Treatment of critical ischaemia of the lower limb by venous arterialization : an interim report.

A method to revascularize the critically ischaemic lower limb by arterialization of the dorsal venous arch of the foot via the long saphenous vein is described. Satisfactory procedures were achieved in 5 of 6 patients for whom standard arterial reconstructions were not possible and who would otherwise have required amputation. Of these, 2 failed in the early postoperative period and amputation was performed. Two others failed after 1 year and 18 months respectively but amputation was not required. One patient died 8 months after operation with a functioning arterialized vein and pain-free limb. In the 5 patients with successfully revascularized limbs rest pain was relieved, and incisions, ischaemic ulcers and gangrene healed, showing that effective nutrition of the lower limb was achieved by delivering arterial blood through the venous system. Complications were minor and easily controlled. Although as a result of the procedure amputation was avoided in 3 out of 6 patients, the place of the method in the treatment of critical ischaemia of the lower limb remains dubious. Further investigation and modification of the method are planned.