Journal articles on the topic 'Bypass graft'
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1
Davidovic, Lazar, Ilija Kuzmanovic, Dusan Kostic, Ilijas Cinara, Slobodan Cvetkovic, Miljko Ristic, Dusan Velimirovic, and Dragica Jadranin. "Obturator or "lateral" bypass in the management of infected vascular prostheses at the groin." Srpski arhiv za celokupno lekarstvo 130, no. 1-2 (2002): 27–32. http://dx.doi.org/10.2298/sarh0202027d.
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The infection of the previously implanted vascular graft at the groin, is associated with great mortality and morbidity rate [1]. The authors present a retrospective study in which they analyzed management of infected vascular prostheses at the groin, using obturator bypass in 26 cases, and "lateral" bypass in 15 cases. The indications for obturator bypass reconstructions included: 20 infections of aorto-femoral grafts, two infected pse udoaneurysms in the groin after RTA of the superficial femoral artery, and 4 infections of iliac-femoral grafts. The indications for lateral bypass reconstructions were: infections after aorto-femoral reconstructions - 8 cases; infection after femora-popliteal reconstructions - 4 cases; infection after iliac-femoral reconstruction - 2 patients, and one infected pseudoaneurysm in the groin after RTA of the superficial femoral artery. In 3 subjects obturator bypass was performed using extraperitoneal approach while in other 23 patients transperitoneal approach was done by donor's artery. The obturator bypass was performed using a PTFE graft in 3 cases and Dacron graft in 23. The donor's artery used for obturator bypass was a noninfected proximal part of aortofemoral graft in 20 cases, and iliac artery in 6 patients. The superfical femoral artery was recipient artery for obturator bypass in 3 cases, deep femoral artery in one case, and above the knee popliteal artery in 22 cases (Figure 1). In two patients transperitoenal approach to donors artery for "lateral" bypass has been used, and in 13 cases extraperitoneal. The proximal noninfected part of aorto femoral graft was used as a donor's artery for lateral bypass in 8 patients, while common iliac artery in 7 subjects. In 5 cases recon structions were performed using PTFE grafts, in 3 using autologous saphenous vein grafts, and in 7 using Dacron grafts. The recipient artery for "lateral" bypass was deep femoral in 8 cases, superficial femoral in three patients and above the knee popliteal artery in 4 subjects. After both types of reconstruction, extirpation of infected grafts from the groin was performed (Figure 2). The control examination was performed using physical and Doppler ultrasonographic examinations, one, 3, 6, 12 months, and then every year after the operation. In cases with suspected graft infection or thrombosis, control angography was also performed. One intraoperative perforation of the urinary bladder has been done accidentally during obturator bypass reconstruction. The mean follow-up period for patients with obturator bypasses was 2.3 years, while 2.1 years for patients with "lateral" bypasses. Comparing with "lateral" bypass, obturator bypass showed statistically significant lower (p < 0.05) 30- day mortality and early graft infection rate, as well as statistically significant better early and total limb salvage rate. There were no statistically significant differences (p > 0.05) between obturator and "lateral" bypass procedures having in mind, late graft infection rate, as well as early and late graft patency (Figures 3 and 4). In cases with infected vascular prostheses in the groin, the authors recommend obturator bypass comparing with "lateral" bypass.
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Januszewski, Jacob, Jeffrey S. Beecher, David J. Chalif, and Amir R. Dehdashti. "Flow-based evaluation of cerebral revascularization using near-infrared indocyanine green videoangiography." Neurosurgical Focus 36, no. 2 (February 2014): E14. http://dx.doi.org/10.3171/2013.12.focus13473.
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Object Indocyanine green (ICG) videoangiography has been established as a noninvasive technique to gauge the patency of a bypass graft; however, intraoperative graft patency may not always correlate with graft flow. Altered flow through the bypass graft may directly cause delayed graft occlusion. Here, the authors report on 3 types of flow that were observed through cerebral revascularization procedures. Methods Between February 2009 and September 2013, 48 bypass procedures were performed. Excluded from analysis were those cases in which ICG videoangiography was not performed during surgery (whether it was not available or there was a technical issue with the microscope or the quality of ICG angiography) and/or in which angiography or CT angiography was not done within 24–72 hours after surgery. After anastomosis, bypass patency was assessed first using a noninvasive technique and then with ICG videoangiography, and flow through the graft was characterized. Patients who received a vein or radial artery graft were also evaluated with intraoperative angiography. Results Thirty-three patients eligible for analysis were retrospectively analyzed. The patients had undergone extracranial-intracranial (EC-IC) or IC-IC bypass for ischemic stroke (13 patients), moyamoya disease (10 patients), and complex aneurysms (10 patients; 6 giant or large aneurysms, 2 carotid blister-like aneurysms, and 2 dissecting posterior inferior cerebellar artery [PICA] aneurysms). Thirty-six bypasses were performed including 26 superficial temporal artery (STA)–middle cerebral artery (MCA) bypasses (2 bilateral and 1 double-barrel), 6 EC-IC vein grafts, 1 EC-IC radial artery graft, 1 PICA-PICA bypass, 1 MCA–posterior cerebral artery bypass, and 1 occipital artery–PICA bypass. Robust anterograde flow (Type I) was noted in 31 grafts (86%). Delayed but patent graft enhancement and anterograde flow (Type II) was observed in 4 cases (11%); 1 of these cases with an EC-IC vein graft degraded gradually to very delayed flow with no continuity to the bypass site (Type III). Additionally, 1 STA-MCA bypass graft revealed no convincing flow (Type III). The 5 patients with Type II or III grafts were evaluated with a flow probe and reexploration of the bypass site, and in all cases the reason the graft became occluded was believed to be recipient-vessel competitive flow. In no case was there evidence of stenosis or a technical issue at the site of the anastomosis. Three patients with Type II and the 1 patient with Type III flow (11% of procedures) did not have a patent bypass on postoperative imaging. Conclusions Indocyanine green videoangiography is reliable for evaluating flow through the EC-IC or IC-IC bypass. The type of flow observed through the graft has a direct relationship with postoperative imaging findings. Despite the possibility of competitive flow, Type III and some Type II flows through the graft indicate the need for graft evaluation and anastomosis exploration.
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Solaković, Emir, Dragan Totić, and Sid Solaković. "Femoro-Popliteal Bypass Above Knee with Saphenous Vein vs Synthetic Graft." Bosnian Journal of Basic Medical Sciences 8, no. 4 (November 20, 2008): 367–72. http://dx.doi.org/10.17305/bjbms.2008.2899.
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There is still debate whether sintethic graft (polytetrafluoroethylene or Dacron) is equivalent to vein as bypass graft material for the above-knee femoropopliteal bypass. Therefore, we performed prospective randomized trial to compare vein with polytetrafluoroethylene/dacron for femoropopliteal bypasses with the distal anastomosis above the knee. Between January 2000 and June 2003, 121 femoropopliteal bypasses were performed. The indications for operation were severe claudication in 96 cases, rest pain in 16 cases, and ulceration in 9 cases. After randomization, 60 reversed saphenous venous bypasses and 61 polytetrafluoroethylene/ dacron bypasses were performed. No perioperative mortality was seen, and 5% of the patients had minor infections of the wound, not resulting in loss of the bypass, the limb, or life. After 5 years, 37% of the patients had died and 7% were lost to follow-up. Only once saphenous vein was necessary for coronary artery bypass grafting. Primary patency rates after 5 years were 76,6% for venous bypass grafts and 59,1% for polytetrafluoroethylene/dacron grafts (p=0,035). Secondary patency rates were 83,3% for vein and 69,2% for polytetrafluoroethylene/dacron bypasses (p = 0,036). In the venous group, 10 bypasses failed, leading to four new bypasses. In the polytetrafluoroethylene group, 22 bypasses failed, leading to 12 reinterventions. After 5 years of follow-up, we conclude that a bypass with saphenous vein has better patency rates at all intervals and needs fewer reoperations. Saphenous vein should be the graft material of choice for above-knee femoropopliteal bypasses and should not be preserved for reinterventions. Polytetrafluoroethylene/dacron is an acceptable alternative if the saphenous vein is not available.
