title: Early results from an angiosome-directed open surgical technique for venous arterialization in patients with critical lower limb ischemia.
abstract: BACKGROUND
  Patients with critical lower limb ischemia without patent pedal arteries cannot be treated by the conventional arterial reconstruction. Venous arterialization has been suggested to improve limb salvage in this subgroup of patients but has not gained wide acceptance. We report our early experience after implementing deep and superficial venous arterialization of the lower limb.
  
  
  METHODS
  Ten patients with critical ischemia and without crural or pedal arteries available for conventional bypass surgery or angioplasty were treated with distal venous arterialization. Inflow was from the most distal unobstructed segment. Run-off was the dorsal pedal venous arch (n=5), the dorsal pedal venous arch and a concomitant vein of the posterior tibial artery (n=3), or the dorsal pedal venous arch and a concomitant vein of the common plantar artery (n=2) depending on the location of the ischemic lesion. Venous valves were destroyed using antegrade valvulotomes, guide wires, knob needles, or retrograde valvulotomes via an extra incision.
  
  
  RESULTS
  Seven of the operated limbs were amputated after 23 (1-256) days (median [range]). The main reasons for amputation were lack of healing of either the original wound, of incisional wounds on the foot, or persisting pain at rest. In three cases, the bypass was open at the time of amputation. Two patients experienced complete wound healing after 231 and 342 days, respectively. By the end of follow-up, the last patient was ambulating with slow wound healing but without pain 309 days after surgery.
  
  
  CONCLUSIONS
  Venous arterialization may be used as a treatment of otherwise unsalveable limbs. The success rate is, however, limited. Technical optimization of the technique is warranted.
authors.affiliation: Department of Vascular Surgery, Kolding Hospital, Little Belt Hospital, Kolding, Denmark ; Institute of Regional Health Services Research, University of Southern Denmark, Odense M, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Houlind
authors.affiliation: Department of Radiology, Kolding Hospital, Little Belt Hospital, Kolding, Denmark.
authors.forename: Johnny
authors.initials: J
authors.lastname: Christensen
authors.affiliation: Department of Vascular Surgery, Kolding Hospital, Little Belt Hospital, Kolding, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Hallenberg
authors.affiliation: Department of Vascular Surgery, Kolding Hospital, Little Belt Hospital, Kolding, Denmark.
authors.forename: Jørn M
authors.initials: JM
authors.lastname: Jepsen
keywords: amputation prevention; critical limb ischemia; revascularization; venous arterialization; wound healing