gms | German Medical Science

10th Munich Vascular Conference

01.-03.12.2021, online

Arterialization of the deep veins of the foot in patients thromboangiitis obliterans (TO) with arterio-venous fistula creation

Meeting Abstract

10th Munich Vascular Conference. sine loco [digital], 01.-03.12.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. Doc06

doi: 10.3205/21mac06, urn:nbn:de:0183-21mac069

Veröffentlicht: 22. Dezember 2021

© 2021 Puliaieva et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Background: Thromboangiitis obliterans (TO) is a non-atherosclerotic inflammatory disease of medium and small caliber arteries. The annual incidence is 0.5–5.6% in Europe with an increasing number of patients in the eastern regions of Europe.

Objective: To evaluate the necessity of creation of unloading arterio-venous fistula during deep veins arterialization in patients with TO.

Materials and methods: 13 patients with TO from 2019–2021 with chronic critical lower limb ischemia (stage 4 acc. to Fontaine) were examined. The mean age of the patients was 37±4.42 years. 11 patients: male (85%), 2 patients – female (15%). All patients had a long history of smoking more than 20 cigarettes a day. According to angiography (CT) all patients had various degrees of arterial bed lesions with absence of donor arteries on the foot, but also partial contrasting of one of the arteries on the tibia. Necrosis of the foot did not extend proximally to the heads of the metatarsal bones in all patients. In order to reduce the level of circulating immune complexes, the patients underwent courses of plasmapheresis. All patients underwent arterialization of the deep venous system using an autovein (unreversed vena saphena magna after valvulotomy with Le Maitre valvulotome) and creation of proximal anastomosis at the artery level with normal blood flow (9 (69%) femoral artery, 4 (31%) – popliteal artery. Distally there was end-to-side anastomosis created with the posterior tibial vein (PTV) at the level of the inner ankle (100%). The patients were divided into 2 groups (6 patients with fistula creation, 7 – without fistula) depending on whether the unloading side-to-side AV- fistula was created. PTV valves in the foot were preliminarily destructed with metal valvulotomes and cutting balloon. Arteriovenous fistula was formed in 5 cases at the level of distal anastomosis with posterior tibial artery in 4 cases and with fibular artery in one case, in one more case the fistula was formed in middle third of the tibia with PTA). Intraoperative angiography for evaluating quality of valvulotomy was performed. There were 1- and 3-months follow-ups.

Results: 9 patients from both groups had positive results – successful arterialization of the venous system, the venous shunt was patent in 1- and 3-months follow-ups, wound healing was observed, 4 patients undergone autodermoplasty. 3 patients (2 without AV fistula, 1 patient with AV fistula in m/3 of shin) had venous shunt thrombosis during the first 24 hours; attempts of revascularization were unsuccessful. Another patient without AV- fistula had shunt thrombosis at 1-month follow-up. At 3-month follow-up 100% AV fistulas were patent.

Conclusion: Creation of unloading aririo-venous fistula plays an important role when arterial blood flow is switched to the “unprepared” venous system and allows to save the patency of venous shunt until adaptation of the deep venous system.

Figure 1 [Fig. 1], Figure 2 [Fig. 2]