Temporary counter-current arterialization of the diabetic foot.

Aims of this study. First it has to be underlined that the word“arterialization” used in the context of arevascularization implies that it is fulfilled in a counter-current way,by means of veins. The aim of this study is to prove that the arterializationof the diabetic foot is an efficient and durable method,even if the bypass has only been temporarily functional.Patients and Methods. From January 2001 to August 2005 wehave revascularized 39 diabetic patients, one of them bilateral.There were 29 men and 10 women. Their mean age was 71 years(range: 53-87). There were 36 stage IV patients and 3 stage IIIpatients. Thirty non insulinodependant diabetes type 2, and 9 type 1(OMS).The arterialization of the foot has been performed using a venousbypass generally placed reversed between a functional artery upstream(femoral or popliteal) and a vein of the foot downstream,giving the preference to the medial marginal vein, anastomosing itdistally in a termino-lateral way, modifiying the implantation of thegraft by means of a long phlebotomy of about 40 mm (extremes 30-50 mm) and destruction of the valves of the venous axis of the foot.Results. We have only retained the failures and the successes. Fromamong 39 arterialized diabetics, one died on day 18 of myocardialinfarction with patent by-pass; he has not been included.Among the 39 limbs in the 38 remaining patients, 8 have been immediatefailures and have been amputated, 6 of them at the thighand 2 at the leg. The others 31 patients have been successes (79%):7 of them at short term (between 1 and 12 months) and 24 at mediumterm (between 1 and 5 years).In the short term group, 2 diedof myocardial infarction with their bypass occluded. Two othershad their bypass patent only 2 and 3 months respectively and the 3remaining are still alive with a patent bypass.The 24 patients of the medium term group have been followedduring an average of 25 months. One patient died of renal failure 12months after surgery with his bypass occluded. The 23 remainingpatients are still alive. There were 21 thrombosis of the graft inapproximately 10 months (total: 22 thrombosis = 91%) with preservationof the benefits of the operation. The last two patients havetheir bypass patent.The most frequent complication, during the first 30 days, was earlythrombosis, especially during the first week after operation. We had11 early thromboses, 8 of them were failures in spite of repeatedoperations and 3 partial thrombosis of the distal anastomosis whichwere left in observation in order not to hinder the functioning of thebypass. There were 8 cutaneous necroses and 1 necrotic pain syndrome. There was no cardiac overloading, nor varicose veins up tothis date.Conclusion. Arterialization of the ischemic foot in diabetic patientsis an efficient and durable operation in medium term successes,even if the bypass has only been temporarily functional.