Journal articles on the topic 'Distal Graft/Artery'
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Redzek, Aleksandar, Bogoljub Mihajlovic, Pavle Kovacevic, Nada Cemerlic-Adjic, Katica Pavlovic, and Lazar Velicki. "Patency of internal thoracic artery and vein grafts according to revascularized coronary artery properties." Medical review 64, no. 3-4 (2011): 137–42. http://dx.doi.org/10.2298/mpns1104137r.
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Long-term results of surgical myocardial revascularization are determined by the quality of grafts and the progression of atherosclerosis in coronary arteries. The aim of the study was to evaluate the patency rate of internal thoracic artery and great saphenous vein grafts in relation to the hemodynamic properties of revascularized coronary artery. The patency of internal thoracic artery and great saphenous vein grafts was analyzed in relation to the degree of coronary stenosis estimated by angiography and the diameter of distal portion of coronary artery assessed intra-operatively. The long-term patency of great saphenous grafts depends on the distal coronary artery diameter but not on the degree of coronary artery stenosis. The patency of internal thoracic artery graft depends on the degree of co?ronary artery stenosis but not on the distal coronary artery diameter. The internal thoracic artery is the superior graft in coronary surgery, but the low patency rate in case of moderate coronary artery stenosis emphasizes the importance of selective approach.
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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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Kallakuri, S., E. Ascher, A. Hingorani, T. Jacob, and S. Salles-Cunha. "Hemodynamics of Infrapopliteal PTFE Bypasses and Adjunctive Arteriovenous Fistulas." Cardiovascular Surgery 11, no. 2 (April 2003): 125–29. http://dx.doi.org/10.1177/096721090301100204.
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Purpose Blood flow, pressure and peripheral resistance in patients with established polytetrafluoroethylene (PTFE) grafts and adjunctive arteriovenous fistulas (AVF) have rarely been investigated. To better elucidate the effects of this AVF, we obtained noninvasive measurements of hemodynamic variables in patients with infrapopliteal PTFE grafts and an AVF. Methods Systolic, mean and diastolic arm and toe pressures were measured with an oscillometric technique employed in automatic blood pressure monitors. Peak-systolic velocity, end-diastolic velocity and flow rates at the graft and recipient distal artery were measured with duplex ultrasound. Resistance for the leg and foot in peripheral resistance units (PRU) was estimated as mean arm pressure divided by graft flow rate and as mean toe pressure divided by distal artery flow rate respectively. We analyzed data from 21 patients. Toe pressures were measurable in 13 patients. Bypass graft inflow was at the external iliac artery in 11 patients, common femoral in six, common iliac in two and superficial femoral in two. The distal anastomosis was at the anterior tibial artery in 10 patients, peroneal in seven and posterior tibial in four patients. Results Graft systolic and diastolic velocities were 91 ± 46 (mean±sd) and 38 ± 31 (mean±sd) cm/s respectively. Toe systolic pressure averaged 81 ± 28 (mean±SD) mmHg with a corresponding toe/brachial index (TBI) of 0.53 ±0.18 (mean±SD). The ratio between arm mean pressure, 104 ± 20 (mean±SD) mmHg, and graft flow rate, 413 ± 290 (mean±sd) ml/min, yielded an estimated leg resistance of 0.32 ± 0.20 peripheral resistance units (PRU) (mean±sd). The ratio between mean toe pressure, 51 ± 21 (mean ± SD) mmHg, and distal artery flow rate, 37 ± 26 (mean±SD) ml/min, produced an estimated foot resistance averaging 1.66 ± 1.18 PRU (mean±sd). Conclusions Average graft flow rate was five times greater than flow reported for standard tibial bypasses. Although distal artery flow rate and graft peak systolic velocity were within reported normal ranges, mean toe pressure and toe-brachial index were below normal. Leg and foot resistances were decreased. These data suggest that bypasses with arteriovenous fistulas have increased flow, desirable for graft patency, but may affect distal perfusion pressure.
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Diaz-Abele, Julian, Emily Saganski, and Avinash Islur. "Use of Arterial Grafts in Hypothenar Hammer Syndrome: Application of Perforator Flap Anatomy." Plastic Surgery 28, no. 4 (June 17, 2020): 204–9. http://dx.doi.org/10.1177/2292550320933684.
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Background: Hypothenar hammer syndrome (HHS) is traditionally treated with venous bypass grafting, but controversy has arisen as arterial grafts have become more available. Methods: A retrospective review of all patients undergoing ulnar artery bypass grafting for HHS with an arterial graft from 2008 to 2017 was performed. We also review the literature for patency rates and discuss the scenarios that favor different graft choices. Results: Six patients were included in our series. Five had primary surgery and 1 had revision surgery for HHS. Five arterial grafts were from the deep inferior epigastric artery and 1 was from the lateral circumflex femoral artery. The proximal anastomotic site was the ulnar artery for all: n = 6. The distal anastomosis site was the palmar arch and common digital artery (CDA) of the ring/small finger and CDA of the middle/ring finger: n = 3; the palmar arch and the CDA of the ring/small finger: n = 3. All patients were symptom-free at follow-up and had a patent ulnar artery on Allen’s testing or angiogram. Conclusion: Patency rates of arterial grafts for HHS appear to be excellent and this small series and may offer an alternative to traditional venous grafts and end-to-end arterial anastomoses. We suggest using arterial perforator grafts from free flap donor sites. These have well-described anatomy, are easily harvested, and carry minimal donor site morbidity. Lateral circumflex femoral artery graft is favored in patients requiring a single distal anastomosis, who have a ventral hernia, or who are obese. Deep inferior epigastric artery graft is preferred when multiple distal targets or versatile configurations are needed, in thin patients, or in female patients.
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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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Arbağ, Hamdi, Mehmet Erkan Ustun, Mustafa Buyukmumcu, Aynur Emine Cicekcibasi, and Cagatay Han Ulku. "A modified technique to bypass the maxillary artery to supraclinoid internal carotid artery by using radial artery graft: an anatomical study." Journal of Laryngology & Otology 119, no. 7 (July 2005): 519–23. http://dx.doi.org/10.1258/0022215054352153.
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Objective: This study aims to examine the use of a radial artery graft for bypass of the maxillary artery (MA) to the supraclinoid internal carotid artery (ICA) in treating ICA occlusions.Study design and setting: This method was carried out on five adult cadaver sides. The MA was reached 1–2 cm inferior to the crista infratemporalis, following a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally 2–3 cm lateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4 mm tipped drill. A radial artery graft was passed through the hole to the inside of the dura. Before giving the infraorbital artery branch, the MA was dissected from the surrounding tissue and transected. The proximal end of the graft was anastomosed end-to-end with the MA and the distal end of the graft end-to-side with the supraclinoid ICA.Results: The mean calibre of the MA was 2.6 ± 0.3 mm. The mean calibre of the proximal end of the radial artery graft was 2.5 ± 0.25 mm and the distal end was 2.35 ± 0.2 mm. The mean length of the radial artery graft was 4.0 ± 0.5cm.Conclusion: This study suggested that the cases with ICA occlusion, which require high blood flow, may be treated as an alternative to current bypass methods requiring long vein grafts.
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Shirasu, Takuro, Atsushi Akai, Manabu Motoki, and Masaaki Kato. "Clampless In-Situ Immobilized Branching (CLIMB) to Reconstruct the Internal Iliac Artery." Life 12, no. 11 (November 18, 2022): 1928. http://dx.doi.org/10.3390/life12111928.