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Ramanathan, Dinesh, Nancy Temkin, Louis J. Kim, Basavaraj Ghodke, and Laligam N. Sekhar. "Cerebral Bypasses for Complex Aneurysms and Tumors." Neurosurgery 70, no. 6 (March 6, 2012): 1442–57. http://dx.doi.org/10.1227/neu.0b013e31824c046f.
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Abstract BACKGROUND: Various techniques of cerebral bypasses are used to treat aneurysms and tumors. OBJECTIVE: To study long-term clinical and radiological outcome of various bypass types and to analyze techniques used in the management of long-term graft problems. METHODS: A consecutive series of patients who underwent revascularization during a 5-year period were analyzed for indications, graft patency, and neurological outcomes. Potential risk factors for bypass problems and the management of bypass stenosis were studied. RESULTS: A total of 80 patients (69 with aneurysms and 11 with tumors) underwent 88 bypasses (59 extracranial-to-intracranial [EC-IC] bypasses [10 low flow, 49 high flow], 9 intracranial-to-intracranial [IC-IC] bypasses [3 long, 6 short], and 20 local bypasses), with mean radiological follow-up of 32 months (range, 1–53 months). At late follow-up, 5 of 9 (56%) IC-IC (5 short, 0 long grafts), 8 of 9 (90%) EC-IC low-flow, 44 of 48 (92%) EC-IC high-flow, and all local bypasses were patent. Four patients with EC-IC high-flow bypass occlusions were asymptomatic, but transient ischemic attacks were noted in 3 of 6 patients with graft stenosis. None of the risk factors evaluated were significantly predictive of EC-IC graft occlusions or stenosis. EC-IC HF graft stenoses were permanently corrected by microsurgery (n = 4) or endovascular surgery (n = 1). CONCLUSION: The EC-IC and local bypasses have higher long-term patency rates (91% and 100%) compared with IC-IC bypasses (66%, 0% long graft). Some EC-IC bypasses may occlude asymptomatically (9%) or develop graft stenosis (13%) over the long term. Microsurgical and endovascular surgical techniques have been developed to treat graft stenosis.
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Khandanpour, Nader, Felicity J. Meyer, Lily Choy, Jane Skinner, and Matthew P. Armon. "Are femorodistal bypass grafts for acute limb ischemia worthwhile?" Jornal Vascular Brasileiro 8, no. 4 (December 2009): 294–300. http://dx.doi.org/10.1590/s1677-54492009000400003.
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Background: It has been shown that autogenous veins are associated with the best limb salvage rates for femorodistal bypass surgery. However, in emergency settings, when an autogenous vein is unavailable, use of synthetic graft material or amputation is a critical decision to make. Objective: To assess the appropriateness of femorodistal bypass grafts for acute limb ischemia in emergency settings. Methods: Patients who underwent emergent bypass and elective femorodistal bypass surgery between 1996 and 2006 were reviewed retrospectively in a single center. Results: There were 147 patients of which 84 had elective and 63 had emergent bypass. The graft patency rates for elective admissions were 44 and 25% vs. 25 and 23% for admissions for acute femorodistal graft surgery at 2 and 4 years, respectively (p < 0.004). Admissions for acute ischemia who were treated with prosthetic grafts had a primary patency of 24 vs. 27% for vein grafts at 2 years and 24 vs. 23% at 4 years (p = 0.33). In the acute femorodistal grafts group, primary patency at 2 years for vein and prosthetic grafts was 27 and 24% as compared to 42 and 32% for electives. These values for cumulative limb salvage rates for elective bypasses were 73 and 63% as compared to 52% at both time points in the acute femorodistal graft group (p < 0.004). In emergency settings, the limb salvage rate for acute femorodistal bypass with prosthetic grafts was 38%, and for vein grafts it was 62% at both time points (p = 0.08). Conclusion: The long term limb salvage rate of 38% suggests that emergent femorodistal revascularization is worthwhile.
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Mohit, Alex A., Laligam N. Sekhar, Sabareesh K. Natarajan, Gavin W. Britz, and Basavaraj Ghodke. "High-flow Bypass Grafts in the Management of Complex Intracranial Aneurysms." Operative Neurosurgery 60, suppl_2 (February 1, 2007): ONS—105—ONS—123. http://dx.doi.org/10.1227/01.neu.0000249243.25429.ee.
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Abstract THE MAJORITY OF intracranial aneurysms can be treated by either endovascular coiling or microsurgical clipping. A small group of aneurysms may require vascular bypass or reconstruction for their management. A variety of vascular reconstruction techniques are available, including direct suture, patch grafting, local reimplantations, side to side anastomosis, and bypass grafts. Bypass grafts may include low-flow (superficial temporal to middle cerebral) and high-flow bypass grafts using either the radial artery or saphenous vein. In this article, the indications and techniques of high-flow bypasses and concurrent aneurysm management are discussed. Troubleshooting of these bypasses is also illustrated. Seven intraoperative videos have been provided to demonstrate the various techniques of radial artery graft harvesting, cervical exposure of carotid vessels, bypasses, and concurrent aneurysm management.
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Alcocer, Francisco, William D. Jordan, Douglas J. Wirthlin, and David Whitley. "Early Results of Lower Extremity Infrageniculate Revascularization with a New Polytetrafluoroethylene Graft." Vascular 12, no. 5 (September 2004): 318–24. http://dx.doi.org/10.1258/rsmvasc.12.5.318.
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When an autologous vein is not available for lower extremity revascularization, prosthetic grafts are often required. However, prosthetic bypass grafts have limited patency for infrageniculate reconstruction. To potentially improve patency, a new geometric modification of the polytetrafluoroethylene (PTFE) graft, Distaflo (Impra, Tempe, AZ), has been developed for lower extremity bypass. We reviewed our early experience with the Distaflo graft in patients who required infrageniculate bypass for lower extremity ischemia when no suitable autologous saphenous vein was available. All patients were maintained on warfarin anticoagulation postoperatively. All grafts were followed at 6- to 12-week intervals with duplex ultrasound evaluation. Patient characteristics, operative procedures, and graft surveillance information were maintained on a computerized registry. Thirty-two patients with limb-threatening ischemia underwent 35 infrageniculate reconstructions with a Distaflo graft between February 26, 1999, and August 24, 2000. Thirty-two of 35 bypasses were performed on extremities that had previously undergone a surgical procedure. Forty-eight previous revascularization procedures were done on these 25 extremities. Thirty grafts were constructed to the tibial outflow sites, whereas the remaining five grafts were placed to the below-knee popliteal artery. One patient died on the second postoperative day secondary to unrelated causes, and only one graft (3%) failed during the same hospitalization. Fifteen of 35 grafts (43%) remained patent 1 to 30 months later. Four patent grafts (6%) were ligated between 2 and 14 months for infectious indications. When considering the 20 failed grafts, 9 patients underwent major amputation, 5 patients remain with chronically ischemic limbs, and 6 patients underwent additional bypass grafts. Twenty-three patients (72%) maintained limb salvage. The Distaflo PTFE graft achieves promising early patency for complex infrageniculate revascularization and may be used as an alternative conduit in patients with critical limb ischemia who do not have an adequate vein for lower extremity revascularization.
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Neufang, Achim, Carolina Vargas-Gomez, Patrick Ewald, Nicolaos Vitolianos, Tolga Coskun, Nael Abu-Salim, Rainer Schmiedel, Peter von Flotow, and Savvas Savvidis. "Very distal vein bypass in patients with thromboangiitis obliterans." Vasa 46, no. 4 (June 1, 2017): 304–9. http://dx.doi.org/10.1024/0301-1526/a000624.
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Abstract. Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex findings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin configuration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superficial femoral artery was used for inflow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identified graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after definitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.
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Kawashima, Masatou, Albert L. Rhoton, Necmettin Tanriover, Arthur J. Ulm, Alexandre Yasuda, and Kiyotaka Fujii. "Microsurgical anatomy of cerebral revascularization. Part I: Anterior circulation." Journal of Neurosurgery 102, no. 1 (January 2005): 116–31. http://dx.doi.org/10.3171/jns.2005.102.1.0116.
