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Jornal Vascular Brasileiro

versão impressa ISSN 1677-5449

Resumo

LENGUA, Francisco; MADRID, Andrés La; ACOSTA, Carlos  e  VARGAS, Jorge. Temporal venous arterialization of the diabetic foot. J. vasc. bras. [online]. 2010, vol.9, n.1, pp.14-20.  Epub 23-Abr-2010. ISSN 1677-5449.  http://dx.doi.org/10.1590/S1677-54492010005000007.

Background: The first idea of surgeons (1902) to avoid amputations due to ischemia was to deviate the arterial flow to the venous system using an arteriovenous fistula between adjacent vessels; however, the results were unreliable. Since then, sympathectomies, endarterectomies and bypasses have been created, and more recently, other medical, surgical, and endovascular advances have been used. However, amputations continue to be performed worldwide mainly in diabetic patients. The arterialization of the foot veins, based on the old idea of inverted blood flow, is a new possibility for these patients who, otherwise, could lose their limbs. Objective: To demonstrate that arterialization of the foot veins in diabetic patients with neuroischemic lesions, usually infected (diabetic foot), is an effective and long-lasting method, even though the bypass only works temporally. Patients and method: From January 2000 to February 2009, 59 patients with diabetic foot were threated by means of arterialization of the foot veins. An early death was not included in the analysis. Of the 58 remaining patients, 44 were male and 14 were female. Their mean age was 71 years old: (53-91 years). Fifty-four of them were classified as being Fontaine IV and four were IIIB. The arterialization was conducted using an inverted venous graft proximally anastomized to an artery presenting good flow (external iliac, femoral or popliteal arteries) distally in the internal marginal vein of the foot, eliminating the valves of the foot arch veins. Results: Of the 58 patients who underwent arterialization, 12 failed due to early thrombosis, having amputated limbs, and 46 succeeded (79%): six at short-term, 12 at medium-term, and 28 at long-term. In the groups who were considered to have a successful outcome (two), there were 38 late bypass thrombosis (95%) and four relapses of the ischemic symptoms. There was no case of heart overload or varices. Conclusion: The arterialization of the diabetic foot is possible, effective and long-lasting probably thanks to the induction of a neo-arteriogenesis and neo-angiogenesis that maintain the benefits even after the bypass has occluded (temporal function).

Palavras-chave : Limb salvation; diabetic foot; temporal arterialization; limb amputation.

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