Twenty-one femoro-crural bypass procedures with a distal arteriovenous fistula (dAVF)
were constructed in 20 patients with severe leg ischemia (Fontaine stage III, IV).
They were followed-up for 3 to 22 months, with a mean of 8 months. The 15 patients
with patent grafts and fistulas no longer had pain at rest; ischemic necroses healed.
Telethermography showed a considerable augmentation of the distal limb perfusion.
The mean increase of the transcutaneous oxygen pressure was 30 mmHg. One early postoperative
amputation was necessary due to graft infection. Another patient lost her leg because
of bypass occlusion 9 months after arterial reconstruction. Four patients with late
graft occlusion kept their regained mobility and alleviation. Our data confirm experimental
results suggesting that femoro-crural bypass with a dAVF improves distal leg perfusion
by reversal venous blood flow and Stimulation of a collateral network. Femoro-crural
bypass with a dAVF may be of benefit in selected cases when only one crural artery
is patent and pedal arch vessels are absent.
Arteriovenous fistula - Leg ischemia - Venous blood flow - Crural arterial reconstruction
