Arteriovenous fistula in arterial reconstruction of the ischemic limb
D. B. Hinshaw, C. A. Schmidt, D. B. Hinshaw and J. B. Simpson
The high flow associated with an arteriovenous fistula has been shown to
help maintain patency in small arterial anastomoses. In 37 male patients we
created common ostium arteriovenous fistula at the distal tibial or
peroneal anastomosis as a part of their arterial reconstruction for
threatened limb loss. Limb salvage was achieved in 28. Successful
amputations at a lower level than would have been anticipated were
performed in three. There was early graft failure in four patients
resulting in below-the-knee amputations. This operative approach may be
helpful in patients who have had previous revascularization procedures that
have failed, who resist the idea of amputation, and who fulfill the
angiographic criteria of extremely poor runoff with an absent or deficient
pedal arch.