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Object. Revascularization is an important component of treatment for complex aneurysms that require parent vessel occlusion, skull base tumors that involve major vessels, and certain ischemic diseases. In this study, the authors examined the microsurgical anatomy of cerebral revascularization in the anterior circulation by demonstrating various procedures for bypass surgery. Methods. Twenty-five adult cadaveric specimens were studied, using 3 to 40 magnification, after the arteries and veins had been perfused with colored silicone. The microsurgical anatomy of cerebral revascularization in the anterior circulation was examined with the focus on the donor, recipient, and graft vessels. The techniques discussed in this paper include the superficial temporal artery (STA)—middle cerebral artery (MCA), middle meningeal artery (MMA)—MCA, and side-to-side anastomoses; short arterial and venous interposition grafting; and external carotid artery/internal carotid artery (ICA)—M2 and ICA—ICA bypasses. Bypass procedures for cerebral revascularization are divided into two categories depending on their flow volume: low-flow and high-flow bypasses. A low-flow bypass, such as the STA—MCA anastomosis, is used to cover a relatively small area, whereas a high-flow bypass, such as the ICA—ICA anastomosis, is used for larger areas. Cerebral revascularization techniques are also divided into two types depending on the graft materials: pedicled arterial grafts, such as STA and occipital artery grafts, and free venous or arterial grafts, which are usually saphenous vein and radial artery grafts. Pedicled arterial grafts are mainly used for low-flow bypasses, whereas venous or arterial grafts are used for high-flow bypasses. Conclusions. It is important to understand the methods of bypass procedures and to consider indications in which cerebral revascularization is needed.
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Chantelau. "Does oral anticoagulation improve femoropedal graft patency in diabetic patients? Lessons from the Dutch BOA Study." Vasa 30, Supplement 58 (November 1, 2001): 47–49. http://dx.doi.org/10.1024/0301-1526.30.s58.47.
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Graft patency rates after arterial reconstruction benefit from aspirin treatment. The Dutch Bypass Oral anticoagulant or Aspirin (BOA) Study, a randomized controlled trial, compared the use of oral anticoagulants (e.g. phenprocoumon) versus aspirin in a large sample of patients after infrainguinal arterial bypass surgery. Graft occlusion was the primary endpoint. A total of 2650 bypasses were performed, 531 of which were femorocrural or femoropedal grafts. Of the latter, 194 (37%) were carried out in the subgroup of 700 diabetic patients (i.e. 26% of the total study population). There was no significant difference in patency rates of these particular grafts with either drug. Hence, aspirin 100 mg/day is as effective as oral anticoagulation to benefit patency rates in femorocrural and femoropedal bypass grafts, irrespective of the diabetic status of the patients. Aspirin is sufficient, and oral anticoagulation is not required for this particular type of reconstruction.
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Krasznai, AG, MGJ Snoeijs, MP Siroen, T. Sigterman, A. Korsten, FL Moll, and LH Bouwman. "Treatment of aortic graft infection by in situ reconstruction with Omniflow II biosynthetic prosthesis." Vascular 24, no. 6 (July 9, 2016): 561–66. http://dx.doi.org/10.1177/1708538115621195.
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Currently available conduits for in situ reconstruction after excision of infected aortic grafts have significant limitations. The Omniflow II vascular prosthesis is a biosynthetic graft associated with a low incidence of infection that has succesfully been used in the treatment of infected infrainguinal bypass. We report on the first use of the Omniflow II prosthesis for in situ reconstruction after aortic graft infection. A bifurcated biosynthetic bypass was created by spatulating and anastomosing two 8-mm tubular Omniflow II grafts. This bypass was used for in situ reconstruction after excision of infected aortic grafts in three cases. After a mean follow-up of 2.2 years, no occlusion, degeneration, or rupture of the Omniflow II grafts was observed. Although one patient suffered from graft reinfection, the bypass retained structural integrity and no anastomotic dehiscence was observed. Treatment of aortic graft infection by in situ reconstruction with the Omniflow II vascular prosthesis is feasible. Its resistance to infection and off-the-shelf availability make this graft a promising conduit for aortoiliac reconstruction.
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Watanabe, Go, Tamotsu Yasuda, and Shigeyuki Tomita. "A Multipurpose Arterial Graft Holder for Coronary Artery Bypass Grafting." Heart Surgery Forum 8, no. 2 (March 9, 2005): 98. http://dx.doi.org/10.1532/hsf98.2005-1001.
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A multipurpose arterial graft holder designed for use during coronary artery bypass grafting is described. This new holder is atraumatic and holds the arterial grafts and saphenous vein graft securely during anastomosis. The use of this instrument facilitates the use of multiple arterial grafts for coronary artery bypass grafting.
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Kaisar, Jeremy, Aaron Chen, Mathew Cheung, Elias Kfoury, Carlos F. Bechara, and Peter H. Lin. "Comparison of propaten heparin-bonded vascular graft with distal anastomotic patch versus autogenous saphenous vein graft in tibial artery bypass." Vascular 26, no. 2 (August 23, 2017): 117–25. http://dx.doi.org/10.1177/1708538117717141.
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Introduction Heparin-bonded expanded polytetrafluoroethylene grafts (Propaten, WL Gore, Flagstaff, AZ, USA) have been shown to have superior patency compared to standard prosthetic grafts in leg bypass. This study analyzed the outcomes of Propaten grafts with distal anastomotic patch versus autogenous saphenous vein grafts in tibial artery bypass. Methods A retrospective analysis of prospective collected data was performed during a recent 15-year period. Sixty-two Propaten bypass grafts with distal anastomotic patch (Propaten group) were compared with 46 saphenous vein graft (vein group). Pertinent clinical variables including graft patency and limb salvage were analyzed. Results Both groups had similar clinical risk factors, bypass indications, and target vessel for tibial artery anastomoses. Decreased trends of operative time (196 ± 34 min vs. 287 ± 65 min, p = 0.07) and length of hospital stay (5.2 ± 2.3 days vs. 7.5 ± 3.6, p = 0.08) were noted in the Propaten group compared to the vein group. Similar primary patency rates were noted at four years between the Propaten and vein groups (85%, 71%, 64%, and 57%, vs. 87%, 78%, 67%, and 61% respectively; p = 0.97). Both groups had comparable secondary patency rates yearly in four years (the Propaten group: 84%, 76%, 74%, and 67%, respectively; the vein group: 88%, 79%, 76%, and 72%, respectively; p = 0.94). The limb salvage rates were equivalent between the Propaten and vein group at four years (84% vs. 92%, p = 0.89). Multivariate analysis showed active tobacco usage and poor run-off score as predictors for graft occlusion. Conclusions Propaten grafts with distal anastomotic patch have similar clinical outcomes compared to the saphenous vein graft in tibial artery bypass. Our data support the use of Propaten graft with distal anastomotic patch as a viable conduit of choice in patients undergoing tibial artery bypass.
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Silva, Michael A., Rodolfo E. Alcedo Guardia, Mohammad Ali Aziz-Sultan, and Nirav J. Patel. "Republished: Thrombectomy for late occlusion of high flow extracranial–intracranial saphenous vein bypass graft after 27 years of patency." Journal of NeuroInterventional Surgery 10, no. 11 (April 7, 2018): e27-e27. http://dx.doi.org/10.1136/neurintsurg-2017-013670.rep.
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High flow extracranial–intracranial (EC-IC) bypass with a saphenous vein graft (SVG) has been used for more than 40 years in patients with giant aneurysms of the posterior circulation refractory to medical management, and has demonstrated high long term patency rates. We report the case of a patient treated with external carotid artery (ECA)–posterior cerebral artery SVG bypass in 1989 who presented 27 years later with paresthesias and confusion, and was found to have partial occlusion of her SVG bypass graft and a basilar occlusion. She was treated with mechanical thrombectomy of the basilar occlusion via the partially thrombosed graft, the first report of such a procedure through a high flow posterior circulation EC-IC SVG, resulting in improvement of the patient’s neurologic examination. At 27 years, this is the longest reported delay in thrombosis of a high flow SVG bypass graft, highlighting the long term patency of these grafts and the feasibility of thrombectomy through occluded bypass grafts.
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Doi, Hirosato, Ryuji Koshima, Masato Suzuki, Ken Takahashi, Hiroichi Yokoyama, and Naoya Yoshida. "Can 64-Row Computed Tomography Replace Angiography after Coronary Bypass?" Asian Cardiovascular and Thoracic Annals 16, no. 6 (December 2008): 444–49. http://dx.doi.org/10.1177/021849230801600603.
