at both 1- and 2-year follow-up. Foot salvage was achieved in 25 of 30 patients after surgery. The results of this study indicate that an aggressive vascular surgical approach in patients with severe ischemia and previous failed bypass procedures is justified. In the absence of autogenous vein, the combination of a prosthetic graft and a distal arteriovenous fistula with ligation of the proximal vein increases graft patency.
Descriptors		ARTERIOVENOUS SHUNT, SURGICAL BLOOD VESSEL PROSTHESIS ADULT AGED ISCHEMIA LEG LIFE TABLES REOPERATION