Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492008000300013
Jornal Vascular Brasileiro
Case Report

Arterialização do arco venoso do pé para tratamento da tromboangeíte obliterante

Arterialization of the venous arch of the foot for the treatment of thromboangiitis obliterans

Cesar Roberto Busato; Carlos Alberto Lima Utrabo; Ricardo Zanetti Gomes; Joel Kengi Housome; Eliziane Hoeldtke; Cristiano Teixeira Pinto; Rafael Ignácio Brandão; Cintia Doná Busato

Downloads: 2
Views: 953

Resumo

Em isquemia crítica sem leito arterial distal, um dos modos de irrigar o membro isquêmico é derivar o fluxo de maneira retrógrada através do sistema venoso. As primeiras tentativas de fístulas arteriovenosas terapêuticas datam do início do século passado. Realizadas na parte proximal dos membros inferiores, não obtiveram resultados favoráveis. A partir da década de 70, com os trabalhos pioneiros de Lengua, as fístulas passaram a ser estendidas até o pé, e os bons resultados apareceram em várias publicações. Os autores relatam a evolução de um caso de tromboangeíte obliterante submetida ao procedimento. Essa é uma cirurgia de indicação precisa, que requer estudo pré-operatório arterial e venoso e observância a detalhes de técnica operatória.

Palavras-chave

Arterialização venosa, isquemia crítica, fístulas arteriovenosas terapêuticas, salvamento de membro, tromboangeíte obliterante

Abstract

In critical ischemia without arterial run-off, it is possible to irrigate the ischemic limb by turning the course of the flow reversely through the venous system. The first experiments with therapeutic arteriovenous fistulas date from the beginning of the last century. They were performed in the proximal area of the lower limbs, but showed unfavorable results. Since the 1970's, with the pioneer studies of Lengua, fistulas started being extended to the foot and several publications have reported good outcomes. The authors report the evolution of a case of thromboangiitis obliterans which was submitted to the procedure. This is an accurate surgical procedure which requires arterial and venous preoperative study and the observance of technical operative details.

Keywords

Venous arterialization, critical ischemia, therapeutic arteriovenous fistulas, limb salvage, thromboangiitis obliterans

References

Lengua Almora F, Herrera Zuloeta E, Kunlin J. Nuevos documentos experimentales de inversión circulatoria en miembro isquémico y de inyección retrógrada em piezas anatómicas. Diagnóstico (Peru). 1984;13:77-86.

Szilagyi D, GD 3rd Jay, Munnell ED. Femoral arteriovenous anastomosis in the treatment of occlusive disease. AMA Arch Surg. 1951;63:435-51.

Root HD, Cruz AB Jr. Effects of an arteriovenous fistula on the devascularized limb. JAMA. 1965;191:645-8.

Matolo NM, Cohen SE, Wolfmann EF Jr. Use of an arteriovenous fistula for treatment of the severely ischemic extremity: experimental evaluation. Ann Surg. 1976;5:622-5.

Courbier R, Jausseran JM, Reggi M. Sapheno-femoral shunt in severe ischaemia of the lower limbs. J Chir (Paris). 1973;105:441-8.

Pokrovskii AV, Dan VN, Khorovets AG, Chupin AV. [Arterialization of venous blood flow in the foot in the treatment of severe ischaemia in patients with crural arterial occlusions and non-functioning plantar arch]. Khirurgiia (Mosk). 1990;5:35-42.

Lengua FA, Helfer LV. Técnica de arterialización de la red venosa del pie. Rev Sand Polic. 1974;35:203-10.

Lengua F, Nuss JM, Lechner R, Kunlin J. Arterialization of the venous network of the foot through a bypass in severe arteriophatic ischemia. J Cardiovasc Surg (Torino). 1984;25:357-60.

Lengua F, Nuss JM, Buffet JM, Lechner R. Etude comparative de deux modalités d'artérialisation des veines du pied en ischémie critique. J Chir (Paris). 1993;130:12-9.

Lengua F, Langeron P. Le pontage d'artérialisation veineuse distale peut-il être bénéfique au pied diabétique avec nécrose?. Chirurgie. 1994;120:143-52.

Lengua F, Cohen R, L'Huillier B, Buffet JM. Arteriovenous revascularization for lower limb salvage in unreconstructible arterial occlusive disease (long term outcome). Vasa. 1995;24:261-9.

Lengua F, La Madrid A, Acosta C. L'artérialisation des veines du pied pour sauvetage de membre chez l'artéritique: Technique et résultats. Ann Chir. 2001;126:629-38.

Chen XS, Lin T, Chen DL, Guan YB. Venous arterialization in the treatment of extensive arterial occlusions of lower extremities. J Surg Concepts Pract. 1998;3:219-21.

Taylor RS, Belli AM, Jacob S. Distal venous arterialisation for salvage of critically ischaemic inoperable limbs. Lancet. 1999;354:1962-5.

Engelke C, Morgan RA, Quarmby JW, Taylor RS, Belli AM. Distal venous arterialization for lower limb salvage: angiographic appearances and interventional procedures. Radiographics. 2001;21:1239-48.

Rowe VL, Hood DB, Liphan J. Initial experience with dorsal venous arch arterialization for limb salvage. Ann Vasc Surg. 2002;16:187-92.

Ozbeck C, Kestelli M, Emrecan B. A novel approach: ascending venous arterialization for atherosclerosis obliterans. Eur J Vasc Endovasc Surg. 2005;29:47-51.

Busato CR, Utrabo CAL, Housome JK, Gomes RZ. Arterialização do arco venoso do pé para tratamento da isquemia crítica sem leito distal. Cir Vasc Angiol. 1999;15:117-21.

Gasparis AP, Noor S, Da Silva MS, Tassiopoulos AK, Semel L. Distal venous arterialization for limb salvage: a case report. Vasc Endovascular Surg. 2002;36:469-72.

Kauffman P. Tromboangeíte obliterante. Doenças vasculares periféricas. 2002;2:1271-9.

Lofgren EP, Myers TT, Lofgren KA, Kuster G. The venous valves of the foot and ankle. Surg Gynecol Obstet. 1968;127:289-90.

Garrido MB. Anatomia médico cirúrgica do sistema venoso dos membros inferiores. Doenças vasculares periféricas. 2002;1:133-67.

Lu XW, Idu MM, Ubbink DT, Legemate DA. Meta-analysis of the clinical effectiveness of venous arterialization for salvage of critically ischaemic limbs. Eur J Vasc Endovasc Surg. 2006;31:493-9.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddd65250e8825613a1da3ea jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections