title: Revascularization of the ischemic canine hindlimb by arteriovenous reversal.
abstract: Arteriovenous reversal (AVR) for revascularization of ischemic tissues has previously failed to meet theoretical, experimental, and clinical expectations despite recurrent trials. The efficacy of a new staged approach to AVR was tested against a canine ischemic limb preparation in which global ligation of ipsilateral collaterals inevitably led to limb gangrene. In 12 animals the complications of direct, single-stage end-to-end femoral AVR, inevitably accompanied by the development of extreme edema, were demonstrated. However, when the ischemic preparation was accompanied by a staged AVR, in which an initial end-artery-to-side-vein arteriovenous fistula was converted 1 week later to AVR by ligation of the central venous limb, 20 of 20 animals survived, and 19 of 20 were ambulatory long-term survivors with only mild edema. Serial angiograms at 1 week, 1 month, and 4 months demonstrated patency rates of 100, 84, and 63%, respectively. Histologic examination of animals electively killed from 4 to 24 months showed normal skeletal muscle histology, venous intimal thickening, and mild edema. In the acutely ischemic canine hind limb, a staged AVR can provide both viability and function with only mild edema formation.
mesh_terms: D000818:Animals; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D003097:Collateral Circulation; D004285:Dogs; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005268:Femoral Vein / Q000601:surgery*; D006614:Hindlimb / Q000098:blood supply; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D008297:Male