Free tissue transfer after targeted endovascular reperfusion for complex lower extremity reconstruction: setting the stage for success in the presence of mutlivessel disease.
Citation: Annals of Vascular Surgery. 29(6):1316.e7-1316.e15, 2015 Aug.PMID: 26028463Institution: MedStar Washington Hospital CenterDepartment: Surgery/Vascular SurgeryForm of publication: Journal ArticleMedline article type(s): Case Reports | Journal ArticleSubject headings: *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 PatencyYear: 2015Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:- 0890-5096
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 26028463 | Available | 26028463 |
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.
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