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Background: Surgical reconstruction of the internal iliac artery (IIA) or its branches is sometimes demanding because of difficulty in distal clamping and suturing in the narrow pelvic space. Here we present a hybrid technique of ClampLess In-situ imMobilized Branching (CLIMB) to reconstruct IIA. Methods: in the CLIMB technique, an 8 mm artificial graft is sutured onto the surface of the common iliac artery (CIA) without clamping. Following puncture of the CIA wall, stent grafts are bridged from IIA to the graft. Finally, the graft is sutured to the ipsilateral external iliac artery (EIA). Concomitant endovascular aneurysm repair or IIA branch embolization can also be performed. We applied this technique to the patients unsuited for other IIA reconstruction. Results: eleven patients underwent the current technique. All but one patient underwent contralateral IIA interruption. Seven patients had a history of aorto-iliac repair before the index surgery. Iliac extender, internal iliac component, Viabahn VBX or Fluency covered stent were used for bridging the graft. Simultaneous IIA branch embolization was performed in 2 patients. Distal landing zones were IIA in 7 grafts, superior gluteal artery in 4 grafts and inferior gluteal artery (IGA) in 1 graft. Technical success was achieved in all cases. No patient complained of buttock claudication or other ischemic symptoms on the treatment side. During a mean follow-up period of 38 months, 11 out of 12 grafts were patent without any related endoleak. One IGA graft occluded at 56 months after surgery. Conclusions: the CLIMB technique is a viable alternative to preserve IIA with an acceptable mid-term durability.
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Kobayashi, Junjiro, Osamu Tagusari, Ko Bando, Kazuo Niwaya, Hiroyuki Nakajima, Michiko Ishida, Satsuki Fukushima, and Soichiro Kitamura. "Total Arterial Off-Pump Coronary Revascularization with Only Internal Thoracic Artery and Composite Radial Artery Grafts." Heart Surgery Forum 6, no. 1 (February 2, 2005): 30. http://dx.doi.org/10.1532/hsf.969.
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<P>Objective: Total arterial off-pump coronary artery bypass (OPCAB) grafting with only internal thoracic artery (ITA) and composite radial artery (RA) grafts has been applied extensively to avoid cerebral complications and late vein graft failure. We evaluated the initial experience with this method by clinical and angiographic study. </P><P>Methods: Between April 2000 and May 2002, 257 patients underwent OPCAB grafting with this technique. The range of ages at operation was 42 to 86 years (mean, 66.1 � 8.6 years). On average, 3.28 � 0.86 grafts per patient were completed. More than 4 distal anastomoses were performed in 88 patients (34%). For coronary revascularization, 289 ITA and 555 RA grafts were used. The RA was used as a Y graft in 211 patients, as an I graft (for ITA extension) in 52 patients, and as a K graft (the side of the RA attached to the side of the left ITA) in 28 patients. Sequential bypass grafting was performed with 190 RA and 7 ITA grafts. The sites of distal anastomoses were 256 left anterior descending arteries (30%), 236 posterolateral branches (28%), 144 posterior descending arteries (17%), 106 diagonal branches (13%), 82 obtuse marginal branches (10%), and 19 right coronary arteries (2%). </P><P>Results: There were 1 operative death (0.4%) due to cerebral hemorrhage and 2 episodes of stroke (0.8%) during postoperative angiography. There were no clinical underperfusion syndromes or new intra-aortic balloon pump insertions. Perioperative myocardial infarction occurred in 12 patients (4.7%), sternal dehiscence in 5 (1.9%), and early coronary intervention in 4 (1.6%). There was no deep wound infection, reexploration for bleeding, or hand ischemia. The actuarial survival rate and the cardiac event-free rate at 2 years were 98.6% � 2.4% and 94.2% � 0.8%, respectively. Early postoperative angiography revealed a 97.8% (264/270) graft patency of ITAs and 97.9% (512/523) graft patency of RAs in 238 patients. Flow competition of the RA graft was recognized in 22 patients and, as indicated by follow-up angiographic study, did not cause late graft occlusion. </P><P>Conclusions: OPCAB grafting with ITAs and composite RAs provides excellent early and intermediate clinical results and graft patency.</P>
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SAITOH, S., and Y. NAKATSUCHI. "Long-Term Results of Vein Grafts Interposed in Arterial Defects Using the Telescoping Anastomotic Technique and Fibrin Glue." Journal of Hand Surgery 21, no. 1 (February 1996): 47–52. http://dx.doi.org/10.1016/s0266-7681(96)80011-8.
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Fibrin glue has been applied in the anastomosis of vein grafts placed in rat femoral arteries using the telescoping technique at both ends of the graft. 34 out of 35 grafts which were patent 1 to 3 weeks post-operatively were kept for 3 months to assess the long-term patency, and the effect of the glue on the diameters of the graft and femoral artery. All 34 grafts were patent 3 months post-operatively. Excessive enlargement of the graft diameter was alleviated by the fibrin glue without affecting the diameter of the femoral artery. The diameter at the proximal anastomosis was 66% and that at the distal anastomosis was 87% of the diameter of the femoral artery.
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O'Brien, Thomas, Liam Morris, Michael Walsh, and Tim McGloughlin. "That Hemodynamics and Not Material Mismatch is of Primary Concern in Bypass Graft Failure: An Experimental Argument." Journal of Biomechanical Engineering 127, no. 5 (April 28, 2005): 881–86. http://dx.doi.org/10.1115/1.1992532.
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The long term patency of end-to-side peripheral artery bypasses are low due to failure of the graft generally at the distal end of the bypass. Both material mismatch between the graft and the host artery and junction hemodynamics are cited as being major factors in disease formation at the junction. This study uses experimental methods to investigate the major differences in fluid dynamics and wall mechanics at the proximal and distal ends for rigid and compliant bypass grafts. Injection moulding was used to produce idealized transparent and compliant models of the graft/artery junction configuration. An ePTFE graft was then used to stiffen one of the models. These models were then investigated using two-dimensional video extensometry and one-dimensional laser Doppler anemometry to determine the junction deformations and fluid velocity profiles for the rigid and complaint graft anastomotic junctions. Junction strains were evaluated and generally found to be under 5% with a peak stain measured in the stiff graft model junction of 8.3% at 100mmHg applied pressure. Hemodynamic results were found to yield up to 40% difference in fluid velocities for the stiff/compliant comparison but up to 80% for the proximal/distal end comparisons. Similar strain conditions were assumed for the proximal and distal models while significant differences were noted in their associated hemodynamic changes. In contrasting the fluid dynamics and wall mechanics for the proximal and distal anastomoses, it is evident from the results of this study, that junction hemodynamics are the more variable factor.
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Balkhy, Husam H., Sandeep Nathan, Gianluca Torregrossa, Hiroto Kitahara, Sarah Nisivaco, Mackenzie McCrorey, and Brooke Patel. "Angiographic patency after robotic beating heart totally endoscopic coronary artery bypass grafting facilitated by automated distal anastomotic connectors." Interactive CardioVascular and Thoracic Surgery 31, no. 4 (October 1, 2020): 467–74. http://dx.doi.org/10.1093/icvts/ivaa149.
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Abstract OBJECTIVES Robotic totally endoscopic coronary artery bypass (TECAB) on the beating heart has been facilitated in our experience using distal coronary anastomotic connectors. In this study, we retrospectively reviewed graft patency in all robotic TECAB patients who underwent formal angiography at our current institution over a 5-year period. METHODS Between July 2013 and June 2018, 361 consecutive patients underwent robotic beating-heart TECAB. Of these patients, 121 had a follow-up angiogram, which assessed graft patency. Eighty-four patients had an angiogram as part of planned hybrid procedures and 37 patients underwent an unplanned angiogram for clinical indications. Retrospective analysis of angiographic patency and clinical outcomes was performed. RESULTS The mean Society of Thoracic Surgeons predicted risk of mortality was 1.8%. Single-vessel bypass was performed in 40 (33%) patients and multivessel grafting in 81 (67%). Average flow (ml/min) and pulsatility index in the grafts was 74.7 ± 39.1 and 1.42 ± 0.52, respectively. The number of grafts evaluated was 204 (130 left internal mammary artery and 74 right internal mammary artery grafts). The median time to angiography was 1.0 and 16.0 months and graft patency was 98% and 91% in the hybrid and non-hybrid groups, respectively. Overall graft patency was 95.6% (left internal mammary artery = 96%; right internal mammary artery = 93%). Left internal mammary artery to left anterior descending artery graft patency was 97%. Clinical follow-up was available for 316 (88%) patients at mean 22.5 ± 15.1 months. Freedom from major adverse cardiac events at 2 years was 92%. CONCLUSIONS In this consecutive series of patients undergoing formal angiography after robotic single and multivessel TECAB, we found satisfactory graft patency and 2-year clinical outcomes. Longer-term follow-up is warranted.
