The Role of Ankle Thromboembolectomy and Lytic Therapy in the Reversal of End Stage Foot Ischemia

Abstract

Over the past five years, 11 pa tients have presented with severe ischemic changes of the distalmost portion of the lower extremity or foot. In each instance, the patient was initially managed with a femoral or popliteal approach to restore circula tion more distally. However, the is chemic changes persisted and pro gressed. It was only by approaching the ischemic area in a more direct fashion, by exposing the posterior ti bial artery and the dorsalis pedis ar tery, that this foot ischemia could be reversed.

With ankle thromboembolec tomy, 8 of 11 patients had significant return of circulation to the involved foot or toes, allowing for partial or complete salvage of these limbs. In 10 of the 11 cases, a Fogarty balloon thromboembolectomy, vein patch an gioplasty, and heparin infusion were sufficient to restore the circulation. However, in 1 patient, local infusion of streptokinase into both rethrom bectomized inflow vessels was suc cessful in lysing the microcirculation of the forefoot and subsequently re versing the ischemia.

It was concluded from this series that an aggressive surgical approach to the pedal vessels is warranted in the proper setting and that additional evaluation of intraoperative throm bolytic maneuvers involving the microcirculation of the forefoot may improve foot salvage.