Residual arteriovenous fistulae after ''closed'' in situ bypass grafting: An overrated problem
ABSTRACT To prospectively evaluate the incidence and consequences of residual arteriovenous (AV)-fistulae after "closed" in situ bypass grafting.
In 34 patients, 35 "closed" in situ bypasses were performed. Postoperative assessment of residual AV-fistulae and bypass patency was performed with duplex scanning.
Postoperative mortality was 3%. During 35 "closed" in situ bypass procedures 216 side branches were coil embolised. Postoperatively 39 AV-fistulae were detected (15% of the total number of 216 + 39 = 255 side branches). Of these, 13 (5%) closed spontaneously. Fifteen (6%) remained unchanged and 11 (4%) were treated. In three patients four asymptomatic residual AV-fistulae were treated. In four patients seven symptomatic AV-fistulae were treated for: decreased distal bypass flow in one; persistent leg oedema in one; pain and redness of the skin in two. One-year primary patency was 80% (SE 8.4%). Residual AV-fistulae were detected in none of six bypass occlusions during follow-up.
Residual AV-fistulae detected following "closed" in situ bypass grafting only need treatment if they are symptomatic, which is uncommon.
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ABSTRACT: The "closed" in situ bypass results in a reduction of wound complications compared to the "open" technique. This advantage is partly diminished by extra costs for the "closed" procedure and a larger percentage of residual arteriovenous (AV)-fistulae. This aim of this study was to analyse costs related to "closed" and "open" procedures. The cost affecting parameters: (1) duration of operation; (2) length of hospital stay; and (3) number of treated residual AV-fistulae, were analysed in a randomised group of 73 patients (35 "closed" and 38 "open") in two centres. In addition, costs of the operation, nursing care and treatment of AV-fistulae were analysed. The "closed" and "open" group showed a median duration of operation of 210 min (range 105-570) and 154 min (range 90-355) (p < 0.05), length of hospital stay of 16 days (range 5-51) and 25 days (range 12-65) (p < 0.01), and a percentage of patients treated for residual AV-fistulae of 40% and 5%, respectively (p < 0.01). The median "closed" operation was US$798 more expensive than the "open". Median postoperative care was US$2664 less for the "closed" group. Mean estimated costs for treatment of AV-fistulae was US$9 in the "open" and US$167 in the "closed" group. The "closed" in situ vein bypass technique is cost-effective in comparison with the "open" technique.European Journal of Vascular and Endovascular Surgery 06/1997; 13(5):460-3. DOI:10.1016/S1078-5884(97)80173-6 · 3.07 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the influence on patency of residual arteriovenous fistulae (AVF) after in situ saphenous vein bypass grafting. Between January 1, 1994, and December 31, 1996, 98 in situ saphenous vein bypass grafting procedures were performed in 94 patients. Patency was evaluated with duplex scanning after operation and at 1, 3, 6, 9, and 12 months. The indications for operation were intermittent claudication in two patients and critical leg ischemia in 92 patients. Two above-knee and 48 below-knee femoropopliteal and 48 femorocrural in situ saphenous vein bypass grafting procedures were performed. The median follow-up period was 9 months (range, 1.5 to 12.5 months). There were no residual AVF in 45 veins (44%; group 1), but 110 residual AVF were found in 53 veins (56%; group 2). In group 2, 36 AVF in 18 veins were surgically or radiologically occluded mainly as a result of a flow velocity decrease distal to the AVF, but the remaining 74 AVF were treated conservatively. The 1-year cumulative primary patency rates were 68% in group 1 and 74% in group 2 (log-rank test, 0.47; degree of freedom = 1; P =.52). The 1-year cumulative assisted primary patency rates were 68% in group 1 and 81% in group 2 (log-rank test, 2.19; degree of freedom = 1; P =. 14). Residual AVF after in situ bypass grafting without influence on bypass graft hemodynamics do not compromise patency and thrombose spontaneously.Journal of Vascular Surgery 08/1999; 30(1):99-10. DOI:10.1016/S0741-5214(99)70181-3 · 2.98 Impact Factor
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ABSTRACT: Lower extremity arterial reconstructions with in situ greater saphenous vein (GSV) are an important component of limb salvage surgery. Initially, the procedure was performed through continuous skin incisions for side branch occlusion and valve lysis with a wound complication rate of 5% to 25%. To decrease these complications, we used endoscopic GSV harvest equipment in 25 in situ vein bypass grafts in 25 patients performed over 24 months. The procedures were performed with three skin incisions: two for arterial access and a 2-cm incision above the knee to insert the Endopath device (Ethicon) to locate and clip the GSV side branches. After completion of the proximal anastomosis, the valves were lysed through the distal end of the vein with a flexible valvulotome. Completion cineangiography was performed to confirm side branch occlusion and evaluate the entire reconstruction. The results of this technique were compared with our last 25 in situ bypass grafts done with standard long incisions. In the endoscopic group there was one (4%) minor wound complication (cellulitis). No postoperative arteriovenous fistulas were detected by means of duplex examination, and the average hospital stay was 6.2 +/- 1 days. One graft closed at 9 months as a result of distal vein hyperplasia, but the other grafts have remained patent, with follow-up from 6 to 30 months (mean, 18 months). Patients with the standard in situ bypass grafts had significantly (P < .05) more wound complications (20%) and longer average hospital stay (9.2 +/- 2 days) than the endoscopic group. Patency rates were comparable for both groups. These results show that less invasive endoscopic in situ bypass grafting minimizes wound complications and reduces the need for hospitalization without decreasing patency or increasing operative time.Journal of Vascular Surgery 11/2001; 34(4):668-72. DOI:10.1067/mva.2001.115810 · 2.98 Impact Factor