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Multi-detector (64-row) computed tomography has become an alternative to coronary angiography to diagnose graft occlusion and stenosis after coronary artery bypass. We compared the power of evaluation of multi-detector computed tomography with that of conventional coronary angiography in 60 patients who underwent coronary artery bypass with 135 grafts and 210 graft anastomoses. The diagnostic power of multi-detector computed tomography for graft occlusion was: 100% (2/2) sensitivity, 98.5% (131/133) specificity, 50% (2/4) positive predictive value, and 100% (133/133) negative predictive value; there were no significant differences in rates of occlusion among the different types of graft. The diagnostic power of multi-detector computed tomography for stenosis of the graft anastomosis was: 100% (2/2) sensitivity, 95.1% (194/204) specificity, 16.6% (2/12) positive predictive value, and 100% (194/194) negative predictive value, with no significant differences among grafts. Multi-detector computed tomography permits evaluation of bypass grafts and is much less invasive for the patients.
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Dardik, Herbert. "Bypass graft aneurysm." Vascular 21, no. 3 (May 30, 2013): 195. http://dx.doi.org/10.1177/1708538113476025.
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Blank, Jacqueline J., Abby E. Rothstein, Cheong Jun Lee, Michael J. Malinowski, Brian D. Lewis, Timothy J. Ridolfi, and Mary F. Otterson. "Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition." Vascular and Endovascular Surgery 52, no. 5 (March 19, 2018): 386–90. http://dx.doi.org/10.1177/1538574418764037.
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Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and principles of evaluation and treatment are not well defined. We report 2 cases of aortobifemoral bypass graft malposition through the colon. Case Report: Case 1 is a 54-year-old male who underwent aortobifemoral bypass grafting for acute limb ischemia. He had previously undergone a partial sigmoid colectomy for diverticulitis. Approximately 6 months after vascular surgery, he presented with an occult graft infection. Preoperative imaging and intraoperative findings were consistent with graft placement through the sigmoid colon. Case 2 is a 60-year-old male who underwent aortobifemoral bypass grafting due to a nonhealing wound after toe amputation. His postoperative course was complicated by pneumonia, bacteremia thought to be secondary to the pneumonia, general malaise, and persistent fevers. Approximately 10 weeks after the vascular surgery, he presented with imaging and intraoperative findings of graft malposition through the cecum. Conclusions: Aortic graft infection is usually caused by surgical contamination and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.
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David, Carlos A., Joseph M. Zabramski, and Robert F. Spetzler. "Reversed-flow saphenous vein grafts for cerebral revascularization." Journal of Neurosurgery 87, no. 5 (November 1997): 795–97. http://dx.doi.org/10.3171/jns.1997.87.5.0795.
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✓ The authors sought to create a saphenous vein interposition graft to be used in cerebral bypass procedures that would be more physiologically appropriate than standard vein grafts and would provide a better match between the graft and recipient vessels at the anastomotic sites. The saphenous vein graft was prepared by lysing the valves with a valvulotome. The blood flow could then be reversed in the vein, allowing it to be used in either direction as a bypass graft. An illustrative case including angiograms that confirm good patency and blood flow through the reversed-flow bypass graft is presented. It is concluded that the reversed-flow saphenous vein graft provides a more physiologically suitable conduit than standard vein grafts. Lysis of the valves allows the graft to be used in an orientation that takes advantage of the natural tapering of the vein to produce a better match with the recipient vessels at the anastomotic sites. Minimizing diameter changes at the proximal and distal anastomoses helps reduce turbulence, which has been implicated as a cause of early graft failure and thrombosis.
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Pooria, Ali, Afsoun Pourya, and Alireza Gheini. "Application of tissue-engineered interventions for coronary artery bypass grafts." Future Cardiology 16, no. 6 (November 2020): 675–85. http://dx.doi.org/10.2217/fca-2019-0050.
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Coronary artery bypass graft is one of the extensively conducted procedures to release occlusion in the coronary vessel. Various biological grafts are used for this purpose, superiorly, saphenous vein graft, if unavailable, other vessels in the body, with likewise characteristics are exploited for the purpose. The choice of graft is yet under discovery that could impeccably meet all the requirements. Variation in perioperative and postoperative results have given uneven clinical inferences of these conduits. Alternatively, tissue-engineering is also being applied in this area for clinical improvements. This review underlines some of the commonly used grafts for coronary artery bypass graft and advancements in tissue engineering for this purpose.
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Nossek, Erez, Peter D. Costantino, David J. Chalif, Rafael A. Ortiz, Amir R. Dehdashti, and David J. Langer. "Forearm Cephalic Vein Graft for Short, “Middle”-Flow, Internal Maxillary Artery to Middle Cerebral Artery Bypass." Operative Neurosurgery 12, no. 2 (September 23, 2015): 99–105. http://dx.doi.org/10.1227/neu.0000000000001027.
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Abstract BACKGROUND The cervical carotid system has been used as a source of donor vessels for radial artery or saphenous vein grafts in cerebral bypass. Recently, internal maxillary artery to middle cerebral artery bypass has been described as an alternative, with reduction of graft length potentially correlating with improved patency. OBJECTIVE To describe our experience using the forearm cephalic vein grafts for short segment internal maxillary artery to middle cerebral artery bypasses. METHODS All vein grafts were harvested from the volar forearm between the proximal cubital fossa where the median cubital vein is confluent with the cephalic vein and the distal wrist. RESULTS Six patients were treated with internal maxillary artery to middle cerebral artery bypass. In 4, the cephalic vein was used. Postoperative angiography demonstrated good filling of the grafts with robust distal flow. There were no upper extremity vascular complications. All but 1 patient (mortality) tolerated the procedure well. The other 3 patients returned to their neurological baseline with no new neurological deficit during follow-up. CONCLUSION The internal maxillary artery to middle cerebral artery “middle” flow bypass allows for shorter graft length with both the proximal and distal anastomoses within the same microsurgical field. These unique variable flow grafts represent an ideal opportunity for use of the cephalic vein of the forearm, which is more easily harvested than the wider saphenous vein graft and which has good match size to the M1/M2 segments of the middle cerebral artery. The vessel wall is supple, which facilitates handling during anastomosis. There is lower morbidity potential than utilization of the radial artery. Going forward, the cephalic vein will be our preferred choice for external carotid-internal carotid transplanted conduit bypass.
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Jaff, Michael R., Gerald Dorros, Krishna Kumar, Gerardo Caballero, and Alfred Tector. "Endovascular Repair of an Ascending Aorta-to-Left Common Femoral Artery Graft with Aneurysmal Degeneration." Journal of Endovascular Therapy 2, no. 2 (May 1995): 189–95. http://dx.doi.org/10.1177/152660289500200213.
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Purpose: To report the use of endovascular grafting to repair degenerative aneurysmal changes in an extra-anatomic bypass graft. Methods: A 14-year-old extra-anatomic ascending aorta-to-left common femoral bypass graft (“ventral aorta”) had undergone aneurysmal degeneration, producing symptoms of progressive claudication and local abdominal swelling. The aneurysmal graft dilatation began within the thoracic cavity and extended through the entire extraperitoneal abdominal segment. The option for minimally invasive repair using a customized stent-graft device was offered to the patient as an alternative to standard reoperation. Results: An 8-mm × 42-cm endovascular graft was constructed of polytetrafluoroethylene with 30-mm Palmaz stents sutured to each end. With balloon occlusion of antegrade and retrograde blood flow, the stent-graft was delivered retrograde through an incision in the distal end of the existing bypass graft. The device was successfully positioned and deployed with complete exclusion of the aneurysm. No complications occurred, and the patient's symptoms abated. Follow-up arteriography at 1 month showed a pseudoaneurysm at the distal graft incision site; surgical repair was necessary. At 6 months, angiography demonstrated continued patency of the extra-anatomic bypass graft. Conclusions: Intraluminal aneurysm exclusion techniques in degenerated extra-anatomic bypass grafts may evolve into a viable therapeutic alternative to complex reoperative surgery.