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Wyderka, Rafał, Jakub Adamowicz, Przemysław Nowicki, Adam Ciapka, Bartłomiej Kędzierski, and Joanna Jaroch. "Perforation of saphenous vein graft with mediastinal haemorrhage leading to near closure of distal graft segment." SAGE Open Medical Case Reports 7 (January 2019): 2050313X1983874. http://dx.doi.org/10.1177/2050313x19838745.
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Perforations of saphenous venous grafts during coronary angioplasty are rare and potentially lethal. The objective of this clinical case report is to highlight this unusual complication and necessary treatment. A 76-year-old woman, 3 months after coronary artery bypass grafting (left internal mammary artery to left anterior descendant artery, saphenous vein graft to obtuse marginal, saphenous vein graft to right coronary artery), demonstrated typical signs of acute coronary syndrome. Coronary angiogram revealed, inter alia, two critical lesions in saphenous vein graft to right coronary artery. Percutaneous coronary intervention was performed with placement of two drug-eluting stents, complicated by a vessel rupture and heavy extravasation of contrast. A polyurethane-covered stent was then deployed and successfully sealed the vascular wall. In a computed tomography of the chest, a mediastinal haematoma near the heart base and right heart margin was found. Subsequently, this intrathoracic bleeding caused external impression on saphenous vein graft to right coronary artery, leading to near occlusion of the vessel with recurrence of chest pain and ST-segment elevation in inferior wall electrocardiogram leads. Immediate coronary angiography and drug-eluting stent implantation was performed. During, further, in-hospital follow-up, patient was free of chest pain; computed tomography scan performed after 10 days revealed regression of haematoma. Clinicians must remain alert to the potential of life-threatening complications associated with saphenous venous graft angioplasty, as their recognition is critical to institution of prompt, appropriate therapy.
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Shrestha, Malakh, Nawid Khaladj, Hiroyuki Kamiya, Michael Maringka, Axel Haverich, and Christian Hagl. "Total Arterial Revascularization and Concomitant Aortic Valve Replacement." Asian Cardiovascular and Thoracic Annals 15, no. 5 (October 2007): 381–85. http://dx.doi.org/10.1177/021849230701500505.
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The safety of total arterial revascularization with a left internal thoracic artery-radial artery T-graft was evaluated in patients with at least two-vessel coronary artery disease and aortic valve stenosis requiring concomitant aortic valve replacement. From June 2001 to January 2005, 18 patients underwent aortic valve replacement and total arterial revascularization, while 101 had aortic valve replacement and conventional grafting. By matching age, sex, left ventricular ejection fraction, and number of distal anastomoses, 1:2 matched groups were generated: 15 patients with a left internal thoracic-radial artery T-graft, and 30 with left internal thoracic artery and additional vein grafts. Aortic cross clamp and cardiopulmonary bypass times were similar in both groups. There were no significant differences in postoperative data between the groups. Early mortality was 0% in the T-graft group and 2% in those with conventional grafts. Follow-up ranged from 2 to 50 months. Event-free survival was 100% in the T-graft group and 90% in the conventional graft group. Total arterial grafting with a left internal thoracic-radial artery T-graft can be performed in selected patients with aortic valve stenosis requiring simultaneous aortic valve replacement.
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Harb, Amro, Maxwell Levi, Akio Kozato, Yelena Akelina, and Robert Strauch. "Torsion Does Not Affect Early Vein Graft Patency in the Rat Femoral Artery Model." Journal of Reconstructive Microsurgery 35, no. 04 (October 30, 2018): 299–305. http://dx.doi.org/10.1055/s-0038-1675224.
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Background Torsion of vein grafts is a commonly cited reason for graft failure in clinical setting. Many microsurgery training courses have incorporated vein graft procedures in their curricula, and vein graft torsion is a common technical error made by the surgeons in these courses. To improve our understanding of the clinical reproducibility of practicing vein graft procedures in microsurgery training courses, this study aims to determine if torsion can lead to early vein graft failure in nonsurvival surgery rat models. Methods Sprague-Dawley rats were divided into five cohorts with five rats per cohort for a total of 25 rats. Cohorts were labeled based on degree of vein graft torsion (0, 45, 90, 135, and 180 degrees). Torsion was created in the vein grafts at the distal arterial end by mismatching sutures placed between the proximal end of the vein graft and the distal arterial end. Vein graft patency was then verified 2 and 24 hours postoperation. Results All vein grafts were patent 2 and 24 hours postoperation. At 2 hours, the average blood flow rate measurements for 0, 45, 90, 135, and 180 degrees of torsion were 0.37 ± 0.02, 0.38 ± 0.04, 0.34 ± 0.01, 0.33 ± 0.01, and 0.29 ± 0.02 mL/min, respectively. At 24 hours, they were 0.94 ± 0.07, 1.03 ± 0.15, 1.26 ± 0.22, 1.41 ± 0.11, and 0.89 ± 0.15 mL/min, respectively. Conclusion Torsion of up to 180 degrees does not affect early vein graft patency in rat models. To improve the clinical reproducibility of practicing vein graft procedures in rat models, we suggest that microsurgery instructors assess vein graft torsion prior to clamp release, as vessel torsion does not seem to affect graft patency once the clamps are removed.
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Onohara, Toshihiro, Kaoru Kitamura, Thomas E. Arnold, Teruo Matsumoto, and Morris D. Kerstein. "Management of Failed or Failing Infrainguinal Bypasses with Distal Correctable Lesions." American Surgeon 67, no. 10 (October 2001): 935–38. http://dx.doi.org/10.1177/000313480106701005.
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The goal of this study was to assess the management of failed or failing infrainguinal bypasses with distal correctable lesions. A retrospective analysis of 94 procedures was performed for 72 (77%) failed and 22 (23%) failing infrainguinal bypasses with distal correctable lesions in 94 patients. The 94 procedures included 50 (53%) balloon angioplasties and 44 (47%) distal vein graft extensions from the previous graft to the distal artery. Preprocedural thrombolytic therapy was performed in 62 of 94 limbs with a failed graft, and complete thrombolysis was achieved in 30 of 94. The results of thrombolytic therapy (complete or incomplete thrombolysis) or the means of revision procedure (balloon angioplasty or distal vein graft extension) did not affect the patency. Lower patency was observed for women, patients with a secondary bypass, and grafts with multiple episodes of revision. We conclude that the patency of failing infrainguinal bypasses after revision of distal lesions was affected not by means of therapy but by previous vascular procedures, the usual risk factors, and female gender.
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Seo, Dongkyung, Yutaka Dannoura, Riku Ishii, Keisuke Tada, and Katsumi Horiuchi. "Direction change in a distal bypass graft due to increased collateral perfusion after the free flap transfer: a case report." Archives of Hand and Microsurgery 27, no. 1 (March 1, 2022): 79–82. http://dx.doi.org/10.12790/ahm.21.0107.
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Distal bypass combined with a free flap is a frequent surgical option for ischemic ulcers of the lower extremities. Here, we describe a patient in whom there was a change in the direction of blood flow in a distal bypass graft. A 68-year-old male patient with an ischemic ulcer on his left heel was referred to our facility by a local dermatology clinic. Surgical revascularization was performed between the popliteal artery and the dorsalis pedis artery using an ipsilateral great saphenous vein as the graft vessel. The wound site did not heal postoperatively, so it was covered using a free latissimus dorsi muscle flap. At the same time, the thoracodorsal artery was anastomosed to the bypass graft in an end-to-side manner to serve as a nutrient vessel. Initially, blood flow into the thoracodorsal artery from the bypass graft was via the popliteal artery. However, after occlusion of the proximal anastomotic site of the bypass graft, blood flow into the thoracodorsal artery from the bypass graft was via the dorsalis pedis artery, which was the distal anastomotic site. The change in direction of blood flow might have been the result of an increase in blood flow in the collateral vessels in the ischemic lower leg, which eventually overwhelmed the blood flow in the bypass graft.
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Vivirito, Mario, Massimo Conocchia, Rosario Patanè, and Ezio Micalizzi. "Free Internal Mammary Artery Graft Reimplantation on the Same Vessel in Repeat Coronary Revascularization." Texas Heart Institute Journal 42, no. 2 (April 1, 2015): 162–65. http://dx.doi.org/10.14503/thij-13-3845.
