{"id":13,"date":"2020-04-16T09:50:34","date_gmt":"2020-04-16T12:50:34","guid":{"rendered":"http:\/\/www2.uepg.br\/arterializacao\/?page_id=13"},"modified":"2020-04-22T14:41:07","modified_gmt":"2020-04-22T17:41:07","slug":"a-pesquisa","status":"publish","type":"page","link":"https:\/\/www2.uepg.br\/arterializacao\/a-pesquisa\/","title":{"rendered":"A Pesquisa"},"content":{"rendered":"<div id=\"pl-13\"  class=\"panel-layout\" ><div id=\"pg-13-0\"  class=\"panel-grid panel-no-style\" ><div id=\"pgc-13-0-0\"  class=\"panel-grid-cell\" ><div id=\"panel-13-0-0-0\" class=\"so-panel widget widget_sow-accordion panel-first-child panel-last-child\" data-index=\"0\" ><div\n\t\t\t\n\t\t\tclass=\"so-widget-sow-accordion so-widget-sow-accordion-default-a9f16f41d4be-13\"\n\t\t\t\n\t\t><div>\n\t<div class=\"sow-accordion\">\n\t\t\t<div class=\"sow-accordion-panel\"\n\t\t\t data-anchor=\"01-introdu%c3%a7%c3%a3o\">\n\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-01-introdu%c3%a7%c3%a3o\" aria-controls=\"accordion-content-01-introdu%c3%a7%c3%a3o\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t01 - INTRODU\u00c7\u00c3O\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-01-introdu%c3%a7%c3%a3o\"\n\t\t\t\tid=\"accordion-content-01-introdu%c3%a7%c3%a3o\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\" tabindex=\"0\">\n\t\t\t\t\t<p>Com o avan\u00e7o das t\u00e9cnicas endovasculares, angiogr\u00e1ficas e da microcirurgia tem sido poss\u00edvel a realiza\u00e7\u00e3o de procedimentos em art\u00e9rias de pequeno calibre ao n\u00edvel do tornozelo e do p\u00e9. No entanto, tais t\u00e9cnicas exigem a presen\u00e7a de leito arterial distal que est\u00e1 ausente em muito pacientes o que os leva a uma amputa\u00e7\u00e3o do membro por falta de recursos terap\u00eauticos convencionais.\u00a0 A revasculariza\u00e7\u00e3o retr\u00f3grada \u00e9 uma t\u00e9cnica presente na literatura mundial recente que possibilita salvar membros, com insufici\u00eancia arterial sem leito distal. No Brasil a t\u00e9cnica \u00e9 pouco conhecida e n\u00e3o tem sido praticada com frequ\u00eancia. Existem poucas publica\u00e7\u00f5es nacionais sobre o tema. Este site disponibiliza a bibliografia, t\u00e9cnicas cir\u00fargicas e principalmente pequenos detalhes indispens\u00e1veis para o sucesso do procedimento.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Paciente com tromboangeite obliterante submetido a arterializa\u00e7\u00e3o venosa e amputa\u00e7\u00e3o de dedo<\/strong><\/p>\n<p><div id=\"attachment_16\" style=\"width: 160px\" class=\"wp-caption alignleft\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/intro1-150x150-1.png\"><img aria-describedby=\"caption-attachment-16\" class=\"wp-image-16 size-full\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/intro1-150x150-1.png\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><p id=\"caption-attachment-16\" class=\"wp-caption-text\">Antes<\/p><\/div><\/p>\n<p><div id=\"attachment_17\" style=\"width: 160px\" class=\"wp-caption alignleft\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/intro2-150x150-1.png\"><img aria-describedby=\"caption-attachment-17\" class=\"wp-image-17 size-full\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/intro2-150x150-1.png\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><p id=\"caption-attachment-17\" class=\"wp-caption-text\">Depois<\/p><\/div><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>A aterosclerose obliterante, especialmente aquela acompanhada de diabetes melitus; a tromboangeite obliterante na maioria absoluta dos seus casos; e o aneurisma\u00a0 de art\u00e9ria popl\u00edtea com trombose do leito distal s\u00e3o condi\u00e7\u00f5es em que encontramos pacientes em isquemia cr\u00edtica sem leito arterial distal. Nesta situa\u00e7\u00e3o, a \u00fanica maneira de irrigar o membro isqu\u00eamico \u00e9 derivar o fluxo arterial atrav\u00e9s do sistema venoso, com a finalidade de atingir a micro-circula\u00e7\u00e3o de maneira retr\u00f3grada.<\/p>\n<p>As primeiras tentativas de f\u00edstulas arteriovenosas terap\u00eauticas datam do inicio do s\u00e9culo passado. Realizadas na parte proximal dos membros inferiores n\u00e3o obtiveram resultados favor\u00e1veis. A partir da d\u00e9cada de 70, com os trabalhos pioneiros de Lengua (1975), as f\u00edstulas passaram a ser estendidas at\u00e9 o p\u00e9, e os bons resultados apareceram em v\u00e1rias publica\u00e7\u00f5es.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Refer\u00eancias:<\/strong><\/p>\n<ul>\n<li>Pomposelli FB, Jepsen SJ, Gibbon GW, Campbell DR, Logerfo FW. Efficacy of the dorsal pedal bypass for limb salvage in diabetic patients: Short term observations; J Vasc Surg 1990; 111:745-52.<\/li>\n<li>Campbell WB, Verfaille P, Ridler BM, Thomson JF. Non operative treatment of advanced limb ischaemia: the division for palliative care. Eur J Vasc Endovasc Surg 2000; 19: 246-49.<\/li>\n<li>Lengua F. Technique d\u2019art\u00e9rialisation du r\u00e9seau veineux du pied. Press Med 1975; 4:1039-42.<\/li>\n<\/ul>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\"\n\t\t\t data-anchor=\"02-%e2%80%93-revis%c3%a3o-da-drenagem-venosa-do-membro-inferior\">\n\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-02-%e2%80%93-revis%c3%a3o-da-drenagem-venosa-do-membro-inferior\" aria-controls=\"accordion-content-02-%e2%80%93-revis%c3%a3o-da-drenagem-venosa-do-membro-inferior\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t02 \u2013 REVIS\u00c3O DA DRENAGEM VENOSA DO MEMBRO INFERIOR\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-02-%e2%80%93-revis%c3%a3o-da-drenagem-venosa-do-membro-inferior\"\n\t\t\t\tid=\"accordion-content-02-%e2%80%93-revis%c3%a3o-da-drenagem-venosa-do-membro-inferior\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\" tabindex=\"0\">\n\t\t\t\t\t<p>O membro inferior possui sistema venoso superficial e profundo. As veias superficiais situadas no tecido subcut\u00e2neo s\u00e3o facilmente acess\u00edveis e se prestam para confec\u00e7\u00e3o de enxertos e deriva\u00e7\u00f5es arteriais. As veias profundas situadas sob a f\u00e1scia muscular acompanham as grandes art\u00e9rias. A drenagem venosa do membro \u00e9 realizada principalmente por esse sistema. Sua perviedade \u00e9 condi\u00e7\u00e3o imprescind\u00edvel para o sucesso da arterializa\u00e7\u00e3o venosa.<\/p>\n<p><div id=\"attachment_20\" style=\"width: 210px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/vista.jpg\"><img aria-describedby=\"caption-attachment-20\" class=\"size-medium wp-image-20\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/vista-200x300.jpg\" alt=\"\" width=\"200\" height=\"300\" \/><\/a><p id=\"caption-attachment-20\" class=\"wp-caption-text\">Sistema venoso superficial<\/p><\/div><\/p>\n<p>&nbsp;<\/p>\n<div class=\"page-head\">\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"col-12\">\n<h5>ANATOMIA DO SISTEMA VENOSO DO MEMBRO INFERIOR<\/h5>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"container\">\n<div class=\"row\">\n<div id=\"primary\" class=\"content-area col-sm-12\"><main id=\"main\" class=\"site-main\" role=\"main\">\n<article id=\"post-172\" class=\"post-172 page type-page status-publish hentry\">\n<div class=\"entry-content\">\n<div class=\"at-above-post-page addthis_tool\" data-url=\"https:\/\/www3.uepg.br\/arterializacao\/anatomia-do-sistema-venoso-do-membro-inferior\/\"><\/div>\n<p>A rede venosa do p\u00e9 est\u00e1 disposta em quatro planos:<\/p>\n<p><strong>Superficial dorsal (1\u00ba plano):<\/strong> Formado pelo arco venoso que se origina da veia marginal externa (lateral). Recebe a drenagem venosa de quatro veias metatarsianas em sua margem convexa e dois ou tr\u00eas ramos na margem c\u00f4ncava fazendo continuidade com a veia marginal interna (medial) e a safena magna. O arco dorsal por ser duplo em 1\/3 dos casos quando a parte medial recebe a drenagem da primeira e segunda metatarsiana.<\/p>\n<div id=\"attachment_36\" class=\"wp-caption alignnone\">\n<p><div id=\"attachment_21\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/insuvencro.jpg\"><img aria-describedby=\"caption-attachment-21\" class=\"size-medium wp-image-21\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/insuvencro-300x275.jpg\" alt=\"\" width=\"300\" height=\"275\" \/><\/a><p id=\"caption-attachment-21\" class=\"wp-caption-text\">http:\/\/www.misodor.com\/INSUVENCRO.html<\/p><\/div><\/p>\n<p>&nbsp;<\/p>\n<p><div id=\"attachment_22\" style=\"width: 210px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/vista-1.jpg\"><img aria-describedby=\"caption-attachment-22\" class=\"size-medium wp-image-22\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/vista-1-200x300.jpg\" alt=\"\" width=\"200\" height=\"300\" \/><\/a><p id=\"caption-attachment-22\" class=\"wp-caption-text\">Fonte: MOORE, K.L. Anatomia Orientada para a Cl\u00ednica. 5\u00aa edi\u00e7\u00e3o. Rio de Janeiro: Guanabara Koogan, 2007.<\/p><\/div><\/p>\n<\/div>\n<div id=\"attachment_40\" class=\"wp-caption alignnone\">\n<p class=\"wp-caption-text\">\n<\/p><\/div>\n<p><strong>Trajeto da veia safena magna:\u00a0<\/strong>A veia dorsal do h\u00e1lux + arco venoso dorsal drenam para a veia safena magna que ascende anterior ao mal\u00e9olo medial, segue posterior ao c\u00f4ndilo medial do f\u00eamur, atravessa o hiato safeno e drena para a veia femoral.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Profundo dorsal (2\u00ba plano) e plantar (4\u00ba plano):\u00a0<\/strong>Acompanham as art\u00e9rias digitais e metatarsianas que se comunicam respectivamente com as veias tibiais anteriores e posteriores. S\u00e3o duas veias para cada art\u00e9ria.<\/p>\n<div id=\"attachment_35\" class=\"wp-caption alignnone\">\n<p><div id=\"attachment_23\" style=\"width: 232px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/anatomia.jpg\"><img aria-describedby=\"caption-attachment-23\" class=\"size-medium wp-image-23\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/anatomia-222x300.jpg\" alt=\"\" width=\"222\" height=\"300\" \/><\/a><p id=\"caption-attachment-23\" class=\"wp-caption-text\">Fonte: MOORE, K.L. Anatomia Orientada para a Cl\u00ednica. 5\u00aa edi\u00e7\u00e3o. Rio de Janeiro: Guanabara Koogan, 2007.<\/p><\/div><\/p>\n<p class=\"wp-caption-text\">\n<\/p><\/div>\n<div id=\"attachment_37\" class=\"wp-caption alignnone\">\n<p><div id=\"attachment_24\" style=\"width: 186px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/orientada.jpg\"><img aria-describedby=\"caption-attachment-24\" class=\"size-medium wp-image-24\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/orientada-176x300.jpg\" alt=\"\" width=\"176\" height=\"300\" \/><\/a><p id=\"caption-attachment-24\" class=\"wp-caption-text\">Fonte: MOORE, K.L. Anatomia Orientada para a Cl\u00ednica. 5\u00aa edi\u00e7\u00e3o. Rio de Janeiro: Guanabara Koogan, 2007.<\/p><\/div><\/p>\n<p class=\"wp-caption-text\">\n<\/p><\/div>\n<div id=\"attachment_39\" class=\"wp-caption alignnone\">\n<p><div id=\"attachment_25\" style=\"width: 148px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/vista-posterior.jpg\"><img aria-describedby=\"caption-attachment-25\" class=\"wp-image-25 size-medium\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/vista-posterior-138x300.jpg\" alt=\"\" width=\"138\" height=\"300\" \/><\/a><p id=\"caption-attachment-25\" class=\"wp-caption-text\">Fonte: MOORE, K.L. Anatomia Orientada para a Cl\u00ednica. 