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Strickland, Ben A., Robert C. Rennert, Joshua Bakhsheshian, Sebina Bulic, Adrian J. Correa, Arun Amar, Joseph Carey, and Jonathan J. Russin. "Botulinum toxin to improve vessel graft patency in cerebral revascularization surgery: report of 3 cases." Journal of Neurosurgery 130, no. 2 (February 2019): 566–72. http://dx.doi.org/10.3171/2017.9.jns171292.
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Surgical revascularization continues to play an important role in the management of complex intracranial aneurysms and ischemic cerebrovascular disease. Graft spasm is a common complication of bypass procedures and can result in ischemia or graft thrombosis. The authors here report on the first clinical use of botulinum toxin to prevent graft spasm following extracranial-intracranial (EC-IC) bypass. This technique was used in 3 EC-IC bypass surgeries, 2 for symptomatic carotid artery occlusions and 1 for a ruptured basilar tip aneurysm. In all 3 cases, the harvested graft was treated ex vivo with botulinum toxin before the anastomosis was performed. Post-bypass vascular imaging demonstrated patency and the absence of spasm in all grafts. Histopathological analyses of treated vessels did not show any immediate endothelial or vessel wall damage. Postoperative angiograms were without graft spasm in all cases. Botulinum toxin may be a reasonable option for preventing graft spasm and maintaining patency in cerebral revascularization procedures.
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Brennan, Jeffrey W., Michael K. Morgan, William Sorby, and Verity Grinnell. "Recurrent stenosis of common carotid—intracranial internal carotid interposition saphenous vein bypass graft caused by intimal hyperplasia and treated with endovascular stent placement." Journal of Neurosurgery 90, no. 3 (March 1999): 571–74. http://dx.doi.org/10.3171/jns.1999.90.3.0571.
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✓ Intimal hyperplasia is a well-known cause of delayed stenosis in vein bypass grafts in all types of vascular surgery. Options for treatment of stenosis in peripheral and coronary artery bypass grafts include revision surgery and the application of endovascular techniques such as balloon angioplasty and stent placement. The authors present a case of stenosis caused by intimal hyperplasia in a high-flow common carotid artery—intracranial internal carotid artery (IICA) saphenous vein interposition bypass graft that had been constructed to treat a traumatic pseudoaneurysm of the intracavernous ICA. The stenosis recurred after revision surgery and was successfully treated by endovascular stent placement in the vein graft. The literature on stent placement for vein graft stenoses is reviewed, and the authors add a report of its application to external carotid—internal carotid bypass grafts. Further study is required to define the role of endovascular techniques in the management of stenotic cerebrovascular disease.
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Amin-Hanjani, Sepideh, John H. Shin, Meide Zhao, Xinjian Du, and Fady T. Charbel. "Evaluation of extracranial–intracranial bypass using quantitative magnetic resonance angiography." Journal of Neurosurgery 106, no. 2 (February 2007): 291–98. http://dx.doi.org/10.3171/jns.2007.106.2.291.
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Object To date, angiography has been the primary modality for assessing graft patency following extracranial–intracranial bypass. The utility of a noninvasive and quantitative method of assessing bypass function postoperatively was evaluated using quantitative magnetic resonance (MR) angiography. Methods One hundred one cases of bypass surgery performed over a 5.5-year period at a single institution were reviewed. In 62 cases, both angiographic and quantitative MR angiographic data were available. Intraoperative flow measurements were available in 13 cases in which quantitative MR angiography was performed during the early postoperative period (within 48 hours after surgery). There was excellent correlation between quantitative MR angiographic flow and angiographic findings over the mean 10 months of imaging follow up. Occluded bypasses were consistently absent on quantitative MR angiograms (four cases). The flow rates were significantly lower in those bypasses that became stenotic or reduced in diameter as demonstrated by follow-up angiography (nine cases) than in those bypasses that remained fully patent (mean ± standard error of the mean, 37 ± 13 ml/minute compared with 105 ± 7 ml/minute, p = 0.001). Flows were appreciably lower in poorly functioning bypasses for both vein and in situ arterial grafts. All angiographically poor bypasses (nine cases) were identifiable by absolute flows of less than 20 ml/minute or a reduction in flow greater than 30% within 3 months. Good correlation was seen between intraoperative flow measurements and early postoperative quantitative MR angiographic flow measurements (13 cases, Pearson correlation coefficient = 0.70, p = 0.02). Conclusions Bypass grafts can be assessed in a noninvasive fashion by using quantitative MR angiography. This imaging modality provides not only information regarding patency as shown by conventional angiography, but also a quantitative assessment of bypass function. In this study, a low or rapidly decreasing flow was indicative of a shrunken or stenotic graft. Quantitative MR angiography may provide an alternative to standard angiography for serial follow up of bypass grafts.
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Inoue, Takehiro, and Toshihiko Saga. "Concomitant Aortoaxillary Bypass and Coronary Artery Bypass Grafting." Asian Cardiovascular and Thoracic Annals 13, no. 3 (September 2005): 229–32. http://dx.doi.org/10.1177/021849230501300308.
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The optimal revascularization strategy for patients with subclavian and coronary artery disease has not been established. This study assessed the mid-term clinical outcome of concomitant aortoaxillary bypass and coronary artery bypass grafting in 5 patients. A ring-reinforced polytetrafluoroethylene graft was attached to the ascending aorta and led to the proximal segment of the axillary artery via the pleural cavity. Patients were followed up for 2–10 years (mean, 5.4 ± 3.4 years). Postoperative aortography and angiography demonstrated patent aortoaxillary and coronary bypass grafts in the short-term follow-up of all patients. Two patients with Takayasu aortitis needed re-operations for recurrent angina and annuloaortic dilatation. Another patient required removal of the aortoaxillary bypass graft because of infection, and subsequently underwent a left femoroaxillary bypass one year after the original procedure. Subclavian steal phenomenon did not occur. Aortoaxillary bypass with coronary artery bypass may be an effective option for patients with co-existing subclavian and coronary artery disease.
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Gwon, Jun G., Youngjin Han, Yong-Pil Cho, and Tae-Won Kwon. "Obturator bypass using a ringed polytetrafluoroethylene graft for inguinal graft infection." Vascular 28, no. 5 (May 4, 2020): 530–35. http://dx.doi.org/10.1177/1708538120922112.
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Objective Inguinal vascular graft infections are high-risk events that cannot be controlled medically but require surgical intervention. This study reviewed the long-term clinical outcomes of obturator bypass using a ringed polytetrafluoroethylene graft for inguinal graft infection. Methods A total of eight consecutive patients who underwent obturator bypass using a ringed polytetrafluoroethylene graft for inguinal prosthetic graft infection at a single medical center between January 2006 and October 2017 were retrospectively analyzed. The demographics, clinical characteristics, surgical procedure, and clinical outcomes were evaluated. Results There was no perioperative death; however, there were three operative complications. On the 1st and 9th postoperative day, two patients underwent hematoma evacuation in the pelvic cavity, and the other patient underwent suture reinforcement for partial dehiscence of the distal anastomosis on the 49th postoperative day. The median length of hospital stay was 14.5 (range, 7–29) days. Only one graft occlusion was observed at postoperative month 40; however, there were no ischemic symptoms. There were no limb amputations and postoperative deaths during the long-term follow-up period. There were no infections of the previous residual and obturator bypass grafts and inguinal infection during the follow-up period of 49 (range, 7–154) months. Conclusion Obturator bypass for inguinal graft infection is feasible and durable with excellent long-term outcomes. However, perioperative bleeding should be taken into consideration.
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Uçak, Hacı Ali. "The relationship between epicardial fat tissue thickness and transit time flow measurement values of coronary artery bypass grafts." Journal of Cardiovascular and Thoracic Research 12, no. 4 (November 24, 2020): 307–12. http://dx.doi.org/10.34172/jcvtr.2020.50.