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We describe the case of a 62-year-old man who needed a 3-vessel coronary artery bypass reoperation and mitral valve replacement. The patient's existing free left internal mammary artery graft was not functioning because of a critical stenosis in the native vessel just after the distal anastomosis. The free graft itself was in perfect condition, and we decided to reuse it. Because the course of the graft was so tortuous, we concluded that skeletonization would yield the extra length needed for reimplantation. After reimplanting the graft, we performed venous grafting and mitral valve replacement. The patient was well and had no signs of ischemia at 29 months postoperatively. There have been few reports on recycling internal mammary artery grafts in repeat coronary artery bypass grafting. To our knowledge, ours is the first report of the reimplantation of a free internal mammary artery graft on the same vessel. We describe the procedure and our decision-making process.
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Bittencourt, Marcio, Alexandre Pereira, Nilson Poppi, Luis Dallan, José Krieger, Luiz Cesar, Luís Gowdak, and Luciana Dourado. "Coronary Artery Bypass Surgery in Diffuse Advanced Coronary Artery Disease: 1-Year Clinical and Angiographic Results." Thoracic and Cardiovascular Surgeon 66, no. 06 (March 29, 2017): 477–82. http://dx.doi.org/10.1055/s-0037-1601306.
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Background Proper treatment of patients with diffuse, severe coronary artery disease (CAD) is a challenge due to its complexity. Thus, data on the outcomes after coronary artery bypass graft (CABG) in this population is scarce. In this study, we aimed to determine the impact of CABG on the clinical and functional status, as well as graft patency in those individuals. Methods Patients with severe and diffuse CAD who underwent incomplete CABG due to complex anatomy or extensive distal coronary involvement were evaluated preoperatively and 1 year after surgery. Postoperative coronary angiography was performed to evaluate graft patency. Graft occlusion was defined as the complete absence of opacification of the target vessel. Stratified analysis of graft occlusion was performed by graft type and territories, defined as left anterior descending artery (LAD), the left circumflex branch, and the right coronary artery territories; the latter two, grouped, were further classified as non-LAD territory. Results A total of 57 patients were included, in whom 131 grafts were placed. There was a significant improvement in Canadian Cardiovascular Society angina symptom severity (Z = –6.1; p < 0.001) and maximum oxygen uptake (p < 0.001), with a corresponding decrease in the use of long-acting nitrates (p < 0.001). The overall graft occlusion rate was 19.1%, with no significant difference between LAD and non-LAD territories (p = 0.08). However, a significantly lower occlusion rate was noted for the internal mammary artery (IMA) grafts when compared with saphenous vein grafts (p = 0.01), though this difference was only significant in the LAD territory (p = 0.04). Overall, the use of venous graft was the only predictor occlusion at 1 year (odds ratio: 4.03; p = 0.016). Conclusion In patients with diffuse CAD, incomplete CABG surgery resulted in a significant clinical improvement, with acceptable graft occlusion rates at 1 year, particularly for IMA grafts to the LAD territory.
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Izumoto, Hiroshi, Kazuaki Ishihara, Tetsunori Kawase, Takayuki Nakajima, Hiroshi Satoh, and Kohei Kawazoe. "All Internal Thoracic Artery Composite Graft Revascularization." Asian Cardiovascular and Thoracic Annals 13, no. 4 (December 2005): 357–60. http://dx.doi.org/10.1177/021849230501300413.
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The aim of this study was to determine the most efficient design of composite grafts and clarify the technical feasibility rate of composite grafting using internal thoracic artery exclusively in patients undergoing triple-vessel revascularization. Retrospective analysis of 104 consecutive patients was carried out. An in situ left internal thoracic artery graft for the left anterior descending artery area, with attachment of the right internal thoracic artery to the side of the left internal thoracic artery to revascularize the circumflex and right coronary vessels, was the most efficient graft design. The technical feasibility rate was 80% (83/104 patients). The mean number of distal anastomoses for the entire group was 3.8 ± 0.8 per patient. Intraoperative left internal thoracic artery flow rate was 91.6 ± 37.8 mL·min−1. With more experience, it is thought that the technical feasibility rate could be increased.
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Torstensson, Gustav Nils Johannes, Thomas Lee Torp, Nader Rasuli-Oskuii, and Bo Juel Kjeldsen. "Graft Flow Unaffected by Full Occlusion of Left Anterior Descending Artery during Coronary Artery Bypass Grafting in a Porcine Model." Heart Surgery Forum 16, no. 2 (April 3, 2015): 107. http://dx.doi.org/10.1532/hsf98.20121112.
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<p><b>Background:</b> We investigated in a porcine model whether measuring both the flow distal to an anastomosis and the graft transit time flow (TTF) gives a more accurate picture of the true blood flow in the left anterior descending artery (LAD) than graft TTF measurement alone.</p><p><b>Methods:</b> We performed off-pump coronary artery bypass grafting (CABG)�left internal mammary artery (LIMA) to the LAD�on 5 Yorkshire-Landrace pigs. Snares were placed both proximal and distal to the anastomosis. Flow was measured with ultrasound and TTF. This was carried out on the LIMA and at 2 locations on the LAD. Measurements were performed at the following times: baseline, during proximal snaring, after proximal snare loosening, during distal snaring, after distal snare loosening, and during both proximal and distal snaring.</p><p><b>Results:</b> During distal snaring, the TTF dropped (<i>P</i> = .047), and the pulsatile index (PI) increased (<i>P</i> = .025), while the ultrasound flow in the LAD dropped (<i>P</i> = .002). During proximal and distal snaring, the ultrasound flow dropped (<i>P</i> = .005), but the TTF value did not change significantly, compared with baseline.</p><p><b>Conclusion:</b> A high flow and a low PI were seen in the graft, both proximal and distal to the anastomosis, despite a fully occluded LAD. This result suggests that graft TTF measurement alone is not sufficient when performing CABG, and measurement of flow distal to the anastomosis is also necessary to determine the true blood flow in the LAD.</p>
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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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Iwai, Y., L. N. Sekhar, A. Goel, and S. Cass. "Vein graft replacement of the distal vertebral artery." Acta Neurochirurgica 120, no. 1-2 (March 1993): 81–87. http://dx.doi.org/10.1007/bf02001474.
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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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Alherbish, Aws, Colleen M. Norris, Jay Shavadia, Mohammad Almutawa, Seraj Abualnaja, Jayan Nagendran, Michelle M. Graham, and Sean Van Diepen. "Clinical and Angiographic Outcomes in Coronary Artery Bypass Surgery with Multiple versus Single Distal Target Grafts." Heart Surgery Forum 20, no. 4 (August 24, 2017): 132. http://dx.doi.org/10.1532/hsf.1793.
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Background: Coronary artery bypass grafting (CABG) with multiple distal target (MDT) grafts requires less graft material and reduces cardiopulmonary bypass time; however, there may be a higher incidence of graft failure. A real-world analysis reporting long-term outcomes associated with MDT grafts is lacking.Material and Methods: In 6262 consecutive patients who underwent an isolated first CABG from 2004-2012, patients with MDTs were propensity matched to those with single distal target (SDT) grafts. Logistic regression adjusted for traditional, anatomical, and functional definitions of complete revascularization (CR). Outcomes included 30-day, 1-year, and long-term mortality (median 6.29 years). Results: A total of 549 (8.8%) CABG patients had a MDT graft. CR defined using traditional (96.1% versus 92.0%, P = .005), anatomical (89.0% versus 80.20%, P < .001), and functional (90.7% versus 82.6, P < .001) definitions was more frequent in MDT patients. No significant differences in mortality were observed at 30 days (2% versus 3.3%, P = .18), 1-year (3.8% versus 4.9%, P = .37), or through end of follow-up (18.0% versus 16.6% P = .52) between the MDT and SDT groups, respectively. Similarly, no differences were observed after adjustment for all definitions of CR. Graft failure in MDT and SDT patients was 37.8% and 27.6%, respectively (P = .18).Conclusion: In a contemporary population-based cohort, no differences in mortality were observed between CABG patients with MDT and SDT grafts. Our findings support the safety of MDT grafts to facilitate CR in patients and when graft material is limited.
