[Foot revascularization in patients with critical limb ischemia].

OBJECTIVES

The aim of this paper is to evaluate the results of foot arteries revascularization (dorsalis pedis, retromalleolar posterior tibial and medial plantar) in patients with critical limb ischemia.

METHODS

Of 190 saphenous vein bypass performed in patients with critical limb ischemia, distal anastomosis was performed in the arteries of the foot in 43 procedures (22.6%): 23 dorsalis pedis (53.5%), 16 retromalleolar posterior tibial (37.2%), and four in the medial plantar artery (9.3%). Trophic lesions were present in 40 feet (93.0%), and diabetes mellitus was the most frequent associated disease (78.0%). The saphenous vein was used in situ in 36 cases (83.7%).

RESULTS

The rate of limbs salvage was 81.4% at 30 days postoperative. Eight major amputations (18.6%) were recorded: three cases with patent bypass, due to progressive infection or gangrene, three cases with thrombosis of the bypass, due to poor outflow, and two cases with ligation of the bypass due to bleeding from the distal anastomosis caused by serious infection. Two deaths (4.6%) were registered, both with patent bypass. Long-term follow-up showed patency of 58.1% and 39.5% at one and three years, nd rates of limb salvage of 55.8% and 46.5% in the same period.

CONCLUSIONS

We conclude that these revascularizations of the arteries of the foot are useful even in the presence of gangrene, because of the high rate of limb salvage.