Revascularization of the Ischemic Canine Hindlimb by Arteriovenous Reversal

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Arteriovenous reversal (AVR) for revascularization of ischemic tissues has previously failed to meet theoretical, experimental, and clinical expectations despite recurrent trials. The efficacy of a new staged approach to AVR was tested against a canine ischemic limb preparation in which global ligation of ipsilateral collaterals inevitably led to limb gangrene. In 12 animals the complications of direct, single-stage end-to-end femoral AVR, inevitably accompanied by the development of extreme edema, were demonstrated. However, when the ischemic preparation was accompanied by a staged AVR, in which an initial end-artery-to-side-vein arteriovenous fistula was converted 1 week later to AVR by ligation of the central venous limb, 20 of 20 animals survived, and 19 of 20 were ambulatory long-term survivors with only mild edema. Serial angiograms at 1 week, 1 month, and 4 months demonstrated patency rates of 100, 84, and 63%, respectively. Histologic examination of animals electively killed from 4 to 24 months showed normal skeletal muscle histology, venous intimal thickening, and mild edema. In the acutely ischemic canine hind limb, a staged AVR can provide both viability and function with only mild edema formation.

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