ischemia critica arti inferiori Terapia chirurgica open oggi•E domani? intern conference 18/19 May 2011 Hilton Hotel Giardini Naxos• Surgical Approaches to Chronic Limb Ischemia or critical

ischemia critica arti inferiori Terapia chirurgica open oggi•E domani? intern conference 18/19 May 2011 Hilton Hotel Giardini Naxos• Surgical Approaches to Chronic Limb Ischemia or critical limb ischemia(CLI)

• Although endovascular advances provide a new array of options in appropriately selected patients, surgical techniques also continue to see innovation


• h 9/17, presso Hilton Hotel Giardini Naxos intern Conference
su - Ischemia critica degli arti inferiori: Terapia chirurgica open oggi. E domani?

Dopo i saluti delle Autorità, il convegno introdotto dai prof. Francesco Spinelli, ordinario di Chirurgia vascolare c/o Università Messina, e Richard F. Neville, docente di Chirurgia e Direttore della Divisione di Chirurgia vascolare Washington, Dc, Usa.

• h 9 – 11 Moderatori: G. Bajardi, P. Castelli, V. Monaca

////// • Ischemia Critica del piede diabetico: ruolo della terapia chirurgica aperta e del trattamento endovascolare
A. Stella - Rivascolarizzazioni sopra il ginocchio
G. Melissano - Lettura: Protesi in ePTFE con superficie bioattiva PROPATEN versus vena nei baypass sottogenicolari
R. Neville - Vantaggi e Limiti della Classificazione della TASC II nelle lesioni Femoro-poplitee
J.B. Ricco - Lettura: come avviare un programma per il trattamento del piede diabetico

h 14.15 – 16.30 - Moderatori: F. Intrieri, A. Lomeo, P. Veroux, F. Stilo, G. De Caridi Sessione di casi clinici a proposta libera
1. P. Sangiuolo 2. K. Jones 3. P. Volpe 4. G. Battaglia 5. A. Scolaro 6. F. Talarico 7. G. Roscitano 8. G. Gagliardo

- il recente sviluppo della Chirurgia endovascolare ha aperto nuove prospettive nel trattamento dell’ischemia critica degli arti, ridimensionando il ruolo della chirurgia aperta.

- Tuttavia, lungi dall’essere definitivamente tramontato, il campo d’azione di quest’ultima si è limitato alle situazioni morbose più complesse, mentre la terapia endovascolare si è sempre di più imposta come trattamento di prima intenzione di ogni genere di lesione, anche se con risultati meno duraturi nel tempo.

- È lecito, quindi, interrogarsi sul futuro della chirurgia aperta e chiedersi se sia giusto continuare ad investire risorse per salvaguardare e migliorare le nostre conoscenze in quest’ambito dottrinale.

///////////// ENGLISH VERSION //////////

The treatment of critical limb ischemia (CLI) has changed dramatically because of the explosion of catheter-based interventions.

However, surgical bypass techniques continue to evolve in response to increasingly complex scenarios such as failed endovascular procedures, lack of conduit, and severe, extensive disease. Stimulated by these challenges, innovative approaches to surgical bypass continue to develop.

These innovations include advances in vein bypass, improved prosthetic graft performance, and better knowledge of procedure selection through choice of the proper target artery or choice of bypass, as opposed to endovascular revascularization.

///////////////////////// INNOVATIONS IN VEIN BYPASS ///////////////

The autogenous vein remains the ideal conduit for lower extremity bypass.

The greater saphenous vein results in durable reconstruction no matter which configuration is favored by the surgeon: in situ, reversed, or translocated.

However, lack of saphenous vein is becoming a common clinical scenario because of previous bypass, coronary surgery, thrombophlebitis, or poor vein quality.

As many as 30% of patients in need of bypass lack a suitable saphenous vein.

This number increases to 50% in patients requiring a secondary bypass procedure1 and has led to innovative approaches to alternate autogenous conduit.

Alternative autogenous conduits include the lesser saphenous vein, arm vein, composite veins, umbilical vein, and cryopreserved vein.

These alternative conduits can result in acceptable, although not equivalent, results. Because arm and lesser saphenous segments may not be long enough to reach a distal tibial artery, composite vein configurations can be fashioned from several segments in order to achieve adequate length for the bypass.2,3 Cryopreserved vein and human umbilical vein are other alternative conduits that are biologic in their properties and, therefore, have an intrinsic appeal for distal reconstruction.

However, these conduits have shown limited success when used for tibial bypass.4,5

This limited success arises from the need to splice vein segments together for adequate length and the poor quality of secondary venous conduit.

The use of cryopreserved vein should be limited to bypasses that must traverse infected fields in the absence of other autogenous conduits.6

The initial use of human umbilical vein grafts was impeded by aneurysmal degeneration of the graft material. This complication has been addressed in recent modifications of the graft design.

• Arm vein and lesser saphenous segments remain the best alternative choice for autogenous reconstructions when saphenous vein is not available.

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TAGS: aneurysmal degeneration, Francesco Spinelli, Sicilydistrict, Richard F. Neville Chirurgia vascolare Washington, endovascular procedures

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