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.
[Show abstract][Hide abstract] 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).
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] 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 · 3.02 Impact Factor
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