Residual arteriovenous fistulae after ''closed'' in situ bypass grafting: An overrated problem

Diergaarde Blijdorp, Rotterdam, South Holland, Netherlands
European Journal of Vascular and Endovascular Surgery (Impact Factor: 2.49). 06/1997; 13(5):439-42. DOI: 10.1016/S1078-5884(97)80170-0
Source: PubMed


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 autologous greater saphenous vein is considered to be the best bypass material for below knee femoropopliteal and femorocnual arterial reconstructions . . The history of the greater saphenous vein arterial bypass in humans started in 1949, with its first introduction by Kunlin. Upto 1959, when Rob performed the first in situ saphenous vein bypass, the reversed saphenous vein technique of Kunlin was the standard procedure. The first publication about the in situ bypass was written in 1962 by Karl Victor Hall. After tlus preliminary report, several optimistic reports, written by Hall, ConnOlly, May and Samuel followed. Despite the promissing results, the in situ bypass technique only achieved minimal popularity, mainly in Europe. It was not before Leather, Powers and Karmody published their historical publication in 1979 that the in situ bypass really was considered to be a worthy alternative for the "reversed" technique. Their excellent results received worldwide attention and contributed to the adoption of the in situ bypass technique in many major vascular surgery departments during the early eighties (including those in the USA).
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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 · 2.49 Impact Factor
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