Crural Arterial Reconstruction with an Adjunct Arteriovenous Fistula for Limb Salvage

We studied the efficacy of surgeon-performed combined ipsilateral endovascular and open arterial concomitant reconstruction at the infrainguinal level. It was a retrospective analytic study. The study included 15 patients (9 men, 6 women) who underwent 15 combined procedures between January 2000 and January 2004. They were divided into two groups. The first group consisted of nine patients with an inflow angioplasty. The second group included six patients with an outflow angioplasty. Indications for arterial reconstruction were claudication (one patient), ischemic rest pain (three patients), and gangrene (eleven patients). Immediate technical success of the combined procedures was 100%. In the first group, one patient died owing to a myocardial infarction, ischemic lesions healed in eight patients, one patient required revision of the graft and three reconstructions occluded, with one amputation of the affected limb. In the second group, one patient died owing to stoke, one patient needed a graft revision and one underwent a limb amputation. The cumulative limb salvage at 42 months was 85%. Our results suggest that simultaneous ipsilateral infrainguinal angioplasty and bypass procedures could be performed with good results. Inflow and outfow angioplasty allow using a shorter single graft segment. Outflow angioplasty ameliorates the bypass flow and accelerates the healing of ischemic lesions. The restenosis rate of the inflow angioplasty at the femoral level remains low.

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Arterial reconstruction for limb salvage: is the terminal peroneal artery a disadvantaged outflow tract

Cardiovascular Surgery ◽

10.1016/0967-2109(95)94296-9 ◽

1995 ◽

Vol 3 ◽

pp. 115-115

Author(s):

R LEATHER ◽

W LLOYD ◽

D SHAH ◽

R DARLINGIII ◽

B CHANG ◽

...

Keyword(s):

Limb Salvage ◽

Outflow Tract ◽

Peroneal Artery ◽

Arterial Reconstruction

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Arterial Reconstruction after Mangled Extremity: Injury Severity Scoring Systems Are Not Predictive of Limb Salvage

Vascular ◽

10.1258/rsmvasc.13.2.114 ◽

2005 ◽

Vol 13 (2) ◽

pp. 114-119 ◽

Cited By ~ 17

Author(s):

Mohamed Amin Elsharawy

Keyword(s):

Prospective Study ◽

Limb Salvage ◽

Upper Limb ◽

Injury Severity ◽

University Hospital ◽

Secondary Patency ◽

Arterial Reconstruction ◽

Mangled Extremity ◽

Limb Injuries ◽

A Prospective Study

The Vascular Unit at Suez Canal University Hospital in Egypt covers a wide area with high rates of severe injuries. This is a prospective study of mangled extremities to identify risk factors associated with limb loss in these patients. Between December 2000 and August 2003, a prospective study on all patients with arterial injuries in mangled extremities was undertaken. All patients were scored using the Mangled Extremity Severity Score (MESS) and the Mangled Extremity Severity Index (MESI). During this period, arterial reconstruction was performed in 62 patients. Primary patency, secondary patency, and limb salvage rates were 81%, 85.5%, and 93.5%, respectively. The only factor affecting limb salvage (statistical trend) was the site of trauma (upper limb 100% vs lower limb 89%; p = .08%). There was no significant effect related to the mechanism of trauma (blunt 90% vs stab 100%; p = .125), MESS (< 7, 100% vs > 7, 91%; p = .22), and MESI (< 20, 100% vs > 20, 90.5%; p = .154). Upper limb injuries were the least likely to lead to amputation. We recommend that all injuries, whatever their score, should be surgically explored before treatment decisions are made.

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