Revascularization of Severely Ischemic Limbs by Staged Arteriovenous Reversal

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Abstract
Having succeeded in salvaging severely ischemic canine hindlimbs by staged arteriovenous reversal, the authors then successfully treated, from January, 1984, to June, 1986, 33 patients with a total of 39 lower extremities by this approach, except for 1 limb. According to the different levels of the extensive and diffuse arterial occlusion, the arteriovenous reversal was formed on three different sites: (1) high-deep reversal, produced between the external iliac, com mon femoral, or superficial femoral artery and the superficial femoral vein; (2) low-deep reversal, made between the distal popliteal artery and the tibiopero neal venous trunk; and (3) superficial reversal, established between the distal popliteal artery and the distal portion of the long saphenous vein. As of April, 1988, these limbs have been followed up for twenty-three to fifty-five months. Except for 1, the postoperative results of the patients in this series are excellent or good. The authors suggest that the staged arteriovenous reversal is a new and ef fective approach in the treatment of extensive arterial occlusive disease of the limb.

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