Descargar - Úlceras.net

OPEN SURGERY FOR REVASCULARIZATION OF THE DIABETIC FOOD ■ 93Table IVPrimary assisted patency in the surgicalgroup and in surgical group after failure of EVDISCUSSION AND CONCLUSIONMultilevel arterial disease is best treatedby surgical bypass according to TASC recommendations.The ideal material for AK revascularizationsis synthetic, as it has given results similarto the autologous saphenous vein.Numerous reports have confirmed thelong-term superiority in patency of vein oversynthetic conduit, however, many physicianscontinue to use synthetic grafts in the AK positionto preserve venous conduit for a futuredistal revascularization.The choice of conduit was left to the discretionof the operating surgeon and is eitherePTFE or Dacron.The ideal material for BK revascularizationsis autologous saphenous vein, which hasbeen demonstrated to provide significantlybetter results than prosthetic grafts. When autologousveins are not suitable, the most commonlyused synthetic material is ePTFE associatedin particular situations to technical artificesfor distal anastomosis.Moreover, a significantly higher percentageof early graft thromboses and amputationswere recorded in patients undergoing redoprocedures and in patients with preoperativepoor runoff status. These findings support theneed for continuing to use autologous mate -rials in these subgroups of patients. The widespreaduse of venous material significantly in-fluenced the patency and the limb salvagerates,The EV appears to be a viable option forprimary SFA, particularly when vein is notavailable, if the patient is a poor candidate forconventional bypass, and in case of rest painor severe claudication.But in severe CLI patients, PTA has shownpoor long-term patency.TASC classifications needed to be correlatedto the clinical features to pone the correctindication to the treatment.Distal reconstructive arterial surgery,rather than becoming obsolete, has evolvedtoward more ambitious targets, pushing itslimits and being more distal, more extremeand more demanding for the treatment of tissueloss and gangrene.REFERENCES1. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM,Ahn S et al. Recommended standards for reports dealingwith lower extremity ischemia: Revised version. J Vasc Surg1997; 26:517-538.2. Kalra M, Gloviczki P, Bower TC, Panneton JM, Harmsen WS,Jenkins GD et al. Limb salvage after successful pedal bypassgrafting is associated with improved long-term survival. JVasc Surg 2001; 33:6-16.3. Nguyen LL, Moneta GL, Conte MS, Bandyk DF, Clowes AW,Seely BL. PREVENT III Investigators. Prospective multicenterstudy of quality of life before and after lower extremityvein bypass in 1404 patients with critical limb ischemia. JVasc Surg 2006; 44: 977-984.4. F Spinelli, G De Caridi, M La Spada et al.. By-pass on malleolarand pedal arteries. In A Stella, M Gargiulo: Arteriopatia diabeticaperiferica. Ed. Minerva Medica Torino 2009, pag 109-114.5. Andros G, Harris RW, Salles-Cunha SX, et al: Bypass graftsto the ankle and foot. J Vasc Surg 1988; 7:785-794.6. Belkin M, Welch HJ, Mackey WC, O’Donnell Jr TF: Clinicaland hemodynamic results of bypass to isolated tibial arterysegments for ischemic ulceration of the foot. Am JSurg 1992; 164:281-284.7. Faglia E, Dalla Paola L, Clerici G, et al: Peripheral angioplastyas the first-choice revascularization procedure in diabeticpatients with critical limb ischemia: prospective study of993 consecutive patients hospitalized and followed between1999 and 2003. Eur J Vasc Endovasc Surg 2005; 29:620-627.8. F Spinelli, F Stilo, M La Spada et al.. Results of femoro-distalbypass according to clinical conditions and prostheticmaterials. In C Pratesi, R Pulli: Up-date in ChirurgiaVascolare. Ed. Minerva Medica Torino 2007: 248-253.