Discussion and Conclusion
The aim of surgery for peripheral vascular disease is to increase tissue perfusion and consequently tissue oxygenation. This helps to reverse the adverse changes caused by ischemia and therefore relieves the rest pain or claudication and improves the condition of pre existing ulcers. . The site of vascular occlusion in these cases is usually multiple and therefore site specific bypass operations are unlikely to be of help. In addition the distal runoff is often quite poor and therefore bypass fails to bring in the desired improvement in vascularity in the distal most part which bears the brunt of the effect of the disease. .
Inflammation of any origin is known to cause a series of definite responses i.e. hyperemia through arterioles, capillaries and venules, which consistently double the blood supply at the site of inflammation. [10.11,12]. The method described in this paper attempts to use the natural inflammatory mechanisms to create a vascular leash in the affected area.
The major muscle bulk of the leg corresponds to the upper three fifth of the tibia and its neurovascular bundles are situated on either side of the interosseus membrane. The present method seeks to induce surgically controlled inflammation at the site in order to develop a new vascular leash in the most critical area.
The two steps described viz.:
1] Periosteal elevation, [1,2]
are known to induce an inflammatory response, which in turn stimulates angiogenesis and leads to neovascularisation. This phenomena or principle was used in the past to stimulate epiphysial growth. The inflammatory response achieved by this technique probably persists longer in limbs with peripheral vascular disease because the local vessels are blocked; in contrast to the normal limbs where the inflammation is withdrawn in the presence of normal vessels. Besides, demands of these tissues go on increasing as the patient enlarges his activity from lying down (in rest pain) to walking, providing a stimulus for the channels to remain open. Our long-term clinical results as well as the DSA studies before and after the operation quite clearly showed the persistence of a new vascular network.
We wonder whether interruption of periosteal pain-fibers also have contributory result in stopping rest pain postoperatively. Therefore this technique may provide an interesting and useful alternative to treat limbs with extensive vascular disease.
This procedure based on dependable biological principle of inflammation, seems to be effective in increasing circulation in the ischemic limbs.
Report of thirty-six cases of arterio occlusive disease in the limbs that benefited by extensive periosteal stripping and corticotomy, is presented.
I wish to give sincere thanks to Dr. Ravin Thatte, Dr. Mukund Thatte, Dr. Mangal Parihar, and Dr. Mrinalini Kelkar for their help in the preparation of the manuscript.
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|Kelkar Bharat, M.S.; (1998). Vascularisation of Ischemic Limbs in Severe Occlusive Arterial Diseases, a New Concept and an Easy Technique. Presented at INABIS '98 - 5th Internet World Congress on Biomedical Sciences at McMaster University, Canada, Dec 7-16th. Available at URL http://www.mcmaster.ca/inabis98/|
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