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Introduction: Epicardial fat tissue, the true visceral adipose depot of the heart, has been associated with changes in both cardiac function and morphology. This study aimed to show the relationship between epicardial fat tissue (EFT) thickness and graft flow dynamics in arterial and venous grafts in coronary artery bypass graft surgery (CABG). Methods: Patients underwent transthoracic echocardiography before surgery and epicardial fat thickness were evaluated. The patients were divided into two groups as EFT value <5.5 (group 1) mm and ≥5.5 (group 2) mm. One hundred eighty-one patients with a total of 434 grafts (162 arterial and272 venous) underwent isolated coronary artery bypass grafting surgery. All grafts were examined by transit time flow meter intraoperatively. Results: The mean epicardial fat tissue thickness values were 4.9±0.8 mm and 6.1±1.3 mm, respectively.Mean graft flow values of left internal mammary artery was 44.21±23.2 mL/min in group 1 and39.65 ± 19.2 mL/min in group 2 (P = 0.041). Similarly, mean graft flow values were higher in group1 in all venous grafts regardless of which vessel bypass was performed. There is a significant negative correlation between epicardial fat thickness and mean graft flow. Conclusion: Epicardial fat thickness measurement preoperatively might provide additional data for the faith of the graft.
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Sundt, Thoralf M., and Thoralf M. Sundt. "Principles of preparation of vein bypass grafts to maximize patency." Journal of Neurosurgery 66, no. 2 (February 1987): 172–80. http://dx.doi.org/10.3171/jns.1987.66.2.0172.
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✓ Experience in cardiovascular and peripheral vascular surgery with saphenous vein bypass conduits is reviewed. It is clear that meticulous technique and graft preparation are crucial to short-term and long-term patency. The risk of early thrombosis is related to damage to the graft 's native intima, graft flow, and coagulability of the patient 's blood. Attention to atraumatic harvesting techniques and perfection of anastomoses are crucial to minimizing intimal damage. Graft inflow and outflow are fundamental principles. The use of vitamin K antagonists and platelet inhibitors may improve graft survival. Subacute occlusion is related to structural alterations in the grafts themselves. These include intimal hyperplasia and medial fibrosis as the grafts become “arterialized,” valve fibrosis, aneurysmal dilatation, clamp stenosis, and suture stenosis. Long-term patency is threatened primarily by atherosclerosis in the graft itself. There is some evidence that care in vein harvesting and implantation as well as the use of anticoagulant agents affect the development of this complication. A technique for graft preparation is presented that is based on the experience of the authors in harvesting grafts for both cerebral and coronary bypass conduits.
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Üstün, Mehmet Erkan, Mustafa Büyükmumcu, Cagatay Han Ulku, Aynur Emine Cicekcibasi, and Hamdi Arbag. "Radial Artery Graft for Bypass of the Maxillary to Proximal Middle Cerebral Artery: An Anatomic and Technical Study." Neurosurgery 54, no. 3 (March 1, 2004): 667–71. http://dx.doi.org/10.1227/01.neu.0000109533.72250.e0.
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Abstract OBJECTIVE In this study, we aimed to investigate the use of a radial artery graft for bypass of the maxillary artery (MA) to the proximal middle cerebral artery (MCA) as an alternative to superficial temporal artery-to-MCA anastomosis or extracranial carotid-to-MCA bypass using long grafts. METHODS Five adult cadavers were used bilaterally. After a frontotemporal craniotomy and a zygomatic arch osteotomy, the MA was found easily 1 to 2 cm inferior to the infratemporal crest. A hole was created with a 4-mm-tip drill in the sphenoid bone 2 to 3 mm lateral to the foramen rotundum extradurally, and the dura over the hole was opened. After the carotid and sylvian cisterns had been opened, the M2 segment of the MCA was exposed. The graft was passed through the hole to reach the M2 segment. Then, the MA was freed from the surrounding tissue and was transected before the infraorbital artery branch. The radial artery graft was anastomosed end-to-end to the MA proximally and end-to-side to the M2 segment of the MCA distally. RESULTS The mean thickness of the MA before the infraorbital artery branch was 2.6 ± 0.3 mm. The mean thickness of the largest trunk of the MCA was 2.3 ± 0.3 mm. The average length of the graft was 36 ± 5.5 mm. CONCLUSION MA-to-MCA bypass is as feasible as proximal MCA revascularization using long vein grafts. The thickness of the MA provides sufficient flow; the length of the graft is short, and it has a straight course. MA-to-proximal MCA bypass may be an alternative to superficial temporal artery-to-MCA as well as extracranial carotid-to-MCA bypasses.
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Kim, Louis J., Farzana Tariq, and Laligam N. Sekhar. "Pediatric bypasses for aneurysms and skull base tumors: short- and long-term outcomes." Journal of Neurosurgery: Pediatrics 11, no. 5 (May 2013): 533–42. http://dx.doi.org/10.3171/2013.1.peds12444.
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Object Cerebral bypass is a useful microsurgical technique for the treatment of unclippable aneurysms and invasive skull base tumors. The authors present the largest reported series of cerebrovascular bypasses in the pediatric population. They describe the short- and long-term clinical and radiographic outcomes of extracranial-intracranial and local bypasses performed for complex cerebral aneurysms and recurrent, invasive, and malignant skull base tumors in pediatric patients. Methods A consecutive series of 17 pediatric patients who underwent revascularization were analyzed retrospectively for indications, graft patency, and neurological outcomes. Results The mean age was 12 years (median 11 years, range 4–17 years), and there were 7 boys (41%) and 10 girls (59%). A total of 18 bypasses were performed in 17 patients and included 10 aneurysm cases (55.5%) and 8 tumor cases (45%). Of these 18 bypasses, there were 11 (61.1%) extracranial-intracranial bypasses (10 saphenous vein grafts [90%] and 1 radial artery graft [10%]), 1 side-to-side anastomosis (5.5%), 2 intracranial reimplants (11.1%), and 4 interposition bypass grafts (22.2%; 2 radial artery grafts, 1 saphenous vein graft, and 1 lingual artery graft). The mean clinical follow-up was 40.5 months (median 24 months, range 3–197 months). The mean radiographic follow-up was 40 months (median 15 months, range 9–197 months). Eighty-two percent of patients (14 of 17) achieved a modified Rankin Scale score between 0 and 2; however, 2 patients died of disease progression during long-term follow-up. The short-term (0- to 3-month) graft patency rate was 100%. Two patients had graft stenosis (11.7%) and underwent graft revisions. Two patients (11.1%) with giant middle cerebral artery aneurysms (> 25 mm) had strokes postoperatively but recovered without a persistent neurological deficit. One patient observed for 197 months showed a stable dysplastic change at the end of the graft. The long-term graft patency was 100% with a mean follow-up of 40 months. There were 2 deaths in the cohort during follow-up; both patients died of malignant tumors (osteogenic sarcoma and chondrosarcoma). Conclusions The authors conclude that in properly selected cases, bypasses can be safely performed in patients with aneurysms and skull base tumors. The bypasses remained patent over long periods of time despite the growth of the patients.
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Sechtem, U., Sabine Langkamp, M. Jungehülsing, H. H. Hilger, H. Schicha, and P. Theissen. "Nichtinvasive Beurteilung aortokoronarer Venenbrücken mit Kernspintomographie." Nuklearmedizin 28, no. 06 (1989): 234–42. http://dx.doi.org/10.1055/s-0038-1629496.
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Fortyfour patients with recent cardiac catheterization because of recurrent chest pain after coronary artery bypass surgery were studied by magnetic resonance imaging to evaluate graft patency. To assess the efficacy of this non-invasive method 92 coronary artery bypass grafts were examined by the spin-echo technique. ECG-gated transversal sections were acquired between the diaphragm and the aortic arch. The specificity of magnetic resonance imaging was 83% (48/58) for patent grafts. However, the sensitivity in the detection of occluded bypasses was only 56% (19/34). Despite the good specificity, clinical applications of this method are limited because of its low sensitivity.
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Chandra, Ankur, and Niren Angle. "Occluded Infrainguinal Bypass Graft: Potential Source of Limb-Threatening Emboli." Vascular 14, no. 3 (May 1, 2006): 156–60. http://dx.doi.org/10.2310/6670.2006.00029.
