Roberto Ferraresi1, Andrea Casini2, Fabrizio Losurdo3, Maurizio Caminiti3, Alessandro Ucci4, Matteo Longhi5, Michiel Schreve6, Michael Lichtenberg7, Steven Kum8, Giacomo Clerici3. 1. 1 Peripheral Interventional Unit, Humanitas Gavazzeni, Bergamo, Italy. 2. 2 Vascular Unit, Humanitas Gavazzeni, Bergamo, Italy. 3. 3 Diabetic Foot Clinic, Humanitas Gavazzeni, Bergamo, Italy. 4. 4 Vascular Surgery, University of Parma, Maggiore Hospital, Parma, Italy. 5. 5 Vascular Surgery, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy. 6. 6 Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands. 7. 7 Vascular Centre Arnsberg, Arnsberg Clinic, Arnsberg, Germany. 8. 8 Vascular Service, Department of Surgery, Changi General Hospital, Singapore.
Abstract
PURPOSE: To describe a preliminary experience in treating no-option critical limb ischemia (CLI) patients with a hybrid foot vein arterialization (HFVA) technique combining open plus endovascular approaches. MATERIALS AND METHODS: Between May 2016 and January 2018, 35 consecutive patients (mean age 68±12 years; 28 men) with 36 no-option CLI limbs underwent HFVA in our center. All limbs had grade 3 WIfI (Wound, Ischemia, and foot Infection) ischemia, and the wound classification was grade 1 in 4 (11%) limbs, grade 2 in 4 (11%), and grade 3 in 28 (78%). Surgical bypass was done on the medial marginal vein or a posterior tibial vein, followed by endovascular removal of foot vein valves and embolization of foot vein collaterals. A "tension-free" surgical approach was used to treat foot lesions. RESULTS: At a mean follow-up of 10.8±2 months, limb salvage was achieved in 25 (69%) limbs and wound healing in 16 (44%); 9 patients presented an unhealed wound. Eleven (31%) patients underwent a major amputation (2 below the knee and 9 thigh). One patient with an unhealed wound and open bypass died of myocardial infarction. CONCLUSION: HFVA is a promising technique able to achieve acceptable rates of limb salvage and wound healing in no-option patients generally considered candidates for an impending major amputation. Further studies are needed to standardize the technique and better identify patients who can benefit from this approach.
PURPOSE: To describe a preliminary experience in treating no-option critical limb ischemia (CLI) patients with a hybrid foot vein arterialization (HFVA) technique combining open plus endovascular approaches. MATERIALS AND METHODS: Between May 2016 and January 2018, 35 consecutive patients (mean age 68±12 years; 28 men) with 36 no-option CLI limbs underwent HFVA in our center. All limbs had grade 3 WIfI (Wound, Ischemia, and foot Infection) ischemia, and the wound classification was grade 1 in 4 (11%) limbs, grade 2 in 4 (11%), and grade 3 in 28 (78%). Surgical bypass was done on the medial marginal vein or a posterior tibial vein, followed by endovascular removal of foot vein valves and embolization of foot vein collaterals. A "tension-free" surgical approach was used to treat foot lesions. RESULTS: At a mean follow-up of 10.8±2 months, limb salvage was achieved in 25 (69%) limbs and wound healing in 16 (44%); 9 patients presented an unhealed wound. Eleven (31%) patients underwent a major amputation (2 below the knee and 9 thigh). One patient with an unhealed wound and open bypass died of myocardial infarction. CONCLUSION: HFVA is a promising technique able to achieve acceptable rates of limb salvage and wound healing in no-option patients generally considered candidates for an impending major amputation. Further studies are needed to standardize the technique and better identify patients who can benefit from this approach.
Authors: Gaia Spinetti; Carlo Maria Ferdinando Caravaggi; Andrea Panunzi; Fabiana Madotto; Elena Sangalli; Federica Riccio; Adriana Barbara Sganzaroli; Paolo Galenda; Amelia Bertulessi; Maria Francesca Barmina; Ornella Ludovico; Orazio Fortunato; Francesco Setacci; Flavio Airoldi; Davide Tavano; Laura Giurato; Marco Meloni; Luigi Uccioli; Antonino Bruno Journal: Cardiovasc Diabetol Date: 2022-09-28 Impact factor: 8.949