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Devereux, P. D., S. M. O'Callaghan, M. T. Walsh, and T. McGloughlin. "Mass Transport Disturbances in the Distal Graft/Artery Junction of a Peripheral Bypass Graft." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 219, no. 6 (June 1, 2005): 465–76. http://dx.doi.org/10.1243/095441105x34446.
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Intimal hyperplasia (IH) development is a primary cause of failure of reconstructive bypass surgery. While the exact mechanism by which IH initiates and proliferates has yet to be fully elucidated, it is clear that the abnormal haemodynamics present in the downstream graft/artery junction are intrinsic in its development. Mass transport disturbances owing to abnormal haemodynamics have been associated with atherogenesis and it is for this reason that an investigation into transport of platelet-derived growth factor (PDGF), a known promoter of the intimal hyperplastic response, at the downstream graft/artery junction was carried out. A steady flow analysis in a three-dimensional, idealized, downstream graft/artery junction was carried out using commercial computational fluid dynamics software. It was found that there is a two-and-half fold increase in the transport of PDGF to the artery wall at the bed of the junction when compared with an idealized, healthy artery. The presence of secondary flows in the downstream arterial section also leads to large disturbances in mass transport. It was concluded that PDGF transport in the downstream graft/artery junction tends to be highly disturbed and that there may be a role of this disturbance in the initiation and subsequent development of distal anastomotic intimal hyperplasia.
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Norman, P. E., and A. K. House. "Influence of Dexamethasone on Intimal Thickening in Experimental Vein Graft." Cardiovascular Surgery 1, no. 6 (December 1993): 724–28. http://dx.doi.org/10.1177/096721099300100626.
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The influence of dexamethasone on vein graft intimal hyperplasia was studied in a rat model. The iliolumbar vein was grafted to the common iliac artery in 42 rats. Twenty animals were treated with dexamethasone 0.1 mg/kg per day by injection for 3 weeks; 22 control animals received saline injections. Grafts were harvested at 3 weeks and longitudinal sections prepared. Five deaths and considerable morbidity was seen in the dexamethasone-treated animals. All grafts in the surviving animals in both groups were patent at 3 weeks. Intimal thickening, measured in the proximal, mid and distal graft, was found to be maximal in the proximal graft and least in the mid-portion of the graft. Dexamethasone reduced intimal thickening throughout the graft; the median thickness of the proximal graft was 30 μm (control 50 μm), in the mid-graft 10 μm (control 30 μm) and in the distal graft 20 μm (control 30 μm). This reduction was statistically significant in the mid-graft only ( P <0.05; Mann—Whitney U test). The small effect on anastomotic intimal thickening suggests that dexamethasone is of limited use in the prevention of vein graft intimal hyperplasia in clinical practice.
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Cherukupalli, Chandra, Amit J. Dwivedi, Rajeev Dayal, and Khambapatty V. Krishnasastry. "Aortic Debranching for Descending Thoracic Aortic Aneurysm Repair by Stent Grafts." American Surgeon 73, no. 1 (January 2007): 32–36. http://dx.doi.org/10.1177/000313480707300108.
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Endovascular repair of a descending thoracic aortic aneurysm may result in covering the ostia of the left carotid or left subclavian artery for proper proximal landing zones, and the celiac artery or superior mesenteric artery ostia in the abdomen for distal landing zones. To prevent possible complications of occluding the ostia of these vessels, the authors performed an innominate to left common carotid and left subclavian artery bypass as the first procedure in one patient. In the second patient they performed an aortoceliac and aortomesenteric bypass before stent graft placement. The stent graft repair of the descending thoracic aortic aneurysm was performed subsequently in both patients. This aortic debranching provides subsequent proper placement of thoracic stent grafts.
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Wicander, Janet. "Non-traumatic Dorsalis Pedis Artery Aneurysm." Journal for Vascular Ultrasound 44, no. 4 (October 13, 2020): 200–202. http://dx.doi.org/10.1177/1544316720960571.
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A true dorsalis pedis artery aneurysm is a very rare find. This is a case presentation of a patient with an asymptomatic non-traumatic dorsalis pedis artery aneurysm. A 49-year-old man was referred to the vascular lab for evaluation of an asymptomatic non-traumatic pulsatile lump on the dorsal aspect of his left foot. The patient reported that the lump had been present for at least 4 years. Color flow duplex ultrasound was used to evaluate the lump. Color flow duplex ultrasound examination of the lump demonstrated a dilatation of the dorsalis pedis artery, measuring approximately 1.05 cm by 1.35 cm. Mural thrombus is noted in gray scale image. Normal Doppler flow was noted in the dorsalis pedis artery, proximal, and distal to the aneurysm. The patient was referred to a vascular surgeon. Subsequently, he underwent a lower extremity arteriogram confirming the diagnosis of a dorsalis pedis artery aneurysm, with good distal blood flow to the toes. The patient underwent resection of the dorsalis pedis artery aneurysm. Reverse great saphenous vein was used as an interposition graft. Follow-up graft scans demonstrated good flow in the graft and in the native artery, distal to the graft. True dorsalis pedis artery aneurysms are very rare finding. When left untreated, the patient is at risk for embolization to the digits. Color flow Doppler is a very useful tool in diagnosing and assessing these aneurysms.
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Natarajan, Sabareesh K., Erik F. Hauck, L. Nelson Hopkins, Elad I. Levy, and Adnan H. Siddiqui. "Endovascular Management of Symptomatic Spasm of Radial Artery Bypass Graft." Neurosurgery 67, no. 3 (September 1, 2010): 794–98. http://dx.doi.org/10.1227/01.neu.0000374724.78276.a6.
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Abstract OBJECTIVE To describe the technique of endovascular access for treatment of vasospasm of a radial artery bypass graft from the occipital artery to the M3 branch of the middle cerebral artery (MCA) in a patient with moyamoya disease. CLINICAL PRESENTATION A 32-year-old woman presented with recurrent right-sided ischemic symptoms in the territory of a previous stroke. Angiographic findings were consistent with moyamoya disease, and a perfusion deficit was identified on computed tomography (CT) perfusion imaging. TECHNIQUE The patient underwent a left MCA bypass graft for flow augmentation. She returned with an occluded bypass graft, collateralization of the anterior MCA territory through a spontaneous synangiosis, and a severe perfusion deficit in the posterior MCA territory. She underwent a revision bypass graft procedure with the radial artery from the occipital artery stump to the MCA-M3 branch. She developed repeated symptomatic vasospasm of the radial artery graft postoperatively. After systemic anticoagulation, the graft was accessed through the occipital artery, and intra-arterial verapamil was injected. When this failed to resolve the graft spasm, the radial artery graft was accessed with a 0.14-inch Synchro-2 microwire (Boston Scientific, Natick Massachusetts), and sequential angioplasties were performed using over-the-wire balloons from the proximal to distal anastomosis and in the occipital artery stump. A nitroglycerin patch was applied cutaneously over the graft to relieve the vasospasm. RESULTS No complications occurred. Graft patency with robust flow was observed on the 5-month follow-up angiogram. CONCLUSION Endovascular techniques can be safely used for salvage of spastic extracranial-intracranial grafts.
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Davidovic, Lazar, Dragan Vasic, Ruzica Maksimovic, Dusan Kostic, Dragan Markovic, and Miroslav Markovic. "Aortobifemoral Grafting: Factors Influencing Long-Term Results." Vascular 12, no. 3 (May 2004): 171–78. http://dx.doi.org/10.1258/rsmvasc.12.3.171.