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Surgical bypass represents one of the chief treatment modalities for peripheral arterial occlusive disease. Despite improving techniques, graft occlusion accounts for the majority of these bypass failures. Once occluded, however, these grafts are thought to rarely pose a threat for future ischemic events. This report describes two patients with previously thrombosed grafts who subsequently presented with limb-threatening ischemia owing to peripheral embolization from the graft. Two patients with occluded grafts presented with ipsilateral limb-threatening acute ischemia. Both of these patients developed severe acute limb-threatening ischemia weeks to months after known graft thrombosis. Arteriography revealed peripheral embolization in each case. Both patients were operated on for disconnection of the thrombosed graft from the native circulation and have been free of recurrent symptoms. The occluded graft, although generally innocuous, can be a source of peripheral emboli, resulting in peripheral embolization and acute limb ischemia. Both patients in this report developed limb-threatening ischemia owing to embolization from the cul-de-sac of occluded prosthetic grafts. Due to the rarity of the condition and its associated morbidity and mortality, awareness and recognition of this phenomenon are critical. Operative disconnection is recommended if the embolism occurs downstream of the graft and no other embolic source can be identified.
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Zhang, Y. Jonathan, Daniel L. Barrow, and Arthur L. Day. "Extracranial-Intracranial Vein Graft Bypass for Giant Intracranial Aneurysm Surgery for Pediatric Patients: Two Technical Case Reports." Neurosurgery 50, no. 3 (March 1, 2002): 663–68. http://dx.doi.org/10.1097/00006123-200203000-00048.
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Abstract OBJECTIVE AND IMPORTANCE: Herein we describe two cases of extracranial-intracranial vein graft bypasses for the treatment of giant intracranial aneurysms in prepubertal pediatric patients. One patient is, we think, the youngest patient reported in the literature to have been successfully treated in such a manner, with a good long-term outcome. Such grafts seem to enlarge longitudinally during the growth spurt, making such techniques reasonable long-term therapeutic options for the management of complex intracranial aneurysms in pediatric patients. CLINICAL PRESENTATION: Patient 1, a 13-year-old boy, presented with headaches and rapidly progressive right cavernous sinus syndrome. Computed tomography and cerebral angiography revealed a giant, fusiform, right intracavernous internal carotid artery aneurysm. Patient 2, a 23-month-old girl, was discovered to harbor an asymptomatic, recurrent, giant, fusiform, left M1 middle cerebral artery aneurysm 1 year after presenting with seizures related to subarachnoid hemorrhage from the aneurysm, for which she had been treated with clipping and an M2-M2 anastomosis. INTERVENTION: Both patients underwent craniotomies, with sacrifice of the proximal parent vessel (the distal cervical internal carotid artery and the proximal middle cerebral artery, respectively), combined with cerebral revascularization through extracranial-intracranial saphenous vein bypass grafts. Both patients experienced excellent long-term clinical outcomes, have undergone significant growth, and exhibit excellent long-term graft patency and aneurysm obliteration. CONCLUSION: These two cases highlight the safety and efficacy of extracranial-intracranial vein graft bypasses among prepubertal pediatric patients. The indications for bypass procedures to treat giant intracranial aneurysms are discussed, and the technical aspects of maximizing vein bypass graft patency are reviewed.
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Gunawardena, Manuri, Jeffrey M. Rogers, Marcus A. Stoodley, and Michael K. Morgan. "Revascularization surgery for symptomatic non-moyamoya intracranial arterial stenosis or occlusion." Journal of Neurosurgery 132, no. 2 (February 2020): 415–20. http://dx.doi.org/10.3171/2018.9.jns181075.
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OBJECTIVEPrevious trials rejected a role of extracranial-to-intracranial bypass surgery for managing symptomatic atheromatous disease. However, hemodynamic insufficiency may still be a rationale for surgery, provided the bypass can be performed with low morbidity and patency is robust.METHODSConsecutive patients undergoing bypass surgery for symptomatic non-moyamoya intracranial arterial stenosis or occlusion were retrospectively identified. The clinical course and surgical outcomes of the cohort were evaluated at 6 weeks, 6 months, and annually thereafter.RESULTSFrom 1992 to 2017, 112 patients underwent 127 bypasses. The angiographic abnormality was arterial occlusion in 80% and stenosis in 20%. Procedures were performed to prevent future stroke (76%) and stroke reversal (24%), with revascularization using an arterial pedicle graft in 80% and venous interposition graft (VIG) in 20%. A poor outcome (bypass occlusion, new stroke, new neurological deficit, or worsening neurological deficit) occurred in 8.9% of patients, with arterial pedicle grafts (odds ratio [OR] 0.15), bypass for prophylaxis against future stroke (OR 0.11), or anterior circulation bypass (OR 0.17) identified as protective factors. Over the first 8 years following surgery the 66 cases exhibiting all three of these characteristics had minimal risk of a poor outcome (95% confidence interval 0%–6.6%).CONCLUSIONSProphylactic arterial pedicle bypass surgery for anterior circulation ischemia is associated with high graft patency and low stroke and surgical complication rates. Higher risks are associated with acute procedures, typically for posterior circulation pathology and requiring VIGs. A carefully selected subgroup of individuals with hemodynamic insufficiency and ischemic symptoms is likely to benefit from cerebral revascularization surgery.
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Lucia, Cojocaru, Avram Anamaria, Chioncel Valentin, Rusali Andrei, and Parepa Irinel. "Atherosclerotic Plaque Regression: Cause of Bypass Graft Oclussion." ARS Medica Tomitana 24, no. 1 (February 1, 2018): 20–25. http://dx.doi.org/10.2478/arsm-2018-0005.
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Abstract We present a case of a patient who had coronary artery bypass grafting during surgery for severe aortic stenosis. Seven months after surgery the arterial graft was occluded following native coronary artery disease regression. The heart team must consider this possibility when assessing the requirement for bypass grafts in a borderline lesion.
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JI, Q., Y. Q. MEI, X. S. WANG, and D. W. WUSHA. "WALL SHEAR AND CIRCUMFERENTIAL STRESS CHANGES IN A PORCINE DOUBLE-LAYER VEIN GRAFT." Journal of Mechanics in Medicine and Biology 11, no. 05 (December 2011): 1059–70. http://dx.doi.org/10.1142/s0219519411004320.
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This study aimed to evaluate short-term changes of wall shear stress and circumferential stress in a self-designed double-layer vein graft in a porcine vein graft model. In this study, left and right hind femoral arteries of 40 white pigs were randomly divided into an experimental group (double-layer vein graft) and a control group (single-layer vein graft). At one hour and then at one, two and four weeks after venous bypass grafting, sets of ten animals underwent Doppler-ultrasonic and electromagnetic flowmeter examinations to calculate wall shear stress in middle sections of the vein grafts. Then, the vein grafts were excised and subjected to mechanical tests to assess the circumferential stress. As a result, the double-layer vein grafts showed an increase in wall shear stress by 43.5% compared with the control group at one hour after venous bypass grafting. With time wall shear stress gradually increased, the intimal circumferential stress gradually decreased in the two groups. Intimal circumferential stress in the experimental group was significantly lower than that in the control group at each observational time-point. Hence, the double-layer support of the vein graft may have contributed towards a rise in wall shear stress and reduction in circumferential stress in the true vein graft over the four-week period after venous bypass grafting, and thus conferring some protection to the true vein graft.
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NAKATANI, SUSUMU, Hajime HIROSE, Kohji OZAKI, Yoshikazu IWATA, and Heitaro MOGAMI. "Surgical Technique of Long Saphenous Vein Bypass Graft for Cerebral Revascularization." Surgery for Cerebral Stroke 16, no. 1 (1988): 1–7. http://dx.doi.org/10.2335/scs1987.16.1_1.
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Kocaeli, Hasan, Norberto Andaluz, Ondrej Choutka, and Mario Zuccarello. "Use of radial artery grafts in extracranial–intracranial revascularization procedures." Neurosurgical Focus 24, no. 2 (February 2008): E5. http://dx.doi.org/10.3171/foc/2008/24/2/e5.
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✓Cerebral revascularization procedures have been used in the clinical management of actual or threatened cerebral ischemic states and unclippable cerebral aneurysms. An alternative to a low-flow bypass graft (for example, with the superficial temporal artery) is the use of high-flow grafts created using the saphenous vein (SV) or radial artery (RA). These high-flow grafts are particularly useful when otherwise adequate collateral flow is insufficient to enable sacrifice of the parent vessel without the risk of cerebral ischemia. In their clinical series of 13 patients who underwent high-flow bypass with an RA graft, the authors describe 8 women and 5 men whose ages ranged from 44 to 69 years (mean 57.84 ± 9.05 years). Indications for RA graft bypass were unclippable aneurysms in 10 patients and occlusive cerebrovascular disease in 3 patients. The authors review the properties of the 2 most common conduits, the SV and RA grafts. They present the technique of high-flow extracranial–intracranial bypass produced using RA grafts in the management of occlusive atherosclerotic disease and complex intracranial aneurysms that are not otherwise amenable to either clip ligation or coil occlusion.
