Abstract

Introduction

Materials & Methods

Results

Discussion & Conclusion

References

Discussion
Board

Results were categorized under two heads; early and late.

Early results: In all patients, rest pain disappeared around three days and the colour of the skin had improved with good venous return.

preop presentation.

one week postop, return of venous refill from 3rd day.

healing pattern after two weeks.

postop three weeks.

Late results were judged by the following criteria:

1.Combination of complete absence of rest pain, healed ulcers, absence of any devascularised area and adequate domestic and occupational ambulation without claudication was graded as excellent. This was noted in eleven (eight TAO and three Raynaud’s), out of thirty-six cases.

2. Absence of res t pain, some claudication but which allowed normal domestic and occupational ambulation was graded as good. This was noted in sixteen (eleven TAO, three atherosclerotic, one diabetic, one Raynaud’s) out of thirty-six cases.

3.Recurrence or unhealed ulcers, delayed healing, and inability to resume previous occupation but relief from rest pain was graded as fair. This was noted in four (one TAO, one atherosclerotic, two Raynaud’s) out of thirty-six cases.

4.The result was graded as poor when a major proximal amputation could not be avoided. This was noted in five (two TAO, one atherosclerotic, two Diabetic) out of thirty-six cases.

5.One patient died of myocardial infarction three weeks after surgery.

6.Other complications were minimal. [Two fracture tibia, two minor infections].

Longest follow up is six years and shortest is six months.

Objective measurement of the circulation of the limb was assessed before and after procedure. Clinically there was change of colour of t ips of cyanosed toes/fingers and sole/palm to pink, return of warmth as compared to the other limbs, appearence of venous circulation with good venous refill.Total relief from rest pain was observed around three days. Please note that this duration is not at all sufficient for the symptomatic relief only due to cessation of smoking.

Since soft tissues take six weeks for maturation, a comparison of preoperative and seven weeks postoperative, digital subtraction angiography was done. It showed a remarkable increase in the number of collaterals along the line of operation and a much better visualization of peripheral vessels, though the level of occlusion remained the same.

preoperative DSA at right leg showing occlusion of right anteror tibial, and thin posterior tibial artery.

seven weeks postop DSA shows site for the vascular block remains the same but w ith remarkable increase in collaterals , better enhancement of vessels. Please note absence of distraction of corticotomy fragment.

Distal runoff was also improved .

preoperative DSA at right ankle.

seven-week postop DSA showing improved distal run-off.

We realize that pulse wave changes could have occurred only if original vascular block would have dealt i.e. in angioplasty or vascular bypass. During this procedure, there was no alteration at the site of vascular block, but only addition of vascular leash. So there was no change in ankle systolic pressure [by doppler] which was measured repeatedly for six months postoperatively. Probably for the similar reasons, pulse-wave-dependent oxymetry also did not show prognostic changes. None the less this vascular leash had increased local tissue oxygenation.

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