Multiple Vessel Recanalization Results in High Limb Salvage Rate

A new surgical approach, which involves arterial and venous recanalization prior to addressing diabetic ulcers in patients with critical limb ischemia, has reported a salvage rate better than 97%.

Researchers from the Policlinico Abano Terme (Vicenza, Italy) reported the results of multiple-vessel recanalization technique in 1,019 diabetic patients with critical limb ischemia, treated between January 2007 and September 2010. The surgical technique involves a pedal-plantar loop technique, which uses two wires to improve and maintain outflow in the wound-related arteries, and to rescue patients who have failed on other treatments. The patients were followed for a mean of 9.7 years.

The results showed that limb salvage was 97.2%, and ambulatory function was restored in 78% of patients. Unplanned major amputations occurred in 2.5% of patients, and planned minor amputations (below the ankle) were performed in 32.3%. In all, 319 patients were completely revascularized and 207 were partially revascularized. The complete or partial success rate was 51.6%, with the failures to revascularize attributed to a number of technical limitations of the technique, including severe calcifications and anatomic variations that made treatment challenging. The study was presented at the 37th annual VEITH Symposium, held during November 2010 in New York (NY, USA).

"The old concept was to recanalize one vessel. Now we know that is not enough. We need to revascularize at least two or three vessels and, when possible, the foot arteries for inflow to the limb and outflow to the foot,” said lead author and study presenter Marco Manzi, MD. "You need to identify the wound-related artery and treat that vessel first. This will give you a shorter recovery time and is the best surgical treatment.”

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Policlinico Abano Terme