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Magnetti, Thalhammer, Hechelhammer, Husmann, Pfammatter, and Amann-Vesti. "Spontaneous pseudoaneurysm of a femoro-popliteal Omniflow® II graft treated with a stentgraft." Vasa 39, no. 2 (May 1, 2010): 196–98. http://dx.doi.org/10.1024/0301-1526/a000028.
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We report the case of a symptomatic spontaneous leak of a biosynthetic graft (Omniflow® II) treated endovascularly with a stentgraft. Potential degeneration of biosynthetic grafts with aneurysm formation is a well known problem with a reported incidence of up to 7 %. Implantation of a stentgraft for treatment of a pseudoaneurysm is a valuable treatment option in native arteries; however its use in Omniflow® II bypass grafts has not been reported so far. Surveillance of peripheral bypass grafts with duplex ultrasound may be helpful to detect morphological alterations of the graft.
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Corso, Paul G. "Cardiopulmonary Bypass and Coronary Artery Bypass Graft." Chest 100, no. 2 (August 1991): 298–99. http://dx.doi.org/10.1378/chest.100.2.298.
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Belkin, Michael. "Secondary Bypass after Infrainguinal Bypass Graft Failure." Seminars in Vascular Surgery 22, no. 4 (December 2009): 234–39. http://dx.doi.org/10.1053/j.semvascsurg.2009.10.005.
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Gokalp, Orhan, Ismail Yurekli, Levent Yilik, Serdar Bayrak, Haydar Yasa, Aykut Sahin, Mert Kestelli, Ufuk Yetkin, and Ali Gurbuz. "Crossover Femoropopliteal Bypass: Single Graft or Double Grafts." Annals of Vascular Surgery 26, no. 5 (July 2012): 707–14. http://dx.doi.org/10.1016/j.avsg.2011.11.011.
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Pfeiffer, Thomas, Kever, Grabitz, Reiher, Müller, Hildebrand, and Sandmann. "Das Einheilungsverhalten schmalkalibriger Gefäßprothesen aus Polyester mit plasminbehandelter Fibrinbeschichtung – eine experimentelle Untersuchung." Vasa 29, no. 2 (May 1, 2000): 117–24. http://dx.doi.org/10.1024/0301-1526.29.2.117.
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Background: The autogenous vein represents the graft material of choice in crural and pedal bypass surgery. Because of the numerous problems concerning the graft harvesting and the quality of autogenous vein material an equally good allogenous graft is urgently needed. Up to the present times no such graft material has been able to achieve the success of vein grafts. Methods: We investigated the knitted polyester prosthesis Terumo PF-V (Terumo Comp., Japan), diameter 5 mm with outer reinforce, which is characterized by a new coating of plasmin-treated fibrin. Grafts were implanted as bypass into the ligated carotid (n=10) and femoral arteries (n=10) of 10 dogs (beagles). As a control 5 mm-ePTFE-prostheses (Impra Carboflo) were implanted simultaneously on the contralateral side. Results: After 6 months, seven of 20 PF-V-grafts and 8 of 20 PTFE-grafts were patent. All prostheses presented with good macroscopic healing characteristics. In the patent grafts, angiography showed no substantial stenoses. The histological examination of the material was performed using light microscopy, transmission polarising microscopy, scanning electron microscopy, and transmission electron microscopy. Both types of prostheses showed the typical pattern of graft healing by migration of mesenchymal cells through the prosthesis, formation of capillaries, and growing of a neointima with endothelium-like cells. All failed bypass grafts presented with an occluding proliferation from the arterial wall into the anastomotic region. Conclusions: Using clinically or histologically evaluation, neither graft demonstrated superiority over the other. The results indicate that the coating plays only a minor role for graft healing if any. For proper graft function, the arterial wall proliferation at the anastomotic region, which is not dependent on the type of prosthesis, appears to be most important. The overall results concerning both types of prostheses were disappointing
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Stoodley, Marcus, Jeffrey Rogers, Manuri Gunawardena, and Michael Morgan. "008 Revascularisation surgery for non-moyamoya symptomatic intracranial stenosis and occlusion." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 6 (May 24, 2018): A4.3—A5. http://dx.doi.org/10.1136/jnnp-2018-anzan.8.
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IntroductionPrevious trials rejected a role of extracranial-to-intracranial bypass surgery for managing symptomatic atheromatous disease. However, haemodynamic insufficiency may still be a rationale for surgery, provided it can be performed with low morbidity and that patency is robust.MethodsConsecutive patients undergoing bypass surgery for non-moyamoya symptomatic intracranial arterial stenosis and occlusion were retrospectively identified. The clinical course and surgical outcomes of the cohort were evaluated at six-weeks, six-months, and annually thereafter.ResultsBetween 1992 and 2017, 112 patients underwent 127 bypasses. The angiographic abnormality was arterial occlusion in 80% and stenosis in 20%. Procedures were to prevent future stroke (76%) and stroke reversal (24%), with revascularisation using an arterial pedicle graft in 80% and venous interposition graft (VIG) in 20%. A poor outcome (bypass occlusion, new stroke, new neurological deficit, or worsening neurologic deficit) occurred in 8.9% of patients. The risk of poor outcome was significantly lower with arterial pedicle grafts (Odds ratio=0.15), bypass for prophylaxis against future stroke (Odds ratio=0.11), or anterior circulation bypass (Odds ratio=0.17). Over the first eight years following surgery there were no poor outcomes in the 66 cases exhibiting all three of these characteristics.ConclusionProphylactic arterial pedicle bypass surgery for anterior circulation ischemia is associated with high graft patency and low stroke and surgical complication rates. Higher risks are associated with acute procedures, typically for posterior circulation pathology and requiring VIGs. A carefully selected subset of individuals with haemodynamic insufficiency and ischaemic symptoms are likely to benefit from cerebral revascularisation surgery.
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FitzGibbon, Gerald M., Alan J. Leach, Wilbert J. Keon, Jeffrey R. Burton, and Henryk P. Kafka. "Coronary bypass graft fate." Journal of Thoracic and Cardiovascular Surgery 91, no. 5 (May 1986): 773–78. http://dx.doi.org/10.1016/s0022-5223(19)36000-3.
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Carpenter, Jeffrey P., Micheal D. Lieberman, Richard Shlansky-Goldberg, Stuart E. Braverman, Micheal Soulen, George A. Holland, Richard A. Baum, et al. "Infrageniculate bypass graft entrapment." Journal of Vascular Surgery 18, no. 1 (July 1993): 81–89. http://dx.doi.org/10.1067/mva.1993.41754.
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Mendes, Aysha. "Coronary artery bypass graft." British Journal of Cardiac Nursing 10, no. 4 (April 2, 2015): 205. http://dx.doi.org/10.12968/bjca.2015.10.4.205.
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Usami, Satoshi, Kentaro Tanaka, Alisa Ohkubo, and Mutsumi Okazaki. "Vascularized Nerve Bypass Graft." Plastic and Reconstructive Surgery - Global Open 4, no. 4 (April 2016): e686. http://dx.doi.org/10.1097/gox.0000000000000673.
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Jie, Zhang Ming, Liu Dan Dan, Wan Song, Chen Ming Chit, Lee Chuen Neng, Jean Marie De Smet, and Carlos-A. Mestres. "Coronary Artery Bypass Graft." Asian Cardiovascular and Thoracic Annals 4, no. 1 (March 1996): 63. http://dx.doi.org/10.1177/021849239600400119.
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Hu, Shengshou, Zhe Zheng, Xin Yuan, Yun Wang, Sharon-Lise T. Normand, Joseph S. Ross, and Harlan M. Krumholz. "Coronary Artery Bypass Graft." Circulation: Cardiovascular Quality and Outcomes 5, no. 2 (March 2012): 214–21. http://dx.doi.org/10.1161/circoutcomes.111.962365.
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