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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2001 December;8(4):285-96
language: English, Italian
Distal revascularisation of lower limbs using prosthetic bypass and venous interposition fistula following the Ascer procedure
Spinelli F., D’Alfonso M., Mandolfino T., Acri I., La Spada M., Mirenda F.
From the Institute of Thoracic and Cardiovascular Surgery University of Messina, Messina, Italy
Background. The study aimed to evaluate long-term patency and limb salvage rates in distal prosthetic revascularisation of lower limbs using complementary arteriovenous fistula and deep vein interposition (AVF/VI).
Methods. From 1992 to 2000, AVF/VI was performed as an adjunctive technique for prosthetic bypass on infrapopliteal arteries in 32 patients with 1 or more failed ipsilateral infrainguinal bypasses, in whom a totally autogenous vein bypass was not feasible. Critical ischemia was the sole indication for surgery with rest pain, non-healing ischemic ulcers and foot gangrene.
Results. Perioperative mortality (within 30 days of surgery) was zero. Five bypasses failed at postoperative day 30, 3 bypasses were prolonged distally, 3 amputations were performed. During the follow-up (1-96 months), 15 bypasses occluded. Cumulative patency was 62% at 1 year, 47% at 2 years, 21% at 5 years and 21% at 8 years. Limb salvage was 66% at 1 year, 57% at 2 years, 53% at 5 years and 53% at 8 years.
Conclusions. Adjunctive AVF/VI proved useful in maintaining patency of infrapopliteal prosthetic bypasses and achieving limb salvage.