Method: Merino type sheep were divided into three groups each containing five sheep, and three different surgical techniques were applied. In-group one, distal of artery was ligatured immediately after right femoral arteriovenous anastomosis. In the second group following right femoral arteriovenous anastomosis, on the 11th postoperative day and arteriovenous reversal was made. Proximal of the vein was ligatured in both groups postoperatively on the 11th day. In-group three, only left femoral femoral artery was ligatured at the proximal. One subject randomly chosen from each group underwent digital substract angiography (DSA) and 99mTc macro aggregated albumin (MAA) syntigraphy. Again these subjects were pathologically evaluated on the biopsy samples taken from adductor and semimembranous muscles of ischemic extremity. Besides, the thigh thickness differences, tension arterial (TA), TA levels of extremities compared with the other extremity and whether necrosis existed in distal extremity were evaluated postoperatively on the day of operation, 10th day, 20th day, 30th day and 40th day. ATP evaluation was assessed in the tissue samples taken on the 40th day preoperatively and postoperatively. Clinical findings were more favorable in group 2. Most favorable arterial pressure, syntigraphic appearance and angiographic arterialization were found in group 2. In histopathologic evaluation, ischemic injury was found to be moderate in group 1, mild in group 2 and severe in group 3. Biochemical analysis showed highest level of ATP in group 2.

Result: In conclusion, gradedly applied staged arteriovenous reversal technique was thought to be applicable on patients with ischemic extremity, which cannot be treated with other surgical reconstruction treatments.