Artérialisation veineuse du pied à contre courant comme thérapeutique de l’ischémie critique

Abstract

Purpose of the study. Show that the old idea of ​​replacing the arterial network by the venous network is a
method possible and valid in the long term, in critical ischemia.
Patients and Methods. From January 2000 to July 2009,
we performed 78 venous arterializations of the foot in
arteritics including 60 diabetics; there were 55 men
and 23 women and the mean age was 71 years (range: 53-
91). 69 were at Fontaine stage IV and 9 at stage IIIB.
Arterialization of the veins of the foot was performed by
interposition of a proximal anastomosed venous bypass
to an artery with good flow (femoral or popliteal) and distal
to a vein in the foot, usually the marginal vein
internal, after destruction of the valves of the venous axes of
the forefoot.
Results. Of the 78 AVPs, there were 15 failures followed by
major amputation and 63 successes (80.78%) including 10 short,
33 in the medium and 20 in the long term. There were 4 recurrences of ischemia, 3 of which were treated with percutaneous dilation and one
cause of death from sepsis. 58 bypass grafts were thrombosed late but still retaining the benefits of the operation. 5 bypasses are still permeable. Average tracking is
2 years and 7 months. The average duration of bypass surgery was
7 and a half months. 13 patients died (16.6%). No
heart failure or chronic venous disease.
Conclusion. Arterialization of the veins of the foot in critical ischemia is a feasible, effective and
long-term sustainable; the neo-arteriogenesis and neo-angiogenesis induced by the operation may explain the continued benefits of the operation after the bypass occlusion.