Early results of endovascular-assisted in situ saphenous vein bypass grafting

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...

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Veröffentlicht in:Journal of vascular surgery 1994-05, Vol.19 (5), p.778-787
Hauptverfasser: Cikrit, Dolores F., Dalsing, Michael C., Lalka, Stephen G., Fiore, Nicholas F., Sawchuk, Alan P., Ladd, Alan P., Solooki, Betty
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container_end_page 787
container_issue 5
container_start_page 778
container_title Journal of vascular surgery
container_volume 19
creator Cikrit, Dolores F.
Dalsing, Michael C.
Lalka, Stephen G.
Fiore, Nicholas F.
Sawchuk, Alan P.
Ladd, Alan P.
Solooki, Betty
description 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 V ASC S URG 1994;19:778-87.)
doi_str_mv 10.1016/S0741-5214(94)70002-8
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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 V ASC S URG 1994;19:778-87.)</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/S0741-5214(94)70002-8</identifier><identifier>PMID: 8170031</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Aneurysm - surgery ; Angioscopes ; Angioscopy - methods ; Arteriovenous Shunt, Surgical - instrumentation ; Arteriovenous Shunt, Surgical - methods ; Embolization, Therapeutic - instrumentation ; Embolization, Therapeutic - methods ; Female ; Femoral Artery - surgery ; Fluoroscopy - instrumentation ; Fluoroscopy - methods ; Gangrene - surgery ; Humans ; Intermittent Claudication - surgery ; Intraoperative Care - methods ; Leg Ulcer - surgery ; Male ; Middle Aged ; Popliteal Artery - surgery ; Saphenous Vein - diagnostic imaging ; Saphenous Vein - surgery ; Tibial Arteries - surgery</subject><ispartof>Journal of vascular surgery, 1994-05, Vol.19 (5), p.778-787</ispartof><rights>1994 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c407t-2bbe06053f4699548f66bbfcb49c98e07f03a0513e4cd5a6192bfa4719dd3f773</citedby><cites>FETCH-LOGICAL-c407t-2bbe06053f4699548f66bbfcb49c98e07f03a0513e4cd5a6192bfa4719dd3f773</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0741-5214(94)70002-8$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8170031$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cikrit, Dolores F.</creatorcontrib><creatorcontrib>Dalsing, Michael C.</creatorcontrib><creatorcontrib>Lalka, Stephen G.</creatorcontrib><creatorcontrib>Fiore, Nicholas F.</creatorcontrib><creatorcontrib>Sawchuk, Alan P.</creatorcontrib><creatorcontrib>Ladd, Alan P.</creatorcontrib><creatorcontrib>Solooki, Betty</creatorcontrib><creatorcontrib>From the Department of Surgery, Indiana University Medical Center, Richard L. Roudebush Veteran's Administration Hospital, Indianapolis</creatorcontrib><title>Early results of endovascular-assisted in situ saphenous vein bypass grafting</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>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. 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Roudebush Veteran's Administration Hospital, Indianapolis</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cikrit, Dolores F.</au><au>Dalsing, Michael C.</au><au>Lalka, Stephen G.</au><au>Fiore, Nicholas F.</au><au>Sawchuk, Alan P.</au><au>Ladd, Alan P.</au><au>Solooki, Betty</au><aucorp>From the Department of Surgery, Indiana University Medical Center, Richard L. Roudebush Veteran's Administration Hospital, Indianapolis</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early results of endovascular-assisted in situ saphenous vein bypass grafting</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>1994-05-01</date><risdate>1994</risdate><volume>19</volume><issue>5</issue><spage>778</spage><epage>787</epage><pages>778-787</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><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 V ASC S URG 1994;19:778-87.)</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>8170031</pmid><doi>10.1016/S0741-5214(94)70002-8</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Aneurysm - surgery
Angioscopes
Angioscopy - methods
Arteriovenous Shunt, Surgical - instrumentation
Arteriovenous Shunt, Surgical - methods
Embolization, Therapeutic - instrumentation
Embolization, Therapeutic - methods
Female
Femoral Artery - surgery
Fluoroscopy - instrumentation
Fluoroscopy - methods
Gangrene - surgery
Humans
Intermittent Claudication - surgery
Intraoperative Care - methods
Leg Ulcer - surgery
Male
Middle Aged
Popliteal Artery - surgery
Saphenous Vein - diagnostic imaging
Saphenous Vein - surgery
Tibial Arteries - surgery
title Early results of endovascular-assisted in situ saphenous vein bypass grafting
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