title: Surgical result of critical limb ischemia due to tibial arterial occlusion in patients with systemic scleroderma.
abstract: OBJECTIVE
  To analyze the outcome after surgery for critical limb ischemia (CLI) due to tibial artery occlusion in patients with systemic scleroderma.
  
  
  METHODS
  The medical records of scleroderma patients with CLI due to tibial artery occlusion were reviewed with respect to demographic data and perioperative variables.
  
  
  RESULTS
  Eight patients were identified at The University of Tokyo Hospital from 1991 to 2007. The underlying collagen disease was progressive systemic scleroderma in 6 patients and CREST syndrome in 2 patients. The subjects were 1 man and 7 women with a mean age of 68 years. While hypercoagulability including positive anticardiolipin antibodies was found in only 1 patient, all patients were antinuclear antibody (ANA) positive and 6 of 8 patients had a high titer of centromere-type ANA. Five underwent pedal artery bypass and 1 underwent distal peroneal artery bypass, while 2 underwent primary limb amputation. Although 1 patient with bypass had early graft occlusion (with subsequent below-knee amputation), the other 5 patients with patent grafts quickly achieved pain relief and initial wound healing. However, four of the five patent grafts developed graft occlusion several months after surgery, with severe intimal thickening at the anastomosis. As a result, 2 of 6 patients with bypass (totally 4 of 8 patients) underwent limb loss and 1 patient developed persistent recurrent ulcer.
  
  
  CONCLUSIONS
  Bypass surgery in patients with scleroderma and CLI can be successful in achieving early pain relief and ischemic wound healing. However, the long-term effectiveness is limited with high rates of graft failure and limb loss.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Juno
authors.initials: J
authors.lastname: Deguchi
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shigematsu
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ota
authors.forename: Hideo
authors.initials: H
authors.lastname: Kimura
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukayama
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Miyata
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016638:Critical Illness; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000601:surgery; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000601:surgery; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007871:Leg Ulcer / Q000209:etiology / Q000601:surgery; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012595:Scleroderma, Systemic / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014680:Veins / Q000637:transplantation*; D014945:Wound Healing