5\u00aa edi\u00e7\u00e3o. Rio de Janeiro: Guanabara Koogan, 2007.<\/p><\/div><\/p>\n<p class=\"wp-caption-text\">\n<\/p><\/div>\n<p><strong>Superficial plantar (4\u00ba plano):\u00a0<\/strong>Desembocam na arcada venosa plantar que comunica-se com a safena externa (parva).<\/p>\n<p>Trajeto da safena externa (parva): A veia dorsal do 5\u00ba dedo + o\u00a0 arco venoso plantar desembocam na safena extena (parva) na face lateral do p\u00e9, acende posteriormente ao mal\u00e9olo lateral como continua\u00e7\u00e3o da veia marginal lateral, percorre a margem lateral do tend\u00e3o calc\u00e2neo, inclina-se para a linha mediana da f\u00edbula e penetra na f\u00e1scia muscular, ascende entre as cabe\u00e7as do m\u00fasculo gastrocn\u00eamio na face posterior do mal\u00e9olo lateral e drena para a veia popl\u00edtea.<\/p>\n<div id=\"attachment_38\" class=\"wp-caption alignnone\">\n<p><div id=\"attachment_26\" style=\"width: 185px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/veia-safena.jpg\"><img aria-describedby=\"caption-attachment-26\" class=\"size-medium wp-image-26\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/veia-safena-175x300.jpg\" alt=\"\" width=\"175\" height=\"300\" \/><\/a><p id=\"caption-attachment-26\" class=\"wp-caption-text\">Fonte: MOORE, K.L. Anatomia Orientada para a Cl\u00ednica. 5\u00aa edi\u00e7\u00e3o. Rio de Janeiro: Guanabara Koogan, 2007.<\/p><\/div><\/p>\n<p class=\"wp-caption-text\">\n<\/p><\/div>\n<p><strong>Veias perfurantes:<\/strong>\u00a0Veias que comunicam o sistema venoso superficial com o sistema venoso profundo. Fazem o fluxo do sentido superficial para o profundo.<\/p>\n<p>Sherman (1949) descreveu 8 veias perfurantes na parte medial do p\u00e9 e 7 na lateral.<\/p>\n<p>Lofgren (1968) injetou press\u00e3o em veias perfurantes do arco venoso dorsal (entre o 1\u00ba e o 2\u00ba metatarsiano) e notou enchimento das veias superficiais da por\u00e7\u00e3o pr\u00f3xima, dissecou 10 extremidades amputadas encontrou 6-12 perfurantes sendo que em m\u00e9dia 9 comunicavam o sistema profundo com o superficial. De 94 perfurantes dissecadas, 49 n\u00e3o tinha v\u00e1lvulas, permitindo o fluxo venosos em ambas as dire\u00e7\u00f5es, 41 tinham uma v\u00e1lvula pr\u00f3xima ao sistema superficial e 4 tinham uma segunda v\u00e1lvula.<\/p>\n<p>Outros estudos v\u00eam comprovando essa teoria de que as veias perfurantes do p\u00e9 permitem o duplo sentido de fluxo, a perfurante de maior import\u00e2ncia \u00e9 a do 1\u00ba espa\u00e7o interdigital que mede aproximadamente 3 mm, chamada tamb\u00e9m de perfurante 6, que desemboca em 90% dos casos no arco venoso dorsal e algumas vezes na 1\u00aa metatarsiana dorsal, sendo avalvulada em 93% dos casos (Lengua, 1988; Garrido, 2002).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Refer\u00eancias:<\/strong><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>MOORE, K.L. Anatomia Orientada para a Cl\u00ednica. 5\u00aa edi\u00e7\u00e3o. Rio de Janeiro: Guanabara Koogan, 2007.<\/li>\n<li>Lengua F, Herrera JJ, Florsch CL. Etude des veines du pied par phl\u00e9bographie \u00e0 contrecouraant. J. Mal Vasc. (Paris) 1988; 13:344-350.<\/li>\n<li>Garrido MB. Anatomia m\u00e9dico cir\u00fargica do sistema venoso dos membros inferiores. In: Maffei FHA. Doen\u00e7as vasculares perif\u00e9ricas. 3\u00aa ed. Rio de Janeiro: Medsi; 2002. vol.1, p. 133-67.<\/li>\n<li>\u00a0Lofgren EP, Myers TT, Lofgren KA, Kuster G. The venous valves of the foot and ankle. Surg Gynecol Obstet. 1968;8: 289-90.<\/li>\n<\/ul>\n<\/div>\n<\/article>\n<p><\/p><\/main><\/div>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\"\n\t\t\t data-anchor=\"03-%e2%80%93-revis%c3%a3o-da-anatomia-arterial-do-membro-inferior\">\n\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-03-%e2%80%93-revis%c3%a3o-da-anatomia-arterial-do-membro-inferior\" aria-controls=\"accordion-content-03-%e2%80%93-revis%c3%a3o-da-anatomia-arterial-do-membro-inferior\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t03 \u2013 REVIS\u00c3O DA ANATOMIA ARTERIAL DO MEMBRO INFERIOR\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-03-%e2%80%93-revis%c3%a3o-da-anatomia-arterial-do-membro-inferior\"\n\t\t\t\tid=\"accordion-content-03-%e2%80%93-revis%c3%a3o-da-anatomia-arterial-do-membro-inferior\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\" tabindex=\"0\">\n\t\t\t\t\t<p>Algumas doen\u00e7as como a diabetes melitus, tromboangeite obliterante e aneurisma de art\u00e9ria popl\u00edtea com trombose extensa levam a oclus\u00e3o arterial distal com comprometimento do leito vascular. A art\u00e9ria mais distal que apresente fluxo normal deve ser escolhida para a deriva\u00e7\u00e3o venosa.<\/p>\n<p><div id=\"attachment_29\" style=\"width: 234px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/terceira.jpg\"><img aria-describedby=\"caption-attachment-29\" class=\"wp-image-29 size-medium\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/terceira-224x300.jpg\" alt=\"\" width=\"224\" height=\"300\" \/><\/a><p id=\"caption-attachment-29\" class=\"wp-caption-text\">Art\u00e9rias do dorso do p\u00e9<\/p><\/div><\/p>\n<div class=\"page-head\">\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"col-12\">\n<h3><\/h3>\n<h5>ANATOMIA ARTERIAL DA PERNA E DO P\u00c9<\/h5>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"container\">\n<div class=\"row\">\n<div id=\"primary\" class=\"content-area col-sm-12\"><main id=\"main\" class=\"site-main\" role=\"main\">\n<article id=\"post-175\" class=\"post-175 page type-page status-publish hentry\">\n<div class=\"entry-content\">\n<p>A art\u00e9ria popl\u00edtea ap\u00f3s percorrer o hiato dos adutores em sua regi\u00e3o \u00ednfero-lateral ramifica-se:<\/p>\n<p><strong>Art\u00e9ria tibial anterior:<\/strong>\u00a0Atravessa a membrana inter\u00f3ssea entre o m\u00fasculo tibial anterior e m\u00fasculo extensor longo dos dedos e em sua regi\u00e3o terminal se torna a art\u00e9ria dorsal do p\u00e9.<\/p>\n<p><strong>Art\u00e9ria tibial posterior:<\/strong>\u00a0\u00c9 continua\u00e7\u00e3o da art\u00e9ria popl\u00edteo, da um ramo lateral \u2013 art\u00e9ria fibular, em sua regi\u00e3o terminal se ramifica na art\u00e9ria plantar medial e plantar lateral. Nutre todo o compartimento posterior da perna e do p\u00e9.<\/p>\n<p><strong>Art\u00e9ria fibular:<\/strong>\u00a0Principal ramo da art\u00e9ria tibial posterior, seus principais ramos s\u00e3o a art\u00e9ria nutr\u00edcia fibular, ramo perfurante na membrana inter\u00f3ssea, ramos para o m\u00fasculo popl\u00edteo, ramos maleolares terminais e laterais que se anastomosam com ramos do tornozelo e calcanhar.<\/p>\n<p>A regi\u00e3o lateral da perna \u00e9 nutrida na por\u00e7\u00e3o proximal pela perfurante da art\u00e9ria tibial anterior e em sua por\u00e7\u00e3o distal pela perfurante da art\u00e9ria fibular.<\/p>\n<div id=\"attachment_43\" class=\"wp-caption alignnone\">\n<p><div id=\"attachment_30\" style=\"width: 228px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/primeira.jpg\"><img aria-describedby=\"caption-attachment-30\" class=\"size-medium wp-image-30\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/primeira-218x300.jpg\" alt=\"\" width=\"218\" height=\"300\" \/><\/a><p id=\"caption-attachment-30\" class=\"wp-caption-text\">Fonte: MOORE, K.L. Anatomia Orientada para a Cl\u00ednica. 5\u00aa edi\u00e7\u00e3o. Rio de Janeiro: Guanabara Koogan, 2007.<\/p><\/div><\/p>\n<p class=\"wp-caption-text\">\n<\/p><\/div>\n<div id=\"attachment_44\" class=\"wp-caption alignnone\">\n<p><div id=\"attachment_31\" style=\"width: 245px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/segunda.jpg\"><img aria-describedby=\"caption-attachment-31\" class=\"size-medium wp-image-31\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/segunda-235x300.jpg\" alt=\"\" width=\"235\" height=\"300\" \/><\/a><p id=\"caption-attachment-31\" class=\"wp-caption-text\">Fonte: MOORE, K.L. Anatomia Orientada para a Cl\u00ednica. 5\u00aa edi\u00e7\u00e3o. Rio de Janeiro: Guanabara Koogan, 2007.<\/p><\/div><\/p>\n<p class=\"wp-caption-text\">\n<\/p><\/div>\n<p><strong>Art\u00e9rias do p\u00e9<\/strong><\/p>\n<p><strong>\u00a0Sistema arterial dorsal do p\u00e9:<\/strong>\u00a0Por\u00e7\u00e3o final da art\u00e9ria tibial anterior se localiza na regi\u00e3o antero-medial do tornozelo, seus pricipais ramos s\u00e3o: art\u00e9ria dorsal do 1\u00ba metatarsal,\u00a0 art\u00e9ria plantar profunda, art\u00e9ria arqueada e art\u00e9ria tarsal lateral. A anastomose entre a art\u00e9ria arqueada e tarsal lateral formam o arco dorsal (al\u00e7a arterial).<\/p>\n<p><div id=\"attachment_32\" style=\"width: 234px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/terceira-1.jpg\"><img aria-describedby=\"caption-attachment-32\" class=\"size-medium wp-image-32\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/terceira-1-224x300.jpg\" alt=\"\" width=\"224\" height=\"300\" \/><\/a><p id=\"caption-attachment-32\" class=\"wp-caption-text\">Fonte: MOORE, K.L. Anatomia Orientada para a Cl\u00ednica. 5\u00aa edi\u00e7\u00e3o. Rio de Janeiro: Guanabara Koogan, 2007.<\/p><\/div><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Art\u00e9rias plantares:<\/strong><\/p>\n<p>Art\u00e9ria tibial posterior divide-se em art\u00e9ria plantar medial e lateral:<\/p>\n<p><strong>Art\u00e9ria plantar medial<\/strong>: Ramo da art\u00e9ria tibial posterior. Possui ramos profundo e superficiais. Ramo profundo para a musculatura do h\u00e1lux. Ramos superficiais para pele, face medial da planta, ramos digitais (lateral \u00e0s art\u00e9rias metatarsais plantares mediais).<\/p>\n<p><strong>Art\u00e9ria plantar lateral:<\/strong>\u00a0Ramo da art\u00e9ria tibial posterior. Est\u00e1 profunda ao m\u00fasculo adutor do h\u00e1lux, distalmente se encontra entre o flexor curto dos dedos e o quadrado plantar.<\/p>\n<p><strong>Arco plantar profundo:<\/strong>\u00a0Formado pela art\u00e9ria profunda (ramo da art\u00e9ria dorsal do p\u00e9) + art\u00e9ria plantar lateral.<\/p>\n<p><strong>Arco plantar superficial:<\/strong>\u00a0Formado pelo ramo superficial da art\u00e9ria plantar medial + art\u00e9ria plantar lateral.<\/p>\n<p><div id=\"attachment_33\" style=\"width: 234px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/img1.jpg\"><img aria-describedby=\"caption-attachment-33\" class=\"size-medium wp-image-33\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/img1-224x300.jpg\" alt=\"\" width=\"224\" height=\"300\" \/><\/a><p id=\"caption-attachment-33\" class=\"wp-caption-text\">Fonte: MOORE, K.L. Anatomia Orientada para a Cl\u00ednica. 5\u00aa edi\u00e7\u00e3o. Rio de Janeiro: Guanabara Koogan, 2007.<\/p><\/div><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Rela\u00e7\u00f5es anat\u00f4micas:<\/strong><\/p>\n<p><div id=\"attachment_34\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/img2.jpg\"><img aria-describedby=\"caption-attachment-34\" class=\"wp-image-34 size-medium\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/img2-300x243.jpg\" alt=\"\" width=\"300\" height=\"243\" \/><\/a><p id=\"caption-attachment-34\" class=\"wp-caption-text\">Fonte: MOORE, K.L. Anatomia Orientada para a Cl\u00ednica. 5\u00aa edi\u00e7\u00e3o. Rio de Janeiro: Guanabara Koogan, 2007.<\/p><\/div><\/p>\n<div id=\"attachment_47\" class=\"wp-caption alignnone\">\n<p class=\"wp-caption-text\">\n<\/p><\/div>\n<p><strong>Referencia:<\/strong><\/p>\n<ul>\n<li>MOORE, K.L.\u00a0<strong>Anatomia Orientada para a Cl\u00ednica<\/strong>. 