Biological Maintenance of Distal Vein Arterialization
Eleven weeks after surgery, a fine microvessel network was seen in the feet of patients with arteriosclerosis obliterans treated by distal vein arterialization. A possible mechanism for establishment of blood flow to, and biological maintenance of, the graft in the foot, in relation to oxygen consumption rate during walking was investigated, using Krogh’s tissue cylinder model. Our calculations showed that the increase in oxygen consumption rate of the muscle when patients walked would reduce the size of the oxygen front in the tissue cylinder, thus producing small, transient hypoxic regions in skeletal foot muscle. Such muscle hypoxia, although localized, could stimulate synthesis of vascular endothelial growth factor and facilitate angiogenesis in the grafted tissue. The architecture of fine microvessel networks observed in the foot by angiography seems consistent with this supposition and, moreover, suggests that the reinstatement of blood vessel networks in the foot tissues after grafting is supported by “normal” biological mechanisms.
KeywordsDistal vein arterialization
Thanks are due to Professor Dr. Ian Silver and Professor Dr Maria Erecinska for their kind reading of the manuscript and valuable suggestions.
- 2.Azuma N, Inaba M, Akasaka N, Sasajima T et al (2005) Foot salvage achieved by free flap transfer with bypass surgery. Jpn J Vasc Surg 14:151–158Google Scholar
- 3.Koyama T, Sasajima T (2009) Sufficient oxygen can be transported to resting skeletal muscle via arterialization of the vein: theoretical in a rat model. In: LaManna JC et al (eds) Oxygen transport to tissue, vol XXXII. Springer, NewYork, NY, pp 335–339Google Scholar
- 4.Koyama T, Sasajima T (2012) Retrograde perfusion of the hind leg in diabetic patients suffering from the arteriosclerosis obliterans: theoretical considerations of Oxygen supply and lymphatic flow based on rat models. Adv Exp Med Biol 737: 259–262Google Scholar
- 7.Rissanen TT, Korpisalo P, Markkanen JE et al (2005) Blood flow remodels growing vasculature during vascular endothelial growth factor gene therapy and determines between capillary endothelial growth factor gene therapy and determines between capillary arterization and sprouting angiogenesis. Circulation 112:3937–3946CrossRefGoogle Scholar
- 12.Lumb AB (2005) Nunn’s applied respiratory physiol, 6th edn. Elsevier, Philadelphia, p 240Google Scholar