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We present the results and respective determinant factors of 283 consecutive aortobifemoral bypasses. This prospective study included 283 patients with aortoiliac atherosclerotic occlusive disease treated by aortobifemoral reconstructions. Polytetrafluoroethylene (PTFE) grafts were used in 136 patients and Dacron® grafts in 147 patients. The 30-day mortality rate was 11 patients (3.9%). Perioperative (< 30 days) graft failure occurred in 6 patients (2.1%), whereas in 14 (5.25%) patients, it occurred during the follow-up period. There were 3 (1.05%) distal anastomotic pseudoaneurysms and 5 (1.7%) graft infections, with no statistical difference between the two types of grafts. The type of prosthesis did not influence cumulative graft patency. The end-to-end configuration of proximal anastomosis and a simultaneously performed femoropopliteal bypass significantly increased the graft patency ( p < .05). The associated occlusion of the superficial femoral and popliteal arteries decreased the cumulative graft patency in comparison with that of the patients without artery disease ( p < .05). Our results showed that in the aortobifemoral position, there was no significant difference in the patency, anastomotic pseudoaneurysms, and graft infection between PTFE and Dacron grafts. However, the PTFE grafts had a significantly higher rate ( p < .05) of distal anastomotic stenosis, which was mostly caused by neointimal hyperplasia.
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HAERLE, M., H. E. SCHALLER, and C. MATHOULIN. "Vascular Anatomy of the Palmar Surfaces of the Distal Radius And Ulna: Its Relevance to Pedicled Bone Grafts at the Distal Palmar Forearm." Journal of Hand Surgery 28, no. 2 (April 2003): 131–36. http://dx.doi.org/10.1016/s0266-7681(02)00279-6.
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The potential for harvesting vascularized bone grafts from the palmar surface of the distal radius has been studied in 40 arms of fresh cadavers which had previously been injected with coloured latex solution. It was found that vascularized grafts can be pedicled on the radial part of the palmar carpal arterial arch. If a longer pedicle is required, the bone graft can be pedicled on the anterior branch of the anterior interosseous artery with retrograde flow occurring from the palmar carpal arch.
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Hughes, P. E., and T. V. How. "Flow Structures at the Proximal Side-to-End Anastomosis. Influence of Geometry and Flow Division." Journal of Biomechanical Engineering 117, no. 2 (May 1, 1995): 224–36. http://dx.doi.org/10.1115/1.2796005.
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Flow structures were visualized in transparent polyurethane models of proximal side-to-end vascular anastomoses, using planar illumination of suspended tracer particles. Both the effects of geometry and flow division were determined under steady and pulsatile flow conditions, for anastomosis angles of 15, 30, and 45 degrees. The flow patterns were highly three-dimensional and were characterized by a series of vortices in the fully occluded distal artery and two helical vortices aligned with the axis of the graft. In steady flow, above a critical Reynolds number, the flow changed from a laminar regime to one displaying time-dependent behavior. In particular, significant fluctuating velocity components were observed in the distal artery and particles were shed periodically from the occluded artery into the graft. Pairs of asymmetric flow patterns were also observed in the graft, before the onset of the time-dependent flow regime. The critical Reynolds number ranged from 427 to 473 and appeared to be independent of anastomosis angle. The presence of a patent distal artery had a significant effect on the overall flow pattern and led to the formation of a large recirculation region at the toe of the anastomosis. The main structures observed in steady flow, such as vortices in the distal artery and helical flow in the graft, were also seen during the pulsatile cycle. However, the secondary flow components in the graft were more pronounced in pulsatile flow particularly during deceleration of the flow waveform. At higher mean Reynolds numbers, there was also a greater mixing between fluid in the occluded arterial section and that in the graft.
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Keynton, R. S., M. M. Evancho, R. L. Sims, and S. E. Rittgers. "The Effect of Graft Caliber Upon Wall Shear Within in Vivo Distal Vascular Anastomoses." Journal of Biomechanical Engineering 121, no. 1 (February 1, 1999): 79–88. http://dx.doi.org/10.1115/1.2798047.
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Wall shear has been widely implicated as a contributing factor in the development of intimal hyperplasia in the anastomoses of chronic arterial bypass grafts. Earlier studies have been restricted to either: (1) in vitro or computer simulation models detailing the complex hemodynamics within an anastomosis without corresponding biological responses, or (2) in vivo models that document biological effects with only approximate wall shear information. Recently, a specially designed pulse ultrasonic Doppler wall shear rate (PUDWSR) measuring device has made it possible to obtain three near-wall velocity measurements nonintrusively within 1.05 mm of the vessel luminal surface from which wall shear rates (WSRs) were derived. It was the purpose of this study to evaluate the effect of graft caliber, a surgically controllable variable, upon local hemodynamics, which, in turn, play an important role in the eventual development of anastomotic hyperplasia. Tapered (4–7 mm I.D.) 6-cm-long grafts were implanted bilaterally in an end-to-side fashion with 30 deg proximal and distal anastomoses to bypass occluded common carotid arteries of 16 canines. The bypass grafts were randomly paired in contralateral vessels and placed such that the graft-to-artery diameter ratio, DR, at the distal anastomosis was either 1.0 or 1.5. For all grafts, the average Re was 432 ± 112 and the average Womersley parameter,α, was 3.59 ± 0.39 based on artery diameter. There was a sharp skewing of flow toward the artery floor with the development of a stagnation point whose position varied with time (up to two artery diameters) and DR (generally more downstream for DR = 1.0). Mean WSRs along the artery floor for DR = 1.0 and 1.5 were found to range sharply from moderate to high retrograde values (589 s−1 and 1558 s−1, respectively) upstream to high antegrade values (2704 s−1 and 2302 s−1, respectively) immediately downstream of the stagnation point. Although there were no overall differences in mean and peak WSRs between groups, there were significant differences (p < 0.05) in oscillatory WSRs as well as in the absolute normalized mean and peak WSRs between groups. There were also significant differences (p < 0.05) in mean and peak WSRs with respect to axial position along the artery floor for both DR cases. In conclusion, WSR varies widely (1558 s−1 retrograde to 2704 s−1 antegrade) within end-to-side distal graft anastomoses, particularly along the artery floor, and may play a role in the development of intimal hyperplasia through local alteration of mass transport and mechano-signal transduction within the endothelium.
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Pereira, Adamastor Humberto, Luiz Francisco Machado da Costa, Gilberto Gonçalves de Souza, and Alexandre Araujo Pereira. "Minimally Invasive Surgical Solution in the Treatment of an Unusual Distal Type I Endoleak after Endovascular Abdominal Aortic Aneurysm Repair." Vascular 13, no. 6 (November 1, 2005): 362–64. http://dx.doi.org/10.1258/rsmvasc.13.6.362.
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Most distal type I endoleaks can be treated by endovascular techniques such as coil embolization of the hypogastric artery and additional stent or extension stent grafts. We report a case of a difficult type I endoleak located in the distal end of a monoiliac conical stent graft used to treat an abdominal aortic aneurysm extensively involving both common iliac arteries. Cranial migration of the endograft and incarceration in the contralateral iliac aneurysm were observed on the computed tomographic scan. The patient was submitted to a procedure that involves endovascular and limited open surgery techniques. A 26 mm balloon catheter was used to secure the proximal implantation site, and through a Gibson incision, the iliac arteries were controlled. An interpositional 8 mm regular Dacron graft was then sutured end to end between the endograft and the external iliac artery.
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Conte, Michael S. "Challenges of Distal Bypass Surgery in Patients with Diabetes." Journal of the American Podiatric Medical Association 100, no. 5 (September 1, 2010): 429–38. http://dx.doi.org/10.7547/1000429.
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Surgical revascularization of the lower extremity using bypass grafts to distal target arteries is an established, effective therapy for advanced ischemia. Recent multicenter data confirm the primacy of autogenous vein bypass grafting, yet there remains significant heterogeneity in the utilization, techniques, and outcomes associated with these procedures in current practice. Experienced clinical judgment, creativity, technical precision, and fastidious postoperative care are required to optimize long-term results. The diabetic patient with a critically ischemic limb offers some specific challenges; however, numerous studies demonstrate that the outcomes of vein bypass surgery in this population are excellent and define the standard of care. Technical factors, such as conduit and inflow/outflow artery selection, play a dominant role in determining clinical success. An adequate-caliber, good-quality great saphenous vein is the optimal graft for distal bypass in the leg. Alternative veins perform acceptably in the absence of the great saphenous vein, whereas prosthetic and other nonautogenous conduits have markedly inferior outcomes. Graft configuration (reversed, nonreversed, or in situ) seems to have little effect on outcome. Shorter grafts have improved patency. Inflow can be improved by surgical or endovascular means if necessary, and distal-origin grafts (eg, those arising from the superficial femoral or popliteal arteries) can perform as well as those originating from the common femoral artery. The selected outflow vessel should supply unimpeded runoff to the foot, conserve conduit length, and allow for adequate soft-tissue coverage of the graft and simplified surgical exposure. This review summarizes the available data linking patient selection and technical factors to outcomes and highlights the importance of surgical judgment and operative planning in the current practice of infrainguinal bypass surgery. (J Am Podiatr Med Assoc 100(5): 429–438, 2010)
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SAITOH, S., and Y. NAKATSUCHI. "Arterial Grafting with the Telescoping Anastomotic Technique for Arterial Defects." Journal of Hand Surgery 19, no. 4 (August 1994): 461–65. http://dx.doi.org/10.1016/0266-7681(94)90211-9.
