Ramírez SO, Pacheco PL, Reyes FM, Cruz RMÁ, Morales CR, Mayoral VM

Language: Spanish
References: 25
Page: 47-52
PDF size: 310.32 Kb.

ABSTRACT

Objective: To report the first results into our state from patients underwent to limb salvage revascualarization within a year period.
Patients and methods: From may 2003 to may 2006, fifty bypasses were performed for limb salvage in fifty patients. Thirty one patients (62%) were female and nineteen (38%) were male, with a mean age of 71 years. Eighty percent had diabetes mellitus, from these forty two percent had hypertension, Hypertension alone 18%, obesity 8% smokers 18%, coronary disease 10%, end-stage renal disease 4%, multiple sclerosis 2%. Forty six patients (92%) had critical limb ischemia, rest pain (8%).
Results: Forty eight patients underwent reverse greater saphenous vein revascularization, PTFE (1), composite PTFE- arm vein (1). By pass to infrapopliteal out flow vessels were: paramaleolar vessels 56%, popliteal below knee 40%; by pass to superficial femoral 4%. Failed graft 14%. Operative mortality rate (2%). Primary graft patency (30 days) 84%, six months 84%, one year 80%, three years 78%.
Conclusions: Saphenous vein is an excellent conduit when available. These results justify the routine use of arterial reconstructions for patients with critical limb ischemia.

REFERENCES

1. Veith FJ, et al. New approaches in limb salvage by extended extraanatomic bypasses and reconstructions to foot arteries. Surgery 1978; 84: 764

2. Baele H, et al. lnfrainguinal bypass in patients with end stage disease. Surgery 1995; 117: 319-84.

3. Shad D, et al. Long-term results of in situ saphenous Vein bypass. Ann Surg 1995; 222: 438-48.

4. Cal y Mayor, Serrano LJ, Cossío ZA, et al. Revascularización infrainguinal en pacientes diabéticos. Rev Mex Angiol 2005; 33(1): 18-22.

5. Cervantes J, Wilk M, Dergal E. La vena in situ un nuevo reemplazo arterial. Rev Mex Angiol 1988; 16(75): 10-14.

6. Alcántara P. Cirugía endovascular, experiencia en México. Rev Mex Angiol 1996; 24(2): 31-3.

7. Rodríguez J M, Rodríguez J, Curn S, Escobar G, Rodríguez N. Manejo endovascular para aneurisma poplíteo. Rev Mex Angiol 2000; 280(4): 103-10.

8. Gómez-Palacio VM. Resultados del tratamiento endovascular de las lesiones arteriales obstructivas de la circulación de los miembros inferiores con base en su morfología. Rev Mex Angiol 2005; 33(1): 23-7.

9. Melliére D. Petite historie du traitment des maladies artérielles et de ses pionniers. Paris: Européenne d´editions; 2000, p. 151-3.

10. Ga rcía PJ , Torres SN, Rodríguez PL. Derivaciones infrainguinales para revascularización de miembros inferiores en pacientes con aterosclerosis periodo de tres años en el Centro Médico Nacional Siglo XXI, IMSS. Rev Mex Angiol 2006; 34 (2): 13-21.

11. Townley WA, Carrell TW, Jenkins MP, Wolfe JH, Chesire NJ. Critcal limb isquemia in the dialysis - dependent patient: infrainguinal vein bypass is justified. Vasc Endovasc Surg 2006; 40(5): 362-66.

12. Mandolfino T, Canciglia A, D`Alfonso M, Carmignani A. Infrainguinal revascularization based on duplex ultrasound arterial mapping. Int Angiol 2006; 25(3): 256-60.

13. Jager KA, Ricketts HJ, Strandness D E Jr. Duplex scanning for the evaluation of lower limb arterial disease. Bernstein EF (ed.). Non in vasive diagnostic techniques in vascular disease. St Louis: Mosby; 1985, p. 619-3 1.

14. Meyer JI, Khalil RM, Obuchowski NA, Baus LK. Common carotid artery: variability of Doppler US velocity measurements. Radiology 1997; 204: 339-41.

15. Schneider JR, Walsh DB, Mc Daniel MD, Zwolak RM, Bresso SR, Cronenwett JL. Pedal by pass Versus tibial by pass with autogenous vein: a comparison of out come and hemodynamic results. J Vasc Surg 1993; 17(6): 1029-38.

16. Pomposelli F, Kansal N, Hamdad A, Belfield A, Sheahan M, Campbell D. A decade of experience with dorsalis pedis artery by pass: analysis of outcome in more than 1000 cases. J Vasc Surg 2003; 37: 307-15.

17. Rodríguez TJ, Oropeza MG, Rodríguez RN, Millán HMA, Padilla SL, Cortés-López JAV. Reconstrucción arterial con segmentos cortos de vena safena infrapoplítea en extremidades inferiores isquémicas. Rev Mex Angiol 1995; 23(4): 87-94.

18. Toursarkissian B, Jones W, D´Ayala M, Shireman PK, Harrison A, Schoolfield J, et al. Does the efficacy of dorsalis pedis artery bypasses vary among diabetic patients of different ethnic backgrounds? Vasc Endovascular Surg 2002; 36(3): 207-12.

19. Perler BA, Burdick JF, Williams GM. The multiple sequential distal bypass graft: seven year follow-up. J Vasc Surg 1987; 6(3): 269-300.

20. Probst H, Saucy F, Dusmet M, Ris H, Ducrey N, Haller C, et al. Clinical results of autologous infrainguinal revascularization using grafts originating distal to the femoral bifurcation in patients with mild inflow disease. J Cardiovasc, Surg 2006; 47(4): 437-43.

21. Zaragoza-García JM, Plaza MA, et al. Influencia de la diabetes mellitus en la permeabilidad y tasa de salvamento de extremidad de los bypasses distales a arterias perimaleolares en la isquemia crítica de las extremidades inferiores. Angiología 2006; 58(6): 437-43.

22. Faries P, Logerfo F, Arora S, Pulling M, Rohan D, Akbari C, et al. Arm Vein conduit is superior to composite prosthetic - autógenous graft in lower extremity revascularization. J Vasc Surg 2000; 31(6): 1119-27.

23. Blankensteijn JD, Gertler JP, Petersen MJ, et al. Avoiding infrainguinal by pass wound complications in patients with chronic renal insufficiency: the role of anatomic plane. Eur J Vasc Endovasc, Surg 1996; 11: 98-104.

24. Wengrovitz M, Atnip R, Gifford RR, et al. Wound complications of autogenous subcutaneous infra-inguinal arterial by pass surgery: predisposing factors and management. J Vasc Surg 1990; 11: 156-63.

25. Lepäntalo M, Kallio M, Tukiainen E. Wound and foot healing problems following distal bypass surgery. Branchereau A, Jacobs MD (eds.). Complications in vascular and endovascular surgery. Armonk, NY: Futura Publishing Company; 2002, p. 279-94.