Early results of endovascular-assisted in situ saphenous vein bypass grafting |
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| Affiliation: | 1. AdventHealth East Orlando, 258 South Chickasaw Trail, Suite 203, Orlando, FL 32825, United States of America;2. The Cardiac and Vascular Consultants, 1050 Old Camp Road, Suit 270, The Villages, FL 32162, USA;3. Virginia Commonwealth University, 1755 North Mecklenburg Avenue, South Hill, VA 23970, USA;4. St. Francis Hospital and Medical Center, 100 Trumbull St, Hartford, CT 06103, USA;5. Geisinger Holy Spirit Hospital, 875 Polpar Church Road, Camp Hill, PA 17011, USA;6. New York University, E 24th St, New York, NY 10010, USA;7. Cardiovascular Institute of the South, 6550 Main St, Suite 1000, Zachary, LA 70791, USA;8. The Wright Center for Graduate Medical Education, 111 North Washington Avenue, Scranton, PA 18503, USA;1. Assistant Professor, Anatomical Pathology and Clinical Morphology Department, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia;2. Professor, Deputy of General Director for Science and Preventive Cardiology, National Medical Research Centre of Cardiology after E. Chazov, Moscow, Russia;3. Professor, Scientific Director, Research Institute of Human Morphology FSBI «Petrovskiy NRCS, Moscow, Russia;4. Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran;5. Razi Drug Research Centre, School of Medicine, Iran University of Medical Sciences, Tehran, Iran;6. Professor, Head of Pathophysiology Department, Siberian State Medical University, Tomsk, Russia;7. Associate Professor, Pathophysiology Department, Kuban State Medical University, Krasnodar, Russia;8. Professor, Pathophysiology Department, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia;9. Professor, Head of Internal Diseases Propedeutics Department, Yerevan State Medical University after M. Heratsi, Armenia;10. Associate Professor, Medical Microbiology Department, Yerevan State Medical University after M.Heratsi, Armenia;11. Research Fellow, Atherosclerosis and Metabolic Disorders Research Unit, University of Bologna, Bologna, Italy;12. Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy;13. Professor of Cardiology Department, Head of Cardiology Unit Azienda Policlinico Umberto II, Sapienza University, Rome, Italy;14. Professor, Head of Internal Disease, Cardiology and Clinical Pharmacology Department, Peoples’ Friendship University of Russia (RUDN), Moscow, Russia;15. Isfahan Cardiovascular Research Institute, Isfahan, Iran;p. Professor, Head of Cardiovascular Medicine Division, University of Pisa, Pisa, Italy;q. Professor, Head of Experimental and Clinical Pathology Department, Al. Natishvili Institute of Experimental Morphology, I. Javakhishvili Tbilisi State University, Tbilisi, Georgia;r. Professor, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran |
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| Abstract: | Purpose: This study evaluated an endovascular technique for occlusion of arteriovenous fistula when performing saphenous vein in situ bypass grafting.Methods: In 31 limbs femoropopliteal (17) or femorotibial (14) in situ bypass grafting was performed for claudication/aneurysm (4), rest pain (6), or tissue loss (21). A valvulotome was used for valve lysis. Saphenous vein branches were identified with angioscopy in 16 limbs or with fluoroscopy in the remainder. An electronically steerable endovascular catheter was used to deliver platinum coils into the venous tributaries to occlude them.Results: The maximal number of coils placed in any limb was nine. Most operations were performed with only a groin incision (length = 9.8 ± 1.6 cm) and a distal incision (length = 16.8 ± 6.5 cm). Wound complications occurred in four limbs, whereas four limbs developed localized superficial thrombophlebitis. The postoperative ankle-brachial index increased to a mean of 0.91 ± 0.12. Postoperative duplex imaging revealed a missed arteriovenous fistula in 12 limbs. Two were surgically ligated, whereas the remainder were embolized in the radiology suite. Postoperative length of hospitalization was 4 ± 2 days in uncomplicated cases. Follow-up revealed five graft occlusions. Occlusion occurred at 12 hours, 2 weeks, and 6, 14, and 15 months after operation. Although there were no perioperative deaths, two patients have died of unrelated causes.Conclusion: This endovascular technique of arteriovenous fistula embolization decreased the length of the surgical wounds, and patients were discharged 4 ± 2 days in uncomplicated cases. The ultimate test of its efficacy, however, will be long-term functional results. (J VASC SURG 1994;19:778-87.) |
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