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An arterial graft was taken from the left femoral artery of the rat and grafted into the right femoral artery using the telescoping anastomotic technique at both the proximal and distal anastomoses to compare the patency rate with that of the vein grafts interposed into the arterial defect with the same telescoping technique. The time required for each anastomosis was about 10 minutes and all of the 31 grafts remained patent without application of xylocaine, yielding a higher patency rate than the vein grafts interposed in an arterial defect. The telescoping technique proved to be so dependable that it could be used at least twice in an artery. Inserting one vessel stump into another using the telescoping technique may not itself be responsible for the failure of vein grafts interposed in an arterial defect, but distortion of the slack venous wall of the graft by high arterial blood pressure is.
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Anderson, Curtis A., Alan P. Kypson, Wes Hudson, Bruce Ferguson, and Evelio Rodriguez. "SPY Imaging Assessment Correlates with Transesophageal Echocardiogram Assessment of Ventricular Function during Off-Pump Coronary Artery Bypass Grafting." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 3, no. 3 (May 2008): 155–57. http://dx.doi.org/10.1097/imi.0b013e31817c482f.
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Intraoperative assessment of graft anastomoses is commonly performed after off-pump coronary artery bypass grafting (OPCAB). The SPY imaging system allows intraoperative graft assessment. We document correlation between intraoperative SPY images and wall motion abnormality by transesophageal echocardiogram (TEE) during OPCAB. A 79-year-old female underwent OPCAB. Intraoperative graft patency assessment was performed with the SPY and left ventricular wall motion was assessed by TEE. SPY imaging demonstrated poor flow trough the distal vein graft anastomosis to the posterior descending artery, which correlated with a new posterior wall motion hypokinesis. After graft revision, SPY imaging demonstrated good distal flow and the TEE demonstrated normalization of the left ventricular posterior wall motion. SPY technology allows the surgeon to accurately assess graft patency intraoperatively and allows immediate correction of a technical problem.
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Kute, Stephanie M., and David A. Vorp. "The Effect of Proximal Artery Flow on the Hemodynamics at the Distal Anastomosis of a Vascular Bypass Graft: Computational Study." Journal of Biomechanical Engineering 123, no. 3 (January 29, 2001): 277–83. http://dx.doi.org/10.1115/1.1374203.
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The formation of distal anastomotic intimal hyperplasia (IH), one common mode of bypass graft failure, has been shown to occur in the areas of disturbed flow particular to this site. The nature of the flow in the segment of artery proximal to the distal anastomosis varies from case to case depending on the clinical situation presented. A partial stenosis of a bypassed arterial segment may allow residual prograde flow through the proximal artery entering the distal anastomosis of the graft. A complete stenosis may allow for zero flow in the proximal artery segment or retrograde flow due to the presence of small collateral vessels upstream. Although a number of investigations on the hemodynamics at the distal anastomosis of an end-to-side bypass graft have been conducted, there has not been a uniform treatment of the proximal artery flow condition. As a result, direct comparison of results from study to study may not be appropriate. The purpose of this work was to perform a three-dimensional computational investigation to study the effect of the proximal artery flow condition (i.e., prograde, zero, and retrograde flow) on the hemodynamics at the distal end-to-side anastomosis. We used the finite volume method to solve the full Navier–Stokes equations for steady flow through an idealized geometry of the distal anastomosis. We calculated the flow field and local wall shear stress (WSS) and WSS gradient (WSSG) everywhere in the domain. We also calculated the severity parameter (SP), a quantification of hemodynamic variation, at the anastomosis. Our model showed a marked difference in both the magnitude and spatial distribution of WSS and WSSG. For example, the maximum WSS magnitude on the floor of the artery proximal to the anastomosis for the prograde and zero flow cases is 1.8 and 3.9 dynes/cm2, respectively, while it is increased to 10.3 dynes/cm2 in the retrograde flow case. Similarly, the maximum value of WSSG magnitude on the floor of the artery proximal to the anastomosis for the prograde flow case is 4.9 dynes/cm3, while it is increased to 13.6 and 24.2 dynes/cm3, respectively, in the zero and retrograde flow cases. The value of SP is highest for the retrograde flow case (13.7 dynes/cm3) and 8.1 and 12.1 percent lower than this for the prograde (12.6 dynes/cm3) and zero (12.0 dynes/cm3) flow cases, respectively. Our model results suggest that the flow condition in the proximal artery is an important determinant of the hemodynamics at the distal anastomosis of end-to-side vascular bypass grafts. Because hemodynamic forces affect the response of vascular endo- thelial cells, the flow situation in the proximal artery may affect IH formation and, therefore, long-term graft patency. Since surgeons have some control over the flow condition in the proximal artery, results from this study could help determine which flow condition is clinically optimal.
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Bosaeus, Linus, Kevin Mani, Anders Wanhainen, and Krister Liungman. "Open: Precannulated Fenestrated Endovascular Aneurysm Repair using Guidewire Fixator." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 12, no. 4 (July 2017): 265–68. http://dx.doi.org/10.1097/imi.0000000000000392.
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Objective By using a guidewire fixator, the distal guidewire position can be secured in an artery. This new principle enables a method for fenestrated endovascular aortic repair where the connection between the aortic branches and the stent graft fenestrations is made before inserting and deploying the stent graft. Methods This is conducted using a fenestrated stent graft with preloaded catheters, through which the prepositioned and distally secured guidewires from the branches are inserted. Results This report covers the method when implementing a single fenestration stent graft in pig. Conclusions Successful tests with single and dual fenestrated grafts have been conducted in pigs.
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Kochergin, N. A., N. I. Zagorodnikov, A. V. Frolov, R. S. Tarasov, and V. I. Ganyukov. "Optical coherence tomography as a method for assessing the conduit-anastomosis-artery system in patients after coronary artery bypass grafting." Complex Issues of Cardiovascular Diseases 11, no. 4 (January 10, 2023): 151–57. http://dx.doi.org/10.17802/2306-1278-2022-11-4-151-157.
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Background. Coronary artery bypass grafting (CABG) remains the most common cardiac surgery in the world. In the long-term follow-up period after surgery, graft failure occurs in a substantial proportion of CABG conduits and is a complex pathomorphological process. Optical coherence tomography (OCT) is a high-resolution intravascular imaging modality that allows to assess in-vivo endothelial integrity.Aim. To substantiate the efficacy and safety of OCT assessment of the conduitanastomosis-artery system in CABG patients.Methods. The prospective observational cohort study included 21 patients with chronic coronary artery disease who underwent CABG. 3–5 days after CABG, patients underwent OCT and angiography of arterial and vein grafts, including distal anastomosis and nearby segment of the target coronary artery. At 12-month follow-up, all patients underwent repeated OCT and angiography of the conduitanastomosis-artery system to assess the changes. The primary endpoint of the study was graft failure; secondary endpoints of the study included unplanned repeat myocardial revascularization, cardiac death, and myocardial infarction due to graft failure.Results. At 12-month follow-up, 14.3% of graft failure and 9.5% of cases of unplanned repeated myocardial revascularization were registered. In most cases of graft failure, primary OCT revealed pronounced changes in the conduit and the native coronary artery (conduit/artery diameter ratio was more than 2 mm), whereas the diameter of the coronary artery anastomosis was less than 2.5 mm. Myocardial infarctions and death within 12 months were not registered.Conclusion. Thus, OCT is an effective and safe intravascular imaging technique for assessing coronary arteries and the conduit-anastomosis-artery system. OCT makes it possible to identify morphological changes in coronary bypass grafts, which can predict their early failure. The conduit/artery diameter ratio greater than 2 and target coronary artery diameter less than 2.5 mm was associated with graft failure within 12 months after CABG.
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Pecoraro, Felice, Guido Bajardi, Ettore Dinoto, Gaetano Vitale, Mario Bellisi, and Umberto Marcello Bracale. "Endograft connector technique to treat popliteal artery aneurysm in a morbid obese patient." Vascular 23, no. 2 (May 8, 2014): 165–69. http://dx.doi.org/10.1177/1708538114533961.
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Surgical repair of popliteal artery aneurysm in morbid obese patients poses additional challenges. We report a morbid obese patient who had a 59 mm right popliteal artery aneurysm which was successfully treated with the endograft connector technique. This technique was used to perform the distal anastomosis of the below-knee femoro-popliteal bypass. A 10 mm Dacron graft was used as a main graft bypass and an 11 mm/10 cm stentgraft as endograft connector. Following the respective tunnel of the Dacron graft, an end-to-side proximal anastomosis was performed at distal femoral artery. The aneurysm exclusion was obtained through a proximal and a distal ligation. Postoperative duplex showed adequate bypass patency. Knee x-rays demonstrated no signs of stent kinking/fractures. The postoperative course was uneventful and the patient was discharged home on fourth day post operative. The six-month computed tomography scan and the 12-month duplex control showed a patent bypass with no signs of stenosis.
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Kochergin, N. A., V. I. Ganyukov, N. I. Zagorodnikov, and A. V. Frolov. "Optical coherence tomography of coronary grafts." Complex Issues of Cardiovascular Diseases 8, no. 4S (January 17, 2020): 89–94. http://dx.doi.org/10.17802/2306-1278-2019-8-4s-89-94.
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Background. Coronary artery bypass graft surgery is the most common cardiac surgery in the world. Graft failure is a complex multifactorial process that occurs in a significant part of all grafts.Aim. To identify predictors of early coronary bypass failure using optical coherence tomography.Methods. A prospective observational study included 10 patients with multivessel coronary artery disease who underwent coronary artery bypass grafting. After surgical myocardial revascularization, the patients underwent coronary angiography with optical coherence tomography (OCT) of arterial and venous grafts, including the distal anastomosis and conjugate segment of the target coronary artery. Endothelial damage; the presence of severe tortuosity, stenosis, spasm and parietal thrombi; the ratio of the diameters of the conduit and the native coronary artery was assessed.Results. A control study revealed several findings. In one case, the left internal mammary artery was occluded, which required stenting of the left anterior descending artery. In one patient, a dissection of the left internal mammary artery anastomosis was revealed, while a double lumen with the formation of a false channel was revealed on the OCT. In one case, stenosis of a saphenous vein graft on the right coronary artery was determined (53.1% by area). In three cases, a pronounced recalibration of the diameters of the saphenous vein graft and the target coronary artery with more than two times the ratio was revealed, and in one case, the diameter of the target artery was less than 2 mm.Conclusion. OCT is an effective method for visualizing morphological changes not only in coronary arteries, but also in coronary bypass grafts, which may be associated with early graft failure.
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Tezcaner, Tevfik, Cem Yorgancioğlu, Zeki Çatav, Oğuz Moldibi, Hilmi Tokmakoğlu, Kaya Süzer, and Yaman Zorlutuna. "Coronary Artery Bypass Grafting without Cardiopulmonary Bypass." Asian Cardiovascular and Thoracic Annals 8, no. 2 (June 2000): 97–102. http://dx.doi.org/10.1177/021849230000800202.
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Between March 1994 and April 1998, 2869 patients underwent coronary artery bypass grafting at our institution. Of these, 415 (14.5%) with a mean age of 54.4 ± 9.9 years were operated on without cardiopulmonary bypass. Internal thoracic artery was used in 402 cases (97%) and the left anterior descending artery was revascularized in all except 1. Distal anastomoses ranged from 1 to 3, with a mean of 1.45 ± 0.58. Major postoperative complications comprised reoperation because of internal thoracic artery spasm in 1 patient, lower extremity ischemia due to intraaortic balloon pumping in 1 patient, revision for excessive bleeding in 3, and perioperative myocardial infarction in another 3. Hospital mortality was 1.2% (5 deaths). Coronary angiography was performed in 38 patients, 1 to 44 months postoperatively. Examination of 56 distal anastomoses revealed a patency rate of 86.1% for internal thoracic artery grafts and 55% for saphenous vein grafts. It was concluded that coronary bypass surgery without cardiopulmonary bypass gave favorable results in the early postoperative period. However, considering the late graft patency rates, either patient selection or the technique should be reevaluated.
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Nezic, Dusko. "Distal in situ pedicled (nonskeletonized) internal thoracic artery graft." Journal of Thoracic and Cardiovascular Surgery 147, no. 4 (April 2014): 1437. http://dx.doi.org/10.1016/j.jtcvs.2013.11.064.
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Van Phung, Doan, Takeshi Kinoshita, Tohru Asai, and Tomoaki Suzuki. "Histological and Morphometric Properties of Skeletonized Gastroepiploic Artery and Risk Factors for Intimal Hyperplasia." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 7, no. 3 (May 2012): 191–94. http://dx.doi.org/10.1097/imi.0b013e318264f4cb.
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Objective The aim of the present study was to examine the histological and morphometric properties of skeletonized gastroepiploic artery (GEA) and the risk factors for intimal hyperplasia. Methods We obtained the redundant distal segments of skeletonized GEAs from 33 patients undergoing coronary bypass surgery and microscopically examined the transverse sections just distal to the most distal anastomoses. Intimal hyperplasia was evaluated on the basis of intima-to-media ratio and percentage of luminal narrowing. Risk factors were examined using multivariate linear regression analysis. Results The median (range) of lumen diameter at the most distal anastomosis was 3.8 (2.4–6.4) mm; width of intima, 82 (8–418) μm; width of media, 167 (88–351) μm; wall thickness, 250 (118–554) μm; intima-to-media ratio, 0.59 (0.04–3.88), and percentage of luminal narrowing, 12.3 (1.5–28.9). The number of elastic lamina in the media was 4.2 ± 1.8. Atherosclerosis was found in six patients, and medial calcification, in three patients. The median (range) of graft flow and pulsatile index measured by intraoperative transit-time flow meter was 65 (11–141) mL/min and 3.1 (1.4–5.9), respectively. All GEA grafts were patent at the coronary computed tomography angiography before discharge. Estimated glomerular filtration rate was independently associated with intima-to-media ratio (β coefficient = −0.016, P < 0.01) and percentage of luminal narrowing (β coefficient = −0.012, P < 0.01). Conclusions Skeletonized GEA had sufficient lumen diameter with excellent graft flow and early patency even when used as a sequential graft. Estimated glomerular filtration rate correlates significantly with intimal hyperplasia.
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Chock, Megan M., Johnathon Aho, Nimesh Naik, Michelle Clarke, Stephanie Heller, and Gustavo S. Oderich. "Endovascular treatment of distal thoracic aortic transection associated with severe thoracolumbar spinal fracture." Vascular 23, no. 5 (November 18, 2014): 550–52. http://dx.doi.org/10.1177/1708538114560458.
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Endovascular repair has become the first line of treatment in most patients with blunt aortic injury. The most common mechanism is deceleration injury affecting the aortic isthmus distal to the origin of the left subclavian artery. Injuries of the distal thoracic aorta are uncommon. We report the case of a 25-year-old male patient who presented with paraplegia and distal thoracic aortic pseudoaneurysm associated with severe thoracolumbar vertebral fracture and displacement after a motocross accident. Endovascular repair was performed using total percutaneous technique and conformable C-TAG thoracic stent-graft (WL Gore, Flagstaff, AZ). Following stent-graft placement and angiographic confirmation of absence of endoleak, thoracolumbar spinal fixation was performed in the same operative procedure. This case illustrates a multispecialty approach to complex aortic and vertebral injury and the high conformability of newer thoracic stent-grafts to adapt to tortuous anatomy.
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Hoque, Asraful, Abