Free tissue transfer after targeted endovascular reperfusion for complex lower extremity reconstruction: setting the stage for success in the presence of mutlivessel disease.
Free tissue transfer after targeted endovascular reperfusion for complex lower extremity reconstruction: setting the stage for success in the presence of mutlivessel disease.
- 2015
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
Recent advances in both microsurgical and endovascular techniques have redefined our approach to complex lower extremity reconstruction in high-risk patients with multivessel disease. When used as an adjunct to free tissue transfer, targeted endovascular therapy has been suggested to optimize recipient-site hemodynamics and promote flap survival in regions of compromised distal blood flow. With a paucity of published outcomes to support this approach, however, the perceived benefits derived from adjunctive endovascular therapy remain largely anecdotal. In this report, we present the outcomes and complications for 3 patients in whom preoperative endovascular therapy was used to improve both direct and collateral distal perfusion and recipient-vessel caliber. Flap survival in this series was 100%, and all patients remained ambulatory at a mean final follow-up of 24.7 months. Minor flap necrosis, necessitating debridement and skin grafting, was seen in one patient, who ultimately required a contralateral below-knee amputation secondary to nonsalvageable arterial disease. All patients were satisfied with respect to pain, function, and cosmetic appearance. On the basis of our experience and previously reported cases, we advocate a role for prereconstructive endovascular therapy as part of a multidisciplinary approach to functional limb salvage in patients with advanced arterial disease.Copyright © 2015 Elsevier Inc. All rights reserved.
English
0890-5096
*Angioplasty, Balloon
*Free Tissue Flaps
*Lower Extremity/bs [Blood Supply]
*Peripheral Arterial Disease/th [Therapy]
Aged
Amputation
Angiography, Digital Subtraction
Collateral Circulation
Combined Modality Therapy
Humans
Limb Salvage
Male
Middle Aged
Peripheral Arterial Disease/di [Diagnosis]
Peripheral Arterial Disease/pp [Physiopathology]
Peripheral Arterial Disease/su [Surgery]
Reconstructive Surgical Procedures
Regional Blood Flow
Reoperation
Time Factors
Treatment Outcome
Vascular Patency
MedStar Washington Hospital Center
Surgery/Vascular Surgery
Case Reports
Journal Article
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
Recent advances in both microsurgical and endovascular techniques have redefined our approach to complex lower extremity reconstruction in high-risk patients with multivessel disease. When used as an adjunct to free tissue transfer, targeted endovascular therapy has been suggested to optimize recipient-site hemodynamics and promote flap survival in regions of compromised distal blood flow. With a paucity of published outcomes to support this approach, however, the perceived benefits derived from adjunctive endovascular therapy remain largely anecdotal. In this report, we present the outcomes and complications for 3 patients in whom preoperative endovascular therapy was used to improve both direct and collateral distal perfusion and recipient-vessel caliber. Flap survival in this series was 100%, and all patients remained ambulatory at a mean final follow-up of 24.7 months. Minor flap necrosis, necessitating debridement and skin grafting, was seen in one patient, who ultimately required a contralateral below-knee amputation secondary to nonsalvageable arterial disease. All patients were satisfied with respect to pain, function, and cosmetic appearance. On the basis of our experience and previously reported cases, we advocate a role for prereconstructive endovascular therapy as part of a multidisciplinary approach to functional limb salvage in patients with advanced arterial disease.Copyright © 2015 Elsevier Inc. All rights reserved.
English
0890-5096
*Angioplasty, Balloon
*Free Tissue Flaps
*Lower Extremity/bs [Blood Supply]
*Peripheral Arterial Disease/th [Therapy]
Aged
Amputation
Angiography, Digital Subtraction
Collateral Circulation
Combined Modality Therapy
Humans
Limb Salvage
Male
Middle Aged
Peripheral Arterial Disease/di [Diagnosis]
Peripheral Arterial Disease/pp [Physiopathology]
Peripheral Arterial Disease/su [Surgery]
Reconstructive Surgical Procedures
Regional Blood Flow
Reoperation
Time Factors
Treatment Outcome
Vascular Patency
MedStar Washington Hospital Center
Surgery/Vascular Surgery
Case Reports
Journal Article