5\u00aa edi\u00e7\u00e3o. Rio de Janeiro: Guanabara Koogan, 2007<\/li>\n<\/ul>\n<\/div>\n<\/article>\n<p><\/p><\/main><\/div>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\"\n\t\t\t data-anchor=\"04-%e2%80%93-historico-da-t%c3%a9cnica-de-arterializa%c3%a7%c3%a3o-na-isquemia-cr%c3%adtica\">\n\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-04-%e2%80%93-historico-da-t%c3%a9cnica-de-arterializa%c3%a7%c3%a3o-na-isquemia-cr%c3%adtica\" aria-controls=\"accordion-content-04-%e2%80%93-historico-da-t%c3%a9cnica-de-arterializa%c3%a7%c3%a3o-na-isquemia-cr%c3%adtica\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t04 \u2013 HISTORICO DA T\u00c9CNICA DE ARTERIALIZA\u00c7\u00c3O NA ISQUEMIA CR\u00cdTICA\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-04-%e2%80%93-historico-da-t%c3%a9cnica-de-arterializa%c3%a7%c3%a3o-na-isquemia-cr%c3%adtica\"\n\t\t\t\tid=\"accordion-content-04-%e2%80%93-historico-da-t%c3%a9cnica-de-arterializa%c3%a7%c3%a3o-na-isquemia-cr%c3%adtica\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\" tabindex=\"0\">\n\t\t\t\t\t<p>San Martin em 1902 realizou o primeiro procedimento no sentido de fazer chegar sangue arterial por via venosa retr\u00f3grada em territ\u00f3rios de grande isquemia. Da mesma \u00e9poca s\u00e3o tamb\u00e9m as constata\u00e7\u00f5es de Gallois e Pinatelle em 1903 de que para vencer os obst\u00e1culos das v\u00e1lvulas venosas se faz necess\u00e1ria, uma for\u00e7a muito maior que a press\u00e3o arterial normal (Lengua, 1984). Abalos em 1909 foi quem empregou pela primeira vez o sistema venoso superficial, para confec\u00e7\u00e3o de uma f\u00edstula, mediante a comunica\u00e7\u00e3o da safena magna com a art\u00e9ria femoral. Helsted e Vaughan (1912) criticaram duramente estes procedimentos, embora Roussiel em 1919 reunindo 63 casos tenha demonstrado \u00eaxito em 25% deles (Lengua, 1984).<\/p>\n<p>Szylaghyi\u00a0<em>et al.<\/em>\u00a0em 1951, \u00edcone da cirurgia vascular da \u00e9poca, condenou o m\u00e9todo, depois de aplic\u00e1-lo em nove casos, com 100% de maus resultados, confeccionando f\u00edstulas arteriovenosas em vasos femorais.<\/p>\n<p>Root e Cruz\u00a0<em>et al.<\/em>\u00a0(1965) e Matolo\u00a0<em>et al.<\/em>\u00a0(1976) demonstraram experimentalmente que as f\u00edstulas latero-laterais permitiam um bom retorno venoso e melhores resultados, que aquelas t\u00e9rmino-laterais, que por sobrecarga venosa, levavam a edema, equimose e necrose.<\/p>\n<p>Courbier\u00a0<em>et al.\u00a0<\/em>em 1973 e principalmente Lengua com seus trabalhos a partir de 1974, passaram a estender suas f\u00edstulas at\u00e9 o p\u00e9, obtendo a irriga\u00e7\u00e3o dos dedos e melhores resultados do que seus antecessores.<\/p>\n<p>A arterializa\u00e7\u00e3o do p\u00e9 foi empregada pela primeira vez por Lengua (1975) em um paciente diab\u00e9tico com resultados animadores. Sem d\u00favida, ela n\u00e3o teve uma boa aceita\u00e7\u00e3o e s\u00f3 passou a ser adotada depois que os casos tratados foram aparecendo em publica\u00e7\u00f5es de outras equipes de cirurgia vascular (Pokrovskii\u00a0<em>et al<\/em>,1996; Rowe,2002).<\/p>\n<p>Enxertos venosos com safena reversa derivando a circula\u00e7\u00e3o da art\u00e9ria mais distal que apresente bom fluxo, at\u00e9 o arco venoso do p\u00e9, foram realizados por Courbier\u00a0<em>et al<\/em>\u00a0em 1973, Lengua em 1974, 1984, 1993, 1994, 1995 e 2001,<strong>\u00a0<\/strong>Sheil em 1977; Porkrowski\u00a0<em>et al em<\/em>\u00a01990 e 1996, Chen\u00a0<em>et al<\/em>\u00a0em 1998, Taylor\u00a0<em>et al<\/em>\u00a0em 1999, Engelke\u00a0<em>et al<\/em>\u00a0em 2001, Rowe em 2002,<sup>,\u00a0<\/sup>\u00d6zbek\u00a0<em>et al\u00a0<\/em>em 2005, Gavrilenko\u00a0<em>et al<\/em>\u00a0em 2007, Keshelava\u00a0<em>et al<\/em>\u00a0em 2009, Alexandrescu\u00a0<em>et al<\/em>\u00a0em 2011, Djoric\u00a0<em>et al<\/em>\u00a0em 2011, e Mutirangura\u00a0<em>et al<\/em>\u00a0em 2011.<\/p>\n<p>N\u00f3s (Busato\u00a0<em>et al<\/em>,1999 e 2008) como Gasparis\u00a0<em>et al (<\/em>2002) e Lozano\u00a0<em>et al<\/em>\u00a0(2002), mantivemos a safena magna arterializada \u201cin situ\u201d.<br \/>\nArterializa\u00e7\u00f5es do arco venoso da m\u00e3o tem sido realizada com sucesso por m\u00e9todo semelhante relatadas nas publica\u00e7\u00f5es de Kind (2006), Pokrovski\u00a0<em>et al<\/em>\u00a0(2007), Chloros\u00a0<em>et al<\/em>\u00a0(2008), Nguyen\u00a0<em>et al (<\/em>2011) \u00a0e Matarrese (2011)<strong>.<\/strong><\/p>\n<p>Houlind (2013) apresentou resultados sofr\u00edveis com a t\u00e9cnica, chamando aten\u00e7\u00e3o para necessidade de melhora na t\u00e9cnica.<\/p>\n<p>Schereve (2014) comparou a arterializa\u00e7\u00e3o venosa com pontes arteriais inframaleolares mostrando resultados semelhantes.<\/p>\n<p>Trabalhos experimentais de Sasajima(2014) (2013), Koyama (2014), Ozbeck (2014), Djoric (2012) foram direcionados a demonstrar os mecanismos pelos quais os bons resultados cl\u00ednicos s\u00e3o obtidos.<\/p>\n<p>Busato(2014) em trabalho de pesquisa ainda n\u00e3o publicado demonstrou que o corante Tinta da China interposto entre a art\u00e9ria doadora e a veia receptora foi encontrado em capilar arterial da extremidade.<\/p>\n<p><div id=\"attachment_37\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/historico-300x225-1.png\"><img aria-describedby=\"caption-attachment-37\" class=\"size-full wp-image-37\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/historico-300x225-1.png\" alt=\"\" width=\"300\" height=\"225\" \/><\/a><p id=\"caption-attachment-37\" class=\"wp-caption-text\">Visita do Dr Francisco Lengua Almora a Santa Casa de Miseric\u00f3rdia de Ponta Grossa<\/p><\/div><\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\"\n\t\t\t data-anchor=\"05-%e2%80%93-indica%c3%a7%c3%a3o-cir%c3%bargica-e-avalia%c3%a7%c3%a3o-pr%c3%a9-operat%c3%b3ria\">\n\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-05-%e2%80%93-indica%c3%a7%c3%a3o-cir%c3%bargica-e-avalia%c3%a7%c3%a3o-pr%c3%a9-operat%c3%b3ria\" aria-controls=\"accordion-content-05-%e2%80%93-indica%c3%a7%c3%a3o-cir%c3%bargica-e-avalia%c3%a7%c3%a3o-pr%c3%a9-operat%c3%b3ria\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t05 \u2013 INDICA\u00c7\u00c3O CIR\u00daRGICA E AVALIA\u00c7\u00c3O PR\u00c9-OPERAT\u00d3RIA\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-05-%e2%80%93-indica%c3%a7%c3%a3o-cir%c3%bargica-e-avalia%c3%a7%c3%a3o-pr%c3%a9-operat%c3%b3ria\"\n\t\t\t\tid=\"accordion-content-05-%e2%80%93-indica%c3%a7%c3%a3o-cir%c3%bargica-e-avalia%c3%a7%c3%a3o-pr%c3%a9-operat%c3%b3ria\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\" tabindex=\"0\">\n\t\t\t\t\t<p>A cirurgia tem indica\u00e7\u00e3o restrita para os pacientes com isquemia cr\u00edtica sem leito distal nos quais n\u00e3o se encontra aplicabilidade das t\u00e9cnicas tradicionais de revasculariza\u00e7\u00e3o.<\/p>\n<p>\u00c9 indispens\u00e1vel avalia\u00e7\u00e3o do sistema venoso profundo, da veia que servir\u00e1 para deriva\u00e7\u00e3o do fluxo arterial e mapeamento do arco venoso do p\u00e9.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Mapeamento do arco venoso do p\u00e9 atrav\u00e9s de duplex<\/strong><\/p>\n<div id=\"gallery-1\" class=\"gallery galleryid-75 gallery-columns-3 gallery-size-thumbnail\">\n<p>\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-1 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-1 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 50%;\n\t\t\t}\n\t\t\t#gallery-1 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-1 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-1' class='gallery galleryid-13 gallery-columns-2 gallery-size-thumbnail'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/img1-1.jpg'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/img1-1-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" aria-describedby=\"gallery-1-38\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-1-38'>\n\t\t\t\tMapeamento do arco venoso do p\u00e9\n\t\t\t\t<\/dd><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/indicacao-cirurgica.png'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/indicacao-cirurgica-150x150.png\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" aria-describedby=\"gallery-1-39\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-1-39'>\n\t\t\t\tMapeamento do arco venoso do p\u00e9\n\t\t\t\t<\/dd><\/dl><br style=\"clear: both\" \/>\n\t\t<\/div>\n<\/p>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"page-head\">\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"col-12\">\n<h5>INDICA\u00c7\u00c3O DA T\u00c9CNICA E AVALIA\u00c7\u00c3O PR\u00c9-OPERAT\u00d3RIA<\/h5>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"container\">\n<div class=\"row\">\n<div id=\"primary\" class=\"content-area col-sm-12\"><main id=\"main\" class=\"site-main\" role=\"main\">\n<article id=\"post-178\" class=\"post-178 page type-page status-publish hentry\">\n<div class=\"entry-content\">\n<div class=\"at-above-post-page addthis_tool\" data-url=\"https:\/\/www3.uepg.br\/arterializacao\/indicacao-da-tecnica-e-avaliacao-pre-operatoria\/\"><\/div>\n<p>A cirurgia tem indica\u00e7\u00e3o precisa para tratamento de isquemia cr\u00edtica sem leito distal, condi\u00e7\u00f5es encontrada em maior preval\u00eancia nas doen\u00e7as abaixo:<\/p>\n<p>\u2013 Aterosclerose obliterante;<\/p>\n<p>\u2013 Diabetes melitus;<\/p>\n<p>\u2013 Tromboangeite obliterante (na maioria absoluta dos seus casos);<\/p>\n<p>\u2013 Aneurisma de art\u00e9ria popl\u00edtea com trombose do leito distal.<\/p>\n<p>&nbsp;<\/p>\n<p>A t\u00e9cnica tem a finalidade de tratar dor em repouso, les\u00f5es tr\u00f3ficas ou promover a cicatriza\u00e7\u00e3o de amputa\u00e7\u00f5es menores.<\/p>\n<p>A arteriografia e o duplex arterial s\u00e3o realizados de rotina a procura de leito para tratamento por enxerto convencional e para procura da melhor art\u00e9ria doadora. O duplex venoso estuda e marca preferencialmente a safena magna e sua extens\u00e3o at\u00e9 o p\u00e9, bem como as demais veias do sistema venoso profundo que devem estar perme\u00e1veis para garantir o retorno do hiper-fluxo gerado pela confec\u00e7\u00e3o da f\u00edstula. Avalia e marca, ainda, a proje\u00e7\u00e3o do arco venoso no p\u00e9 bem como a presen\u00e7a de v\u00e1lvulas e origem da primeira metatarsiana (Busato<em>\u00a0et al,<\/em>\u00a02008).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Referencias:<\/strong>\u00a0Busato CR, Utrabo CAL, Gomes RZ, Housome JK, Hoeldtke E, Pinto CT, Brand\u00e3o RI, Busato CD. Arterializa\u00e7\u00e3o do arco venoso do p\u00e9 para tratamento da tromboange\u00edte obliterante. J Vasc Bras. 2008;7(3):267-271.<\/p>\n<\/div>\n<\/article>\n<p><\/p><\/main><\/div>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\"\n\t\t\t data-anchor=\"06-%e2%80%93-t%c3%a9cnicas-cir%c3%bargicas-para-revasculariza%c3%a7%c3%a3o-retr%c3%b3grada\">\n\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-06-%e2%80%93-t%c3%a9cnicas-cir%c3%bargicas-para-revasculariza%c3%a7%c3%a3o-retr%c3%b3grada\" aria-controls=\"accordion-content-06-%e2%80%93-t%c3%a9cnicas-cir%c3%bargicas-para-revasculariza%c3%a7%c3%a3o-retr%c3%b3grada\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t06 \u2013 T\u00c9CNICAS CIR\u00daRGICAS PARA REVASCULARIZA\u00c7\u00c3O RETR\u00d3GRADA\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-06-%e2%80%93-t%c3%a9cnicas-cir%c3%bargicas-para-revasculariza%c3%a7%c3%a3o-retr%c3%b3grada\"\n\t\t\t\tid=\"accordion-content-06-%e2%80%93-t%c3%a9cnicas-cir%c3%bargicas-para-revasculariza%c3%a7%c3%a3o-retr%c3%b3grada\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\" tabindex=\"0\">\n\t\t\t\t\t<p>A t\u00e9cnica cir\u00fargica para revasculariza\u00e7\u00e3o retr\u00f3grada \u00e9 chamada de arterializa\u00e7\u00e3o do arco venoso do p\u00e9. Baseia-se na confec\u00e7\u00e3o de fistula entre o sistema arterial do membro e o arco venoso do p\u00e9. A t\u00e9cnica pode ser realizada com a safena \u201cin situ\u201d ou invertida.<\/p>\n<p><div id=\"attachment_42\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/tecnicas-cirurgicas.png\"><img aria-describedby=\"caption-attachment-42\" class=\"size-medium wp-image-42\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/tecnicas-cirurgicas-300x290.png\" alt=\"\" width=\"300\" height=\"290\" \/><\/a><p id=\"caption-attachment-42\" class=\"wp-caption-text\">Arterializa\u00e7\u00e3o venosa \u201cin situ\u201d Arterializa\u00e7\u00e3o com veia invertida<\/p><\/div><\/p>\n<p>&nbsp;<\/p>\n<p>A t\u00e9cnica cir\u00fargica pode ser realizada como Lengua (2001)<strong>,<\/strong>\u00a0que faz a anastomose distal com safena invertida diretamente no arco venoso ou como preconizamos: mantendo a safena magna \u201cin situ\u201d (Busato\u00a0<em>et al.<\/em>, 1999).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Safena invertida ou devalvulada \u201cex situ\u201d.<\/strong><\/p>\n<p>A t\u00e9cnica operat\u00f3ria \u00e9 descrita com detalhes simples e at\u00e9 f\u00fateis mas que na realidade constituem\u00a0 um rol importante para o resultado final da cirurgia (Lengua,1994).<\/p>\n<p>A anestesia preferencial \u00e9 a peridural com cateter. Protegem-se eventuais les\u00f5es tr\u00f3ficas com material est\u00e9ril e imperme\u00e1vel assim como o apoio do calcanhar com uma luva preenchida de \u00e1gua est\u00e9ril.\u00a0A interven\u00e7\u00e3o pode ser realizada por duas equipes: a primeira retira as safenas de ambas as coxas, prepara e executa uma anastomose na art\u00e9ria doadora.<\/p>\n<p><strong>1. Dissec\u00e7\u00e3o da veia:<\/strong><\/p>\n<p>Uma incis\u00e3o obl\u00edqua longitudinal na parte inferior, lado interno do joelho serve para confec\u00e7\u00e3o do t\u00fanel para o enxerto. A segunda equipe realiza a dissec\u00e7\u00e3o da veia marginal interna do p\u00e9 atrav\u00e9s de incis\u00e3o pr\u00e9-maleolar de dez cent\u00edmetros para baixo na proje\u00e7\u00e3o desta veia. A incis\u00e3o deve evitar \u201ccair\u201d sobre a veia, pois o seu fechamento pode expor a anastomose caso ocorra necrose de pele (figura 1B). Pontos de tra\u00e7\u00e3o s\u00e3o colocados sobre as bordas da ferida incluindo pele e\u00a0f\u00e1scia\u00a0subcut\u00e2nea.\u00a0Para dissec\u00e7\u00e3o da veia marginal bem como para o fechamento da ferida evita-se a utiliza\u00e7\u00e3o de pin\u00e7as e afastadores para evitar a necrose da pele (Lengua,1994).<\/p>\n<p><strong>2. Tunealiza\u00e7\u00e3o:<\/strong><\/p>\n<p>Tuneliza-se o trajeto do enxerto atrav\u00e9s do tecido celular subcut\u00e2neo com uma sonda de material pl\u00e1stico, em trajeto anterior a safena magna pr\u00e9 maleolar. Evita-se tunelizador met\u00e1lico que pode causar descolamento da pele originando necrose.<\/p>\n<p><strong>3. Flebotomia:<\/strong><\/p>\n<p>Com o enxerto localizado em seu leito, sem tor\u00e7\u00f5es, se realiza uma flebotomia na veia marginal do p\u00e9 capaz de permitir acesso \u00e0 primeira metatarsiana e a continuidade do arco venoso. Utilizando-se os dilatadores met\u00e1licos, ap\u00f3s distens\u00e3o venosa com soro fisiol\u00f3gico heparinizado, rompem-se as v\u00e1lvulas acess\u00edveis \u00e0 flebotomia.<\/p>\n<p><strong>4. Anastomose veia-arterial:<\/strong><\/p>\n<p>Procede-se a anastomose do enxerto venoso com prolene 7 zeros e utilizando-se de lentes de aumento evitando deixar uma bolsa que possa ser comprimida pelo fechamento da pele. Quando isto ocorre, \u00e9 prefer\u00edvel deixar a incis\u00e3o apenas aproximada com abertura de 3 a 6 mm, cobrindo-se a anastomose e deixando para cicatrizar por segunda inten\u00e7\u00e3o (Lengua, 1994).<\/p>\n<p>\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-2 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-2 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 50%;\n\t\t\t}\n\t\t\t#gallery-2 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-2 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-2' class='gallery galleryid-13 gallery-columns-2 gallery-size-thumbnail'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06a-150x150-1.png'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06a-150x150-1.png\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" aria-describedby=\"gallery-2-143\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-2-143'>\n\t\t\t\tT\u00e9cnica de arterializa\u00e7\u00e3o do arco venoso do p\u00e9 com safena \u201cex situ\u201d\n\t\t\t\t<\/dd><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06b-150x150-1.png'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06b-150x150-1.png\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" aria-describedby=\"gallery-2-144\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-2-144'>\n\t\t\t\tAproxima\u00e7\u00e3o da pele na incis\u00e3o cir\u00fargica do p\u00e9\n\t\t\t\t<\/dd><\/dl><br style=\"clear: both\" \/>\n\t\t<\/div>\n<\/p>\n<div><\/div>\n<p><strong>5. Destrui\u00e7\u00e3o das v\u00e1lvulas venosas:<\/strong><\/p>\n<p>Para a destrui\u00e7\u00e3o das v\u00e1lvulas do p\u00e9 foi desenvolvido um conjunto flex\u00edvel de 5 hastes, de 24 cent\u00edmetros de comprimento, armado com curtas olivas de ponta c\u00f4nica de di\u00e2metros vari\u00e1veis de 1 a 2,5 mm com comprimento de 4 a 5 mm\u00a0 implantados num \u00e2ngulo de 10 graus e uma de 6 cm, sem angula\u00e7\u00e3o, para destruir as v\u00e1lvulas ostiais da primeira metatarsiana. A rotura \u00e9 feita girando a oliva para dentro do l\u00famen evitando lesionar a parede da veia (figura 2). A t\u00e9cnica cir\u00fargica deve ser meticulosamente seguida porque o resultado depende de pequenos detalhes (Lengua, 2006).<\/p>\n<p><div id=\"attachment_59\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/resultados.png\"><img aria-describedby=\"caption-attachment-59\" class=\"wp-image-59 size-medium\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/resultados-300x177.png\" alt=\"\" width=\"300\" height=\"177\" \/><\/a><p id=\"caption-attachment-59\" class=\"wp-caption-text\">Fonte: Arterialization del pie por isquemia, F Lengua A.<\/p><\/div><\/p>\n<div id=\"attachment_88\" class=\"wp-caption alignnone\">\n<p>&nbsp;<\/p>\n<p class=\"wp-caption-text\">\n<\/p><\/div>\n<p><strong>Safena \u201cin situ\u201d<\/strong><\/p>\n<p>A safena magna mantida \u201cin situ\u201d, deve ser anastomosada \u00e0 melhor art\u00e9ria doadora, (figuras 3A e B) que deve ser esqueletizada, pela ligadura de todas as colaterais, at\u00e9 a perfurante anterior do mal\u00e9olo (figura 4), que deriva parte do fluxo, para as veias tibiais anteriores e dorso proximal do p\u00e9.<\/p>\n<p>&nbsp;<\/p>\n<p>\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-3 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-3 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 50%;\n\t\t\t}\n\t\t\t#gallery-3 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-3 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-3' class='gallery galleryid-13 gallery-columns-2 gallery-size-thumbnail'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06d-hi.jpg'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06d-hi-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06e-hi.jpg'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06e-hi-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" \/><\/a>\n\t\t\t<\/dt><\/dl><br style=\"clear: both\" \/>\n\t\t<\/div>\n<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>A partir desta, todas as veias do p\u00e9 devem ser preservadas. Realizamos valvulotomia ascendente atrav\u00e9s das colaterais ao longo da safena (figura 5) e no p\u00e9 atrav\u00e9s de flebotomia (figura 6). O procedimento pode ser simplificado pela passagem de um valvul\u00f3tomo flex\u00edvel a partir da flebotomia que \u00e9 realizada pr\u00f3xima a emerg\u00eancia da primeira metatarsiana. Completamos a valvulotomia descendente na metatarsiana e no arco venoso do p\u00e9.<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06f-hi.jpg\"><img class=\"size-medium wp-image-63 aligncenter\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06f-hi-300x226.jpg\" alt=\"\" width=\"300\" height=\"226\" \/><\/a><\/p>\n<p>\u00c9 imprescind\u00edvel a presen\u00e7a de pulso e fr\u00eamito ao n\u00edvel do arco venoso dorsal, (figura 7 A e B) manuten\u00e7\u00e3o das veias do p\u00e9 a partir da perfurante anterior do mal\u00e9olo e integridade do sistema venoso profundo do membro que serve como \u201crota de fuga\u201d ao hiper-fluxo gerado pela f\u00edstula (Busato, 1999, 2008).<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-4 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-4 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 50%;\n\t\t\t}\n\t\t\t#gallery-4 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-4 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-4' class='gallery galleryid-13 gallery-columns-2 gallery-size-thumbnail'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06g-hi.jpg'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06g-hi-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06h-hi.jpg'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/06h-hi-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" \/><\/a>\n\t\t\t<\/dt><\/dl><br style=\"clear: both\" \/>\n\t\t<\/div>\n<\/p>\n<p>A utiliza\u00e7\u00e3o da safena magna \u201cin situ\u201d permite \u201carterializar\u201d o arco venoso do p\u00e9 com apenas uma anastomose. Evita a retirada da veia de seu leito original e dispensa a confec\u00e7\u00e3o de t\u00fanel.<\/p>\n<p>Os bons resultados da cirurgia est\u00e3o relacionados mais a indica\u00e7\u00e3o precisa, estudo pr\u00e9-operat\u00f3rio arterial e venoso da extremidade em risco e detalhes t\u00e9cnicos do que do tipo de cirurgia escolhida.<\/p>\n<p><strong>Referencias:<\/strong><\/p>\n<ul>\n<li>Lengua F, Madrid A La, Acosta C, Barriga H, Maliqui C, Arauco R, Lengua A. L\u2019arterialisation des veines du pied pour sauvetage de membre chez l\u2019art\u00e9ritique. Technique et resultats. Ann Chir 2001;126:629-638.<\/li>\n<li>Djoric P. Early individual experience with distal venous arterialization as a lower limb salvage procedure. Am Surg 2011;77(6):726-30.<\/li>\n<li>Busato C.R, Utrabo C.A.L, Housome J.K, Gomes R.Z. Arterializa\u00e7\u00e3o do arco venoso do p\u00e9 para tratamento da isquemia cr\u00edtica sem leito distal. Cir Vasc &amp; Angiol 1999;15:117-121.<\/li>\n<li>Busato CR, Utrabo CAL, Gomes RZ, Housome JK, Hoeldtke E, Pinto CT, Brand\u00e3o RI, Busato CD. Arterializa\u00e7\u00e3o do arco venoso do p\u00e9 para tratamento da tromboange\u00edte obliterante. J Vasc Bras. 2008;7(3):267-270.<\/li>\n<li>Lengua F. Le pontage d\u2019art\u00e9rialisation veineuse distale peut-il \u00eatre b\u00e9n\u00e9fique au pied diab\u00e9tique avec n\u00e9crose? Chirurgie1994-1995;120:143-152.<\/li>\n<li>Lengua Almora F; Arterialization Del Pie Por Isquemia \u2013 Ultima Oportunidad para evitar amputaciones em diab\u00e9ticos.1\u00aa edicion. Lima, Ed. Delvi S.R.L.Julio, 2006<\/li>\n<\/ul>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\"\n\t\t\t data-anchor=\"07-%e2%80%93-p%c3%b3s-operat%c3%b3rio-e-fisiologia-da-arterializa%c3%a7%c3%a3o\">\n\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-07-%e2%80%93-p%c3%b3s-operat%c3%b3rio-e-fisiologia-da-arterializa%c3%a7%c3%a3o\" aria-controls=\"accordion-content-07-%e2%80%93-p%c3%b3s-operat%c3%b3rio-e-fisiologia-da-arterializa%c3%a7%c3%a3o\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t07 \u2013 P\u00d3S-OPERAT\u00d3RIO E FISIOLOGIA DA ARTERIALIZA\u00c7\u00c3O\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-07-%e2%80%93-p%c3%b3s-operat%c3%b3rio-e-fisiologia-da-arterializa%c3%a7%c3%a3o\"\n\t\t\t\tid=\"accordion-content-07-%e2%80%93-p%c3%b3s-operat%c3%b3rio-e-fisiologia-da-arterializa%c3%a7%c3%a3o\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\" tabindex=\"0\">\n\t\t\t\t\t<p>Existem tr\u00eas hip\u00f3teses para a fisiologia da arterializa\u00e7\u00e3o:<\/p>\n<p>(1) Invers\u00e3o parcial: O fluxo veno-arterial atingiria a arter\u00edola pr\u00e9-capilar.<\/p>\n<p>(2) Invers\u00e3o total: O fluxo veno-arterial atingiria os capilares.<\/p>\n<p>(3) Invers\u00e3o mista: Os dois fen\u00f4menos coexistem.<\/p>\n<p>A manuten\u00e7\u00e3o da f\u00edstula arterio venosa ao n\u00edvel do p\u00e9 por um per\u00edodo superior a 30 dias induz o desenvolvimento de arteriog\u00eaneses e angiog\u00eanese de tal forma que sua oclus\u00e3o raramente est\u00e1 associada a perda do membro (Lengua).<\/p>\n<p><div id=\"attachment_68\" style=\"width: 241px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/pos-operatorio.png\"><img aria-describedby=\"caption-attachment-68\" class=\"size-medium wp-image-68\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/pos-operatorio-231x300.png\" alt=\"\" width=\"231\" height=\"300\" \/><\/a><p id=\"caption-attachment-68\" class=\"wp-caption-text\">Antes e Depois Fonte: Arterialization del pie por isquemia, F Lengua A.<\/p><\/div><\/p>\n<p>&nbsp;<\/p>\n<div class=\"page-head\">\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"col-12\">\n<h5 style=\"text-align: center;\">P\u00d3S-OPERAT\u00d3RIO E FISIOLOGIA<\/h5>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"container\">\n<div class=\"row\">\n<div id=\"primary\" class=\"content-area col-sm-12\"><main id=\"main\" class=\"site-main\" role=\"main\">\n<article id=\"post-189\" class=\"post-189 page type-page status-publish hentry\">\n<div class=\"entry-content\">\n<p>Embora Lengua (2006) utilize heparina de BPM durante uma semana no p\u00f3s-operat\u00f3rio imediato de seus pacientes passando para varfarina. N\u00f3s utilizamos a heparina como profilaxia para TVP\/TEP juntamente com antiplaquet\u00e1rio que mantemos nos pacientes com insufici\u00eancia arterial.<\/p>\n<p>A difus\u00e3o do sangue arterializado atrav\u00e9s do arco venoso e das metatarsianas se faz para veias profundas do p\u00e9, que por sua vez, se difundem para superficiais proximais gra\u00e7as a aus\u00eancia de v\u00e1lvulas em um n\u00famero consider\u00e1vel de veias perfurantes (Lofgren<em>\u00a0et al,<\/em>1968).<\/p>\n<p>Estes achados podem ser comprovados pela arteriografia p\u00f3s-operat\u00f3ria de pacientes que apresentam difus\u00e3o do contraste nos arcos venoso dorsal (figura 1A) e plantar, como na (figura 1B) onde notamos o enchimento do arco plantar do p\u00e9 e da veia safena parva.<\/p>\n<\/div>\n<p>\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-5 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-5 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 50%;\n\t\t\t}\n\t\t\t#gallery-5 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-5 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-5' class='gallery galleryid-13 gallery-columns-2 gallery-size-thumbnail'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/7a-hi.jpg'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/7a-hi-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/7b-hi.jpg'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/7b-hi-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" \/><\/a>\n\t\t\t<\/dt><\/dl><br style=\"clear: both\" \/>\n\t\t<\/div>\n<\/p>\n<\/article>\n<p>&nbsp;<\/p>\n<article id=\"post-189\" class=\"post-189 page type-page status-publish hentry\">\n<div class=\"entry-content\">\n<p>Lengua (2006) apresenta tr\u00eas hip\u00f3teses para a fisiologia da arterializa\u00e7\u00e3o:<\/p>\n<p>&nbsp;<\/p>\n<ol>\n<li>Invers\u00e3o parcial: O aumento do gradiente veno-arterial permitiria o fluxo atrav\u00e9s das comunica\u00e7\u00f5es arteriovenosas em sentido inverso atingindo a arter\u00edola pr\u00e9-capilar.<\/li>\n<li>Invers\u00e3o total: O fluxo arterial \u00e0 contra corrente atingiria os capilares no sentido veno-arterial.<\/li>\n<li>Invers\u00e3o mista: aonde os dois fen\u00f4menos anteriores coexistiriam.<\/li>\n<\/ol>\n<p><strong>\u00a0\u00a0\u00a0 Refer\u00eancias:<\/strong><\/p>\n<ul>\n<li>Lengua Almora F; Arterialization Del Pie Por Isquemia \u2013 Ultima Oportunidad para evitar amputaciones em diab\u00e9ticos.1\u00aa edicion. Lima, Ed. Delvi S.R.L.Julio, 2006.<\/li>\n<li>Lofgren E.P, Myers T.T, Lofgren K.A, Kuster G. The venous valves of the foot and ankle. Surg Gynecol &amp; Obst1968;8:289-290<\/li>\n<\/ul>\n<\/div>\n<\/article>\n<p><\/p><\/main><\/div>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\"\n\t\t\t data-anchor=\"08-%e2%80%93-complica%c3%a7%c3%b5es\">\n\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-08-%e2%80%93-complica%c3%a7%c3%b5es\" aria-controls=\"accordion-content-08-%e2%80%93-complica%c3%a7%c3%b5es\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t08 \u2013 COMPLICA\u00c7\u00d5ES\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-08-%e2%80%93-complica%c3%a7%c3%b5es\"\n\t\t\t\tid=\"accordion-content-08-%e2%80%93-complica%c3%a7%c3%b5es\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\" tabindex=\"0\">\n\t\t\t\t\t<div class=\"page-head\">\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"col-12\">\n<p>As complica\u00e7\u00f5es principais s\u00e3o precoces e se caracterizam por necrose cut\u00e2nea da ferida operat\u00f3ria, progress\u00e3o da necrose, s\u00edndrome dolorosa do p\u00e9 por hiperperfus\u00e3o, hiperestesias dolorosas e roubo por FAV residuais no trajeto da veia at\u00e9 o p\u00e9.<\/p>\n<p><div id=\"attachment_71\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/complicacoes.png\"><img aria-describedby=\"caption-attachment-71\" class=\"size-medium wp-image-71\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/complicacoes-300x222.png\" alt=\"\" width=\"300\" height=\"222\" \/><\/a><p id=\"caption-attachment-71\" class=\"wp-caption-text\">Manchas equim\u00f3ticas na primeira semana de p\u00f3s operat\u00f3rio. F Lengua A.<\/p><\/div><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"container\">\n<div class=\"row\">\n<div id=\"primary\" class=\"content-area col-sm-12\"><main id=\"main\" class=\"site-main\" role=\"main\">\n<article id=\"post-84\" class=\"post-84 page type-page status-publish has-post-thumbnail hentry\">\n<div class=\"entry-content\">\n<div id=\"attachment_85\" class=\"wp-caption aligncenter\">\n<p class=\"wp-caption-text\">\n<\/p><\/div>\n<p><strong>Complica\u00e7\u00f5es Precoces:<\/strong><\/p>\n<ul>\n<li>Necroses cut\u00e2neas da ferida operat\u00f3ria no p\u00e9, progress\u00e3o da necrose apesar da pat\u00eancia da f\u00edstula AV.<\/li>\n<li>S\u00edndromes necr\u00f3ticos dolorosos do p\u00e9 por hiper-perfus\u00e3o (figura 01).<\/li>\n<li>Hiperestesias dolorosas.<\/li>\n<li>Manchas equim\u00f3ticas<\/li>\n<li>Manchas petequiais<\/li>\n<li>FAV residuais no trajeto da esqueletiza\u00e7\u00e3o.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Complica\u00e7\u00f5es Tardias:<\/strong><\/p>\n<ul>\n<li>As s\u00e9ries estudadas n\u00e3o referem casos de sobrecarga card\u00edaca nem de varizes do membro operado. As tromboses tardias do enxerto geralmente n\u00e3o s\u00e3o acompanhadas de fen\u00f4menos isqu\u00eamicos.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Refer\u00eancias:<\/strong>\u00a0Lengua Almora F; Arterialization Del Pie Por Isquemia \u2013 Ultima Oportunidad para evitar amputaciones em diab\u00e9ticos.1\u00aa edicion. Lima, Ed. Delvi S.R.L.Julio, 2006.<\/p>\n<\/div>\n<\/article>\n<p><\/p><\/main><\/div>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\"\n\t\t\t data-anchor=\"09-%e2%80%93-resultados-recentes\">\n\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-09-%e2%80%93-resultados-recentes\" aria-controls=\"accordion-content-09-%e2%80%93-resultados-recentes\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t09 \u2013 RESULTADOS RECENTES\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-09-%e2%80%93-resultados-recentes\"\n\t\t\t\tid=\"accordion-content-09-%e2%80%93-resultados-recentes\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\" tabindex=\"0\">\n\t\t\t\t\t<div class=\"page-head\">\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"col-12\">\n<p>Estudos recentes tem mostrado o aperfei\u00e7oamento da t\u00e9cnica. Os bons resultados est\u00e3o relacionados \u00e0 indica\u00e7\u00e3o precisa, estudo pr\u00e9-operat\u00f3rio arterial e venoso da extremidade em risco e detalhes de t\u00e9cnica operat\u00f3ria <em>(valvulotomia do arco venoso do p\u00e9 e da primeira metatarsiana)<\/em>\u00a0(Busato\u00a0<em>et al<\/em>, 2008).<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"container\">\n<div class=\"row\">\n<div id=\"primary\" class=\"content-area col-sm-12\"><main id=\"main\" class=\"site-main\" role=\"main\">\n<article id=\"post-87\" class=\"post-87 page type-page status-publish has-post-thumbnail hentry\">\n<div class=\"entry-content\">\n<ul>\n<li>Lu\u00a0<em>et al<\/em>\u00a0(2006): Metan\u00e1lise, salvamento de 71%, com cicatriza\u00e7\u00e3o de les\u00f5es, pequenas amputa\u00e7\u00f5es e melhora da dor em repouso.<\/li>\n<li>Busato\u00a0<em>et al<\/em>\u00a0(2010): Salvamento de 10 em 18 membros (55,6%) de pacientes candidatos \u00e0 amputa\u00e7\u00e3o.<\/li>\n<li>Mutirangura\u00a0<em>et al.\u00a0<\/em>(2011): 73,1% cicatriza\u00e7\u00e3o de les\u00f5es sem dor em repouso e 76,02% de salvamento do membro.<\/li>\n<li>Djoric (2011): Salvamento do membro de 91,7% para grupo cir\u00fargico contra 12,5% do grupo clinico.<\/li>\n<li>Alexandrescu\u00a0<em>et al\u00a0<\/em>(2011) teve\u00a0sucesso t\u00e9cnico em 21 de 25 membros arterializados (80%), sem mortalidade operat\u00f3ria em 30 dias. Pat\u00eancia cumulativa prim\u00e1ria e secund\u00e1ria de 66%, 60% e 48% aos 12, 24 e 36 meses. Salvamento do membro de 73% em seguimento de 3 anos.<\/li>\n<li>Schreve\u00a0<em>et al\u00a0<\/em>(2014) comparou a cirurgia de bypass com a arterializa\u00e7\u00e3o venosa, e conclui que ambas tem resultados similares.<\/li>\n<li>Kum\u00a0<em>et al\u00a0<\/em>(2015) fez um estudo piloto com a realiza\u00e7\u00e3o da arterializa\u00e7\u00e3o venosa por via percut\u00e2nea, obtendo sucesso cl\u00ednico e angiogr\u00e1fico em 6 pacientes.<\/li>\n<\/ul>\n<p><div id=\"attachment_72\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/resultados-1.png\"><img aria-describedby=\"caption-attachment-72\" class=\"wp-image-72 size-medium\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/resultados-1-300x177.png\" alt=\"\" width=\"300\" height=\"177\" \/><\/a><p id=\"caption-attachment-72\" class=\"wp-caption-text\">Valvul\u00f3tomos para arco venoso e primeira metatarsiana. Fonte: Arterialization del pie por isquemia, F Lengua A.<\/p><\/div><\/p>\n<\/div>\n<\/article>\n<p><\/p><\/main><\/div>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\"\n\t\t\t data-anchor=\"10-%e2%80%93-casu%c3%adsticas\">\n\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-10-%e2%80%93-casu%c3%adsticas\" aria-controls=\"accordion-content-10-%e2%80%93-casu%c3%adsticas\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t10 \u2013 CASU\u00cdSTICAS\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-10-%e2%80%93-casu%c3%adsticas\"\n\t\t\t\tid=\"accordion-content-10-%e2%80%93-casu%c3%adsticas\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\" tabindex=\"0\">\n\t\t\t\t\t<div class=\"page-head\">\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"col-12\">\n<p>Lengua <em>et al.<\/em>\u00a0(2010): De 60 membros arterializados 12 foram amputados. De 48 (80%) que mantiveram o membro, 40 foram seguidos em m\u00e9dia por 4 anos.Destes 38 (95%) oclu\u00edram suas pontes em um tempo m\u00e9dio de 8 meses.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"container\">\n<div class=\"row\">\n<div id=\"primary\" class=\"content-area col-sm-12\"><main id=\"main\" class=\"site-main\" role=\"main\">\n<article id=\"post-90\" class=\"post-90 page type-page status-publish has-post-thumbnail hentry\">\n<div class=\"entry-content\">\n<p>Busato\u00a0<em>et al.<\/em> (2010): De 18 pacientes arterializados, 10 mantiveram suas extremidades (55,6%), 6 cicatrizaram amputa\u00e7\u00f5es menores, 7 sofreram amputa\u00e7\u00f5es maiores (38,9%) e 1 foi \u00e0 \u00f3bito.<\/p>\n<p>\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-6 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-6 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 50%;\n\t\t\t}\n\t\t\t#gallery-6 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-6 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-6' class='gallery galleryid-13 gallery-columns-2 gallery-size-thumbnail'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/pos-op-7dias.png'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/pos-op-7dias-150x150.png\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" aria-describedby=\"gallery-6-73\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-6-73'>\n\t\t\t\tP\u00f3s operat\u00f3rio \u2013 7 dias\n\t\t\t\t<\/dd><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/pos-op-30dias.png'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/pos-op-30dias-150x150.png\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" aria-describedby=\"gallery-6-74\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-6-74'>\n\t\t\t\tP\u00f3s operat\u00f3rio \u2013 30 dias\n\t\t\t\t<\/dd><\/dl><br style=\"clear: both\" \/>\n\t\t<\/div>\n<\/p>\n<\/div>\n<div class=\"page-head\">\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"col-12\">\n<h5><\/h5>\n<h5 style=\"text-align: center;\">CASU\u00cdSTICAS<\/h5>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"container\">\n<div class=\"row\">\n<div id=\"primary\" class=\"content-area col-sm-12\"><main id=\"main\" class=\"site-main\" role=\"main\">\n<article id=\"post-193\" class=\"post-193 page type-page status-publish hentry\">\n<div class=\"entry-content\">\n<p>Entre Janeiro de 2000 e fevereiro de 2009\u00a0<strong>LENGUA<\/strong>\u00a0<em>et al.\u00a0<\/em>(2010) realizaram 61 arterializa\u00e7\u00f5es\u00a0 em 59 pacientes com p\u00e9 diab\u00e9tico, dois bilaterais, Um paciente foi a \u00f3bito no 18\u00ba dia de p\u00f3s-operat\u00f3rio. Dos 58 restantes, 44 homens e 14 mulheres, com idade m\u00e9dia de 71 anos (53 a 91anos), 50 do tipo 2 e 8 insulino dependentes. Trinta e cinco hipertensos, 15 com transtornos do ritmo card\u00edaco, 12 com doen\u00e7a coronariana, 8 com insufici\u00eancia renal dos quais 2 em hemodi\u00e1lise, 6 com Parkinson, 5 com antecedentes de IAM, 4 com retinite diab\u00e9tica e 3 com c\u00e2ncer de pr\u00f3stata. Arteriografia de todos os membros comprovou comprometimento arterial da perna e do p\u00e9. Em dois pacientes realizaram explora\u00e7\u00e3o cir\u00fargica: art\u00e9ria dorsal do p\u00e9 e tibial posterior. O sistema venoso superficial e profundo foi avaliado com Doppler. Como enxerto usaram a safena interna retirada de um ou dos dois membros conforme a necessidade. Utilizaram em 32 vezes um segmento venoso, 27 invertidos e 5 n\u00e3o invertidos. Dezoito compostos de dois segmentos venosos, 8 com PTFE e veia invertida sendo que em um caso utilizaram veia doada por familiar. A art\u00e9ria doadora foi a popl\u00edtea 25 vezes, 27 a femoral superficial, 3 a femoral comum e 3 a il\u00edaca externa<\/p>\n<p>O paciente que foi \u00e0 \u00f3bito no 18\u00ba dia apresentava sua ponte perme\u00e1vel. Dos 60 membros arterializados 12 foram amputados, 9 em n\u00edvel de coxa e 3 em perna. Dos 48 restantes 40 foram seguidos em m\u00e9dia por 4 anos e 4 meses (dois anos e seis meses a seis anos e dois meses). Durante o seguimento ocorreu a oclus\u00e3o de 38 pontes (95%) com uma m\u00e9dia de pat\u00eancia em torno de 8 meses. (sete a nove meses). Duas continuavam perme\u00e1veis, uma h\u00e1 1 ano e 10 meses e outra h\u00e1 6 anos e dez meses. Sete pacientes foram a \u00f3bito durante o seguimento .<\/p>\n<p>&nbsp;<\/p>\n<p><strong>BUSATO,\u00a0<\/strong><em>et al.<\/em> (2010) submeteram dezoito pacientes com isquemia cr\u00edtica sem leito arterial distal \u00e0\u00a0 arterializa\u00e7\u00e3o do arco venoso do p\u00e9 com a safena \u201cin situ\u201d.\u00a0 Destes onze com aterosclerose obliterante , seis com tromboangeite e um paciente com evolu\u00e7\u00e3o tardia de aneurisma de art\u00e9ria popl\u00edtea com\u00a0 trombose distal. Seis dos onze pacientes com aterosclerose (figura 1 e 2) apresentavam diabetes melitus e destes dois com insufici\u00eancia renal dependente de hemodi\u00e1lise.<\/p>\n<p>\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-7 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-7 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 50%;\n\t\t\t}\n\t\t\t#gallery-7 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-7 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-7' class='gallery galleryid-13 gallery-columns-2 gallery-size-thumbnail'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/pos-op-7dias.png'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/pos-op-7dias-150x150.png\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" aria-describedby=\"gallery-7-73\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-7-73'>\n\t\t\t\tP\u00f3s operat\u00f3rio \u2013 7 dias\n\t\t\t\t<\/dd><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/pos-op-30dias.png'><img width=\"150\" height=\"150\" src=\"https:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/pos-op-30dias-150x150.png\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" loading=\"lazy\" aria-describedby=\"gallery-7-74\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-7-74'>\n\t\t\t\tP\u00f3s operat\u00f3rio \u2013 30 dias\n\t\t\t\t<\/dd><\/dl><br style=\"clear: both\" \/>\n\t\t<\/div>\n<\/p>\n<p>&nbsp;<\/p>\n<p>Dos dezoito pacientes \u201carterializados\u201d, dez mantiveram suas extremidades (55,6%). Seis cicatrizaram amputa\u00e7\u00f5es menores, duas trans-metatarsianas, duas de dedos e duas de falanges. Sete sofreram amputa\u00e7\u00f5es maiores (38,9%). Tr\u00eas em n\u00edvel de coxa e quatro em n\u00edvel de perna. Tiveram um \u00f3bito (5,5%) em paciente com diabetes melitus, insufici\u00eancia renal cr\u00f4nica e septicemia por infec\u00e7\u00e3o ascendente.<\/p>\n<p>Dos onze pacientes com aterosclerose obliterante, cinco mantiveram a extremidade, cinco sofreram amputa\u00e7\u00f5es maiores e um entrou em \u00f3bito.<\/p>\n<p>Dos seis pacientes com tromboangeite obliterante, cinco mantiveram a extremidade e um sofreu\u00a0 amputa\u00e7\u00e3o maior.<\/p>\n<p>O paciente com trombose distal, de aneurisma popl\u00edteo, foi amputado em n\u00edvel de coxa. .<\/p>\n<p>Os pacientes que mantiveram o membro tiveram um seguimento m\u00e9dio de 695,6 dias (213 a 1066). Daqueles com aterosclerose, dois foram a \u00f3bito por co-morbidades com manuten\u00e7\u00e3o do membro, dois apesar de fecharem suas f\u00edstulas mantiveram o membro e um paciente apresentava ainda sua f\u00edstula p\u00e9rvia. Daqueles com tromboangeite obliterante, quatro tinham f\u00edstulas patentes e um f\u00edstula fechada.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Referencias:<\/strong><\/p>\n<ul>\n<li>Alexandrescu V; Ngongang C; Vincent G; Ledent G; Hubermont G. Deep calf veins arterialization for inferior limb preservation in diabetic patients with extended ischaemic wounds, unfit for direct arterial reconstruction: preliminary results according to an angiosome model of perfusion. Cardiovasc Revasc Med 2011;12(1):10-9.<\/li>\n<li>Djoric P. Early individual experience with distal venous arterialization as a lower limb salvage procedure. Am Surg 2011;77(6):726-30.<\/li>\n<li>Mutirangura P; Ruangsetakit C; Wongwanit C; Sermsathanasawadi N;Chinsakchai K. Pedal bypass with deep venous arterialization: the therapeutic option in critical limb ischemia and unreconstructable distal arteries. Vascular 2011;19(6):313-9.<\/li>\n<li>Busato CR, Utrabo CAL, Gomes RZ, Housome JK, Hoeldtke E, Pinto CT, Brand\u00e3o RI, Busato CD. Arterializa\u00e7\u00e3o do arco venoso do p\u00e9 para tratamento da tromboange\u00edte obliterante. J Vasc Bras. 2008;7(3):267-271.<\/li>\n<li>Lu X.W, Idu M.M, Ubbink D.T, Legemate D.A. Meta-analysis of the clinical effectiveness of venous arterialization for salvage of critically ischaemic limbs. Eur J Vasc Endovasc Surg 2006;31:493-9.<\/li>\n<li>Lengua F; La Madrid A; Acosta C; Vargas J. Arterializacion venosa temporal del pie diab\u00e9tico. J.vasc.bras.vol 9 n\u00ba1 Porto Alegre 2010 Epub Apr 23,2010.<\/li>\n<li>Busato CR; Utrabo<sup>I\u00a0<\/sup>CAL; Gomes RZ; Hoeldtke<sup>I\u00a0<\/sup>E; Housome JK; CostaDMM; Busato CD.The great saphenous vein\u00a0<em>in situ<\/em>\u00a0for the arterialization of the venous arch of the foot.J. vasc. bras. vol.9 no.3 Porto Alegre Sept. 2010.<\/li>\n<\/ul>\n<\/div>\n<\/article>\n<p><\/p><\/main><\/div>\n<\/div>\n<\/div>\n<\/article>\n<p><\/p><\/main><\/div>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\"\n\t\t\t data-anchor=\"11-%e2%80%93-coment%c3%a1rios\">\n\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-11-%e2%80%93-coment%c3%a1rios\" aria-controls=\"accordion-content-11-%e2%80%93-coment%c3%a1rios\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t11 \u2013 COMENT\u00c1RIOS\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-11-%e2%80%93-coment%c3%a1rios\"\n\t\t\t\tid=\"accordion-content-11-%e2%80%93-coment%c3%a1rios\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\" tabindex=\"0\">\n\t\t\t\t\t<div class=\"page-head\">\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"col-12\">\n<p>Trabalhos recentes de revasculariza\u00e7\u00e3o distal \u00e0s art\u00e9rias do p\u00e9 mostram \u00edndices de salvamento de membro de 81,7% e 69% em um e tr\u00eas anos de seguimento (Brochado-Neto, 2012); 81,8% (Good, 2011); 89,65% (Slais, 2011); Lengua (2010) com a arterializa\u00e7\u00e3o obteve salvamento de 80% com um tempo m\u00e9dio de permeabilidade de f\u00edstula de 8,5 meses e um seguimento m\u00e9dio de 4 anos e 4 meses sem amputa\u00e7\u00e3o maior.<\/p>\n<p><div id=\"attachment_75\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/comentarios.png\"><img aria-describedby=\"caption-attachment-75\" class=\"size-medium wp-image-75\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/comentarios-300x194.png\" alt=\"\" width=\"300\" height=\"194\" \/><\/a><p id=\"caption-attachment-75\" class=\"wp-caption-text\">Angiog\u00eanese p\u00f3s arterializa\u00e7\u00e3o \u2013 Antes e depois. Fonte: Arterialization del pie por isquemia, F Lengua A.<\/p><\/div><\/p>\n<\/div>\n<p>Os par\u00e2metros adotados na avalia\u00e7\u00e3o de resultados das pontes cl\u00e1ssicas n\u00e3o s\u00e3o aplic\u00e1veis aos da arterializa\u00e7\u00e3o.<\/p>\n<p>&nbsp;<\/p>\n<p>A manuten\u00e7\u00e3o da f\u00edstula arterio venosa ao n\u00edvel do p\u00e9 por um per\u00edodo superior a 30 dias induz o desenvolvimento de neo colaterais e neo arter\u00edolas (arteriog\u00eanese) que s\u00e3o evidenciadas em arteriografias de controle (figura 1 A e B) e neo capilares (angiog\u00eanese) (figura 2 A e B) (Wahlberg\u00a0<em>et al<\/em>.,2003; Mousa\u00a0<em>et al<\/em>, 2004) de tal forma que sua oclus\u00e3o raramente est\u00e1 associada a perda do membro(Alexandrescu\u00a0<em>et al<\/em>, 2011). Nas deriva\u00e7\u00f5es cl\u00e1ssicas a conserva\u00e7\u00e3o do membro est\u00e1 estreitamente relacionada \u00e0 dura\u00e7\u00e3o da ponte.<\/p>\n<p><div id=\"attachment_68\" style=\"width: 241px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/pos-operatorio.png\"><img aria-describedby=\"caption-attachment-68\" class=\"size-medium wp-image-68\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/pos-operatorio-231x300.png\" alt=\"\" width=\"231\" height=\"300\" \/><\/a><p id=\"caption-attachment-68\" class=\"wp-caption-text\">Aumento da rede de arter\u00edolas mantida ap\u00f3s a oclus\u00e3o do enxerto. Fonte: Arterialization del pie por isquemia, F Lengua A<\/p><\/div><\/p>\n<p>&nbsp;<\/p>\n<div id=\"attachment_82\" class=\"wp-caption aligncenter\">\n<p><div id=\"attachment_75\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/comentarios.png\"><img aria-describedby=\"caption-attachment-75\" class=\"wp-image-75 size-medium\" src=\"http:\/\/www2.uepg.br\/arterializacao\/wp-content\/uploads\/sites\/57\/2020\/04\/comentarios-300x194.png\" alt=\"\" width=\"300\" height=\"194\" \/><\/a><p id=\"caption-attachment-75\" class=\"wp-caption-text\">Aumento da rede capilar mantida ap\u00f3s oclus\u00e3o do enxerto. Fonte: Arterialization del pie por isquemia, F Lengua A.<\/p><\/div><\/p>\n<\/div>\n<div id=\"attachment_95\" class=\"wp-caption alignnone\">\n<p class=\"wp-caption-text\">\n<\/p><\/div>\n<p>Trabalhos recentes de re-vasculariza\u00e7\u00e3o distal \u00e0s art\u00e9rias do p\u00e9 mostram \u00edndices de salvamento de membro de 81,7 e 69% em um e tr\u00eas anos de seguimento(Brochado-Neto, 2012 ); 81,8% (Good\u00a0<em>et al<\/em>, 2011); 89,65% (Slais\u00a0<em>et al<\/em>, 2011 ); 78,1 e 68,5% em 1 ano (grupo1 com tratamento cir\u00fargico inicial e 2 p\u00f3s tentativa de tratamento endovascular) (Spinelli\u00a0<em>et al<\/em>, 2011 ); 78% em 30 meses (Staffa\u00a0<em>et al<\/em>, 2010 ); 50,4% em 5 anos (Brochado-Neto\u00a0<em>et al<\/em>, 2010) e 76% em 24 meses (Khalifa\u00a0<em>et al<\/em>, 2009).<\/p>\n<p>Lengua com a arterializa\u00e7\u00e3o obteve salvamento de 80% com um tempo m\u00e9dio de permeabilidade de f\u00edstula de 8,5 meses e um seguimento m\u00e9dio de 4 anos e 4 meses sem amputa\u00e7\u00e3o maior. Estudo recente comparou as pontes tradicionais abaixo dos mal\u00e9olos com a arterializa\u00e7\u00e3o venosa do arco do p\u00e9, mostrando resultados semelhantes.\u00a0 Nas revasculariza\u00e7\u00f5es com ponte a supress\u00e3o da sintomatologia \u00e9 r\u00e1pida, pois se faz por via fisiol\u00f3gica enquanto que na arterializa\u00e7\u00e3o a recupera\u00e7\u00e3o \u00e9 lenta, \u00e0s vezes com certa progress\u00e3o da necrose, apesar da permeabilidade da f\u00edstula, o que se explica pela forma n\u00e3o fisiol\u00f3gica de revasculariza\u00e7\u00e3o.<\/p>\n<p>Os bons resultados das arterializa\u00e7\u00f5es nos diab\u00e9ticos que no passado era de 64% \u00a0com uma destrui\u00e7\u00e3o mais eficaz das v\u00e1lvulas atinge \u00edndices de 80%. Estes resultados foram obtidos em pacientes sem leito distal e pela falta de estudos randomizados n\u00e3o devem ser comparados com as revasculariza\u00e7\u00f5es tradicionais.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Referencias:<\/strong><\/p>\n<ul>\n<li>Alexandrescu V; Ngongang C; Vincent G; Ledent G; Hubermont G. Deep calf veins arterialization for inferior limb preservation in diabetic patients with extended ischaemic wounds, unfit for direct arterial reconstruction: preliminary results according to an angiosome model of perfusion. Cardiovasc Revasc Med 2011;12(1):10-9.<\/li>\n<li>Busato C.R, Utrabo C.A.L, Housome J.K, Gomes R.Z. Arterializa\u00e7\u00e3o do arco venoso do p\u00e9 para tratamento da isquemia cr\u00edtica sem leito distal. Cir Vasc &amp; Angiol 1999;15:117-121.<\/li>\n<li>Lengua F; La Madrid A; Acosta C; Vargas J. Arterializacion venosa temporal del pie diab\u00e9tico. J.vasc.bras.vol 9 n\u00ba1 Porto Alegre 2010 Epub Apr 23,2010.<\/li>\n<li>BusatoCR; Utrabo<sup>I\u00a0<\/sup>CAL; Gomes RZ; Hoeldtke<sup>I\u00a0<\/sup>E; Housome JK; CostaDMM; Busato CD.The great saphenous vein\u00a0<em>in situ<\/em>\u00a0for the arterialization of the venous arch of the foot.J. vasc. bras. vol.9 no.3 Porto Alegre Sept. 2010<\/li>\n<li>Wahlberg E. Angiogenesis and arteriogenesis in limb ischaemia. J Vasc Surg 2003; 38: 198-203.<\/li>\n<li>Mousa AY. In Advances in Vascular Surgery 2004; Vol. 11; Chapter 9: Angiogenesis in limb ischemia. pp. 122.<\/li>\n<li>Brochado-Neto FC; Cury MV; Bonadiman SS; Matielo MF; Tiossi SR; Godoy MR; Nakano K; Sacilotto R. Vein bypasses to branches of pedal arteries. J Vasc Surg 2012;55(3):746-52.<\/li>\n<li>Good DW;Al Chalabi H; Hameed F; Egan B; Tierney S; Feeley TM. Popliteo-pedal bypass surgery for critical limb ischemia. Ir J Med Sci 2011;180(4):829-35.<\/li>\n<li>Slais M; Czinner P;Koriskov\u00e1 Z; Vit\u00e1sek P; Dvor\u00e1cek L; St\u00e1dler P.Pedal bypass occupies an irreplaceable position in the spectrum of vascular surgery. Cas Lek Cesk 2011;150(4-5):289-92.<\/li>\n<li>Spinelli F; Stilo F; Benedetto F; De Caridi G; La Spada M. Early and one-year results of infrainguinal bypass after failure of endovascular therapy. Int Angiol 2011;30(2):156-63.<\/li>\n<li>Staffa R; Kriz Z. Pedal bypass- ten years experience. Rozhl Chir 2010;89(1):55-8.<\/li>\n<li>Brochado-Neto FC; Cury MV; Costa VS;Casella IB; Matielo MF; Nakamura ET; Pecego CS; Sacilotto R. Inframalleolar bypass grafts for limb salvage. Eur J Vasc Endovasc Surg 2010;40(6):747-53.<\/li>\n<li>Khalifa AA; Gueret G; Badra A; Gouny P. Diabetic critical ischemia of lower limbs: distal arterial revascularization. Acta Chir Belg 2009;109(3):321-6.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\"\n\t\t\t data-anchor=\"12-%e2%80%93-conclus%c3%a3o\">\n\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-12-%e2%80%93-conclus%c3%a3o\" aria-controls=\"accordion-content-12-%e2%80%93-conclus%c3%a3o\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t12 \u2013 CONCLUS\u00c3O\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-12-%e2%80%93-conclus%c3%a3o\"\n\t\t\t\tid=\"accordion-content-12-%e2%80%93-conclus%c3%a3o\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\" tabindex=\"0\">\n\t\t\t\t\t<div class=\"page-head\">\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"col-12\">\n<p>Apesar da literatura mundial recente, mostrar um aumento de publica\u00e7\u00f5es utilizando o m\u00e9todo com sucesso, um n\u00famero expressivo de pacientes sem leito distal continua sendo levado \u00e0 amputa\u00e7\u00e3o sem esta tentativa.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"container\">\n<div class=\"row\">\n<div id=\"primary\" class=\"content-area col-sm-12\"><main id=\"main\" class=\"site-main\" role=\"main\">\n<article id=\"post-97\" class=\"post-97 page type-page status-publish has-post-thumbnail hentry\">\n<div class=\"entry-content\">\n<p>A aus\u00eancia de novas publica\u00e7\u00f5es nacionais a respeito demonstra que a cirurgia, ainda n\u00e3o \u00e9 praticada pelos cirurgi\u00f5es brasileiros, com a frequ\u00eancia esperada.<\/p>\n<p>Os resultados de Lengua\u00a0<em>et al.<\/em>\u00a0(2010) demonstraram que a arterializa\u00e7\u00e3o do p\u00e9 diab\u00e9tico \u00e9 eficaz e dur\u00e1vel a m\u00e9dio e longo prazo devido \u00e0 neo-arteriog\u00eanese e neo-angiog\u00eanese induzida pela f\u00edstula, ainda que esta esteja patente apenas por um per\u00edodo m\u00e9dio de 8 meses. Os dados por n\u00f3s apresentados t\u00eam como base apenas a observa\u00e7\u00e3o cl\u00ednica.<\/p>\n<p>Conclu\u00edmos que a invers\u00e3o do fluxo arterial atrav\u00e9s da \u201carterializa\u00e7\u00e3o\u201d do arco venoso do p\u00e9 deve ser considerada para salvamento de extremidade com isquemia cr\u00edtica sem leito arterial distal (Busato\u00a0<em>et al.<\/em>, 1999).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Referencias:<\/strong><\/p>\n<ul>\n<li>Busato C.R, Utrabo C.A.L, Housome J.K, Gomes R.Z. Arterializa\u00e7\u00e3o do arco venoso do p\u00e9 para tratamento da isquemia cr\u00edtica sem leito distal. Cir Vasc &amp; Angiol 1999;15:117-121.<\/li>\n<li>Lengua F; La Madrid A; Acosta C; Vargas J. Arterializacion venosa temporal del pie diab\u00e9tico. J.vasc.bras.vol 9 n\u00ba1 Porto Alegre 2010 Epub Apr 23,2010.<\/li>\n<\/ul>\n<\/div>\n<\/article>\n<p><\/p><\/main><\/div>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\"\n\t\t\t data-anchor=\"13-%e2%80%93-bibliografia\">\n\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-13-%e2%80%93-bibliografia\" aria-controls=\"accordion-content-13-%e2%80%93-bibliografia\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t13 \u2013 BIBLIOGRAFIA\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-13-%e2%80%93-bibliografia\"\n\t\t\t\tid=\"accordion-content-13-%e2%80%93-bibliografia\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\" tabindex=\"0\">\n\t\t\t\t\t<div class=\"page-head\">\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"col-12\">\n<p>1 \u2013 \u00a0 <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24729255\">Skin temperature in lower hind limb subjected to\u00a0<strong>distal<\/strong>\u00a0vein\u00a0<strong>arterialization<\/strong>\u00a0in rats.<\/a>Sasajima T, Kikuchi S, Ishikawa N, Koyama T. Adv Exp Med Biol. 2014;812:361-8. doi: 10.1007\/978-1-4939-0620-8_48. PMID:24729255<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"container\">\n<div class=\"row\">\n<div id=\"primary\" class=\"content-area col-sm-12\"><main id=\"main\" class=\"site-main\" role=\"main\">\n<article id=\"post-202\" class=\"post-202 page type-page status-publish has-post-thumbnail hentry\">\n<div class=\"entry-content\">\n<p>2 \u2013 \u00a0\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24729249\">Venular valves and retrograde perfusion.<\/a>\u00a0Koyama T, Sugihara-Seki M, Sasajima T, Kikuchi S. Adv Exp Med Biol. 2014;812:317-23. doi: 10.1007\/978-1-4939-0620-8_42. PMID:24729249<\/p>\n<p>3 \u2013 \u00a0\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24585641\">Surgical stimulation of angiogenesis.<\/a>Ozbek C, Kestelli M, Bozok S, Ilhan G, Yurekli I, Ozpak B, Akyuz M, Bademci M. Asian Cardiovasc Thorac Ann. 2014 Jan;22(1):36-9. doi: 10.1177\/0218492312468285. Epub 2013 Jul 11. PMID:24585641<\/p>\n<p>4 \u2013 \u00a0\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24358432\">Early results from an angiosome-directed open surgical technique for\u00a0<strong>venous<\/strong>\u00a0<strong>arterialization<\/strong>\u00a0in patients with critical lower limb ischemia.<\/a>Houlind K, Christensen J, Hallenberg C, Jepsen JM. Diabet Foot Ankle. 2013 Dec 17;4. doi: 10.3402\/dfa.v4i0.22713. eCollection 2013. PMID:24358432<\/p>\n<p>5 \u2013 \u00a0\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24314764\">Pathomorphological description of the shunted portion of a filum terminale arteriovenous fistula.<\/a>Takeuchi M, Niwa A, Matsuo N, Joko M, Nakura T, Aoyama M, Yokoi T, Takayasu M. J. 2014 Feb 1;14(2):e7-10. doi: 10.1016\/j.spinee.2013.09.022. Epub 2013 Oct 12. PMID:24314764<\/p>\n<p>6 \u2013 \u00a0\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24189192\">Comparative study of\u00a0<strong>venous<\/strong>\u00a0<strong>arterialization<\/strong>\u00a0and pedal bypass in a patient cohort with critical limb ischemia.<\/a>Schreve MA, Minnee RC, Bosma J, Leijdekkers VJ, Idu MM, Vahl AC. Ann Vasc Surg. 2014 Jul;28(5):1123-7. doi: 10.1016\/j.avsg.2013.08.010. Epub 2013 Nov 1. PMID:24189192<\/p>\n<p>7 \u2013 \u00a0\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22879040\">Biological maintenance of\u00a0<strong>distal<\/strong>\u00a0vein\u00a0<strong>arterialization<\/strong>.<\/a>Sasajima T, Koyama T.Adv Exp Med Biol. 2013;765:245-50. doi: 10.1007\/978-1-4614-4989-8_34.PMID:22879040<\/p>\n<p>8 \u2013 \u00a0\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22678100\"><strong>Distal<\/strong>\u00a0<strong>venous<\/strong>\u00a0<strong>arterialization<\/strong>\u00a0and reperfusion injury: focus on oxidative status.<\/a>Djoric P, Zeleskov-Djoric J, Stanisavljevic DM, Markovic ZD, Zivkovic V, Vuletic M, Djuric D, Jakovljevic V. Eur Surg Res. 2012;48(4):200-7. doi: 10.1159\/000338619. Epub 2012 Jun 7. PMID:22678100<\/p>\n<p>9 \u2013 \u00a0\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22008976\">Pedal bypass with deep\u00a0<strong>venous<\/strong>\u00a0<strong>arterialization<\/strong>: the therapeutic option in critical limb ischemia and unreconstructable\u00a0<strong>distal<\/strong>\u00a0arteries.<\/a>Mutirangura P, Ruangsetakit C, Wongwanit C, Sermsathanasawadi N, Chinsakchai K.Vascular. 2011 Dec;19(6):313-9. doi: 10.1258\/vasc.2010.oa0278. Epub 2011 Oct 18. PMID:22008976<\/p>\n<p>10 \u2013 \u00a0\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21296474\">[Treatment of hand ischemia with\u00a0<strong>arterialization<\/strong>\u00a0of the\u00a0<strong>venous<\/strong>\u00a0system of the hand: report of three cases].<\/a>Nguyen PS, Legr\u00e9 R, Gay AM. Ann Chir Plast Esthet. 2011 Jun;56(3):200-6. doi: 10.1016\/j.anplas.2010.12.005. Epub 2011 Feb 5. French. PMID:21296474<\/p>\n<p>11 \u2013 \u00a0\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20471787\">Successful repair for a ruptured\u00a0<strong>venous<\/strong>\u00a0aneurysm: an unusual complication of\u00a0<strong>venous<\/strong>\u00a0<strong>arterialization<\/strong>\u00a0in Buerger\u2019s disease.<\/a>Wu WW, Liu CW, Liu B, Ye W, Chen Y, Jiang XY. Ann Vasc Surg. 2010 Jul;24(5):693.e5-7. doi: 10.1016\/j.avsg.2009.10.015. Epub 2010 May 14. PMID:20471787<\/p>\n<p>12 \u2013 \u00a0Busato, CR. O papel da revasculariza\u00e7\u00e3o retr\u00f3grada no salvamento do p\u00e9 isqu\u00eamico. In: Moreira, RCR. Dor na perna. Uma abordagem multidisciplinar das dores do membro inferior. Curitiba: XI Encontro de angiologia e de cirurgia vascular do Conesul, 2012. p. 425-444.<\/p>\n<p>13 \u2013 \u00a0 Alexandrescu V; Ngongang C; Vincent G; Ledent G; Hubermont G.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21241966\">Deep calf veins arterialization for inferior limb preservation in diabetic patients with extended ischaemic wounds, unfit for direct arterial reconstruction: preliminary results according to an angiosome model of perfusion<\/a>. Cardiovasc Revasc Med 2011; 12 (1): 10-9.<\/p>\n<p>14 \u2013 \u00a0 Djoric P.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21679641\">Early individual experience with distal venous arterialization as a lower limb salvage procedure<\/a>. Am Surg. 2011 Jun;77(6):726-30.<\/p>\n<p>15\u00a0\u2013 \u00a0 Mutirangura P, Ruangsetakit C, Wongwanit C, Sermsathanasawadi N, Chinsakchai K.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22008976\">Pedal bypass with deep venous arterialization: the therapeutic option in critical limb ischemia and unreconstructable distal arteries<\/a>. Vascular. 2011 Dec;19(6):313-9.<\/p>\n<p>16\u00a0\u2013 \u00a0 Matarrese MR, Hammert WC.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22054709\">Revascularization of the ischemic hand with arterialization of the venous system<\/a>. J Hand Surg Am. 2011 Dec;36(12):2047-51.<\/p>\n<p>17 \u2013 \u00a0\u00a0Nguyen PS; Legr\u00e9 R; Gay AM.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21634210\">Traitement de le main en isch\u00e9mie chronique par arterialization du syt\u00e8me veineux superficial: \u00e0q propos de trios cas<\/a>. Ann Chir Plast Esthet 2011; 56(3): 200-6.<\/p>\n<p>18 \u2013 \u00a0 Lengua F, La Madrid A, Acosta C, Vargas J.\u00a0<a href=\"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&amp;pid=S1677-54492010000100003\">Arterializacion venosa temporal del pie diab\u00e9tico<\/a>. J. vasc. Bras. Vol.9 no. 1 Porto Alegre 2010 Epub Apr 23, 2010.<\/p>\n<p>19 \u2013 \u00a0 Busato CR; Utrabo CAL; Gomes RZ; Hoeldtke E; Housome JK; Costa DMM; Busato CD.\u00a0<a href=\"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&amp;pid=S1677-54492010000300004\">The great saphenous vein in situ for the arterialization of the venous arch of the foot<\/a>. J. vasc. bras. Vol.9 no.3 Porto Alegre Sept.2010.<\/p>\n<p>20 \u2013 \u00a0 Keshelawa G, Gigilashvili K, Chkholaria A, Pagava G, Janashia G, Beselia K.\u00a0<a href=\"http:\/\/www.jvascnurs.net\/article\/S1062-0303(08)00118-0\/abstract?cc=y=\">Foot venous system arterialization for salvage of non\u00acreconstructable acute ischemic limb: a case report<\/a>. J Vasc Nurs. 2009; 27:13-6.<\/p>\n<p>21 \u2013 \u00a0 Khalifa AA, Gueret G, Badra A, Gouny P.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19943587\">Diabetic critical ischemia of lower limbs: distal arterial revascularisation<\/a>. Acta Chir Belg. 2009 May-Jun;109(3):321-6.<\/p>\n<p>22 \u2013 \u00a0 Busato CR, Utrabo CAL, Gomes RZ, et al.\u00a0<a href=\"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&amp;pid=S1677-54492008000300013\">Arterializa\u00e7\u00e3o do arco ve\u00acnoso do p\u00e9 para tratamento da tromboange\u00edte obliterante<\/a>. J Vasc Bras. 2008; 7:267-71.<\/p>\n<p>23 \u2013 \u00a0 Chloros GD, Li Z, Koman LA.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18762095\">Long-term successful outcome of severe hand ischemia using arterialization with reversal of venous flow: case report<\/a>. J Hand Surg Am. 2008 Sep;33(7):1048-51.<\/p>\n<p>24 \u2013 \u00a0 Pokrovsky AV, Dan VN, Chupin AV, Kalinin AA.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18004268\">Arterialization of the hand venous system in patients with critical ischemia and thrombangiitis obliterans<\/a>. Angiol Sosud Khir. 2007;13(2):105-11.<\/p>\n<p>25 \u2013 \u00a0 Gavrilenko AV, Skrylev SI.\u00a0<a href=\"http:\/\/europepmc.org\/abstract\/MED\/18004267\/reload=0;jsessionid=4%20o4FBWLlQNzfC4OE7iDB.24\">Long-term results of venous blood flow arterialization of the leg and foot in patients with critical lower limb ischemia<\/a>. Angiol Sosud Khir. 2007;13:95-103.<\/p>\n<p>26 \u2013 \u00a0 Lengua F; Arterialization Del Pie por isquemia \u2013 Ultima oportunidad para evitar amputaciones em diab\u00e9ticos. 1\u00aa edicition. Lima, Ed. Delvis S.R.L. Julio, 2006.<\/p>\n<p>27 \u2013 \u00a0 Lu XW, Idu MM, Ubbink DT, Legemate DA.\u00a0<a href=\"http:\/\/www.ejves.com\/article\/S1078-5884%2806%2900040-2\/abstract\">Meta-analysis of the clinical effectiveness of venous arterialization for salvage of critically ischaemic limbs<\/a>. Eur J Vasc Endovasc Surg. 2006;31:493-9.<\/p>\n<p>28 \u2013 \u00a0 Kind GM.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16874213\">Arterialization of the venous system of the hand<\/a>. Plast Reconstr Surg. 2006 Aug;118(2):421-8.<\/p>\n<p>29 \u2013 \u00a0 Ozbeck C, Kestelli M, Emrecan B, et al.\u00a0<a href=\"http:\/\/www.ejves.com\/article\/S1078-5884%2804%2900449-6\/abstract\">A novel approach: ascending venous arterialization for atherosclerosis obliterans<\/a>. Eur J Vasc Endovasc Surg. 2005;29:47-51<\/p>\n<p>30 \u2013 \u00a0 Mousa AY. In Advances in Vascular Surgery 2004; vol. 11; Chapter 9:\u00a0<a href=\"http:\/\/vmj.sagepub.com\/content\/9\/3\/193.short\">Angiogenesis in limb ischemia<\/a>. pp. 122.<\/p>\n<p>31 \u2013 \u00a0 Wahlberg E.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12844115\">Angiogenesis and arteriogenesis in limb ischemia<\/a>. J Vasc Surg. 2003 Jul;38(1):198-203.<\/p>\n<p>32 \u2013 \u00a0 Rowe VL, Hood DB, Liphan J, et al.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11972250\">Initial experience with dorsal venous arch arterialization for limb salvage<\/a>. Ann Vasc Surg. 2002;16:187-92.<\/p>\n<p>33 \u2013 \u00a0 Gasparis AP, Noor S, Da Silva MS, Tassiopoulos AK, Semel L.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12476238\">Distal venous arterialization for limb salvage\u2013a case report<\/a>. Vasc Endovascular Surg. 2002;36:469-72.<\/p>\n<p>34 \u2013 \u00a0 Garrido MB. 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J Vasc Bras, v. 16, n. 3, p. 187-194, 2017.<\/p>\n<p>66 \u2013\u00a0Lichtenberg, M et al.\u00a0<a href=\"http:\/\/econtent.hogrefe.com\/doi\/pdf\/10.1024\/0301-1526\/a000669\">Surgical and endovascular venous arterialization for treatment of critical limb ischaemia<\/a>. Vasa, v. 1, n. 1, p. 1-6, 2017.<\/p>\n<\/div>\n<\/article>\n<p><\/p><\/main><\/div>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>01 &#8211; INTRODU\u00c7\u00c3O Com o avan\u00e7o das t\u00e9cnicas endovasculares, angiogr\u00e1ficas e da microcirurgia tem sido poss\u00edvel a realiza\u00e7\u00e3o de procedimentos em art\u00e9rias de pequeno calibre ao n\u00edvel do tornozelo e do p\u00e9. No entanto, tais t\u00e9cnicas exigem a presen\u00e7a de leito arterial distal que est\u00e1 ausente em muito pacientes o que os leva a uma&nbsp;&hellip;<\/p>\n","protected":false},"author":24,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www2.uepg.br\/arterializacao\/wp-json\/wp\/v2\/pages\/13"}],"collection":[{"href":"https:\/\/www2.uepg.br\/arterializacao\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www2.uepg.br\/arterializacao\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www2.uepg.br\/arterializacao\/wp-json\/wp\/v2\/users\/24"}],"replies":[{"embeddable":true,"href":"https:\/\/www2.uepg.br\/arterializacao\/wp-json\/wp\/v2\/comments?post=13"}],"version-history":[{"count":29,"href":"https:\/\/www2.uepg.br\/arterializacao\/wp-json\/wp\/v2\/pages\/13\/revisions"}],"predecessor-version":[{"id":168,"href":"https:\/\/www2.uepg.br\/arterializacao\/wp-json\/wp\/v2\/pages\/13\/revisions\/168"}],"wp:attachment":[{"href":"https:\/\/www2.uepg.br\/arterializacao\/wp-json\/wp\/v2\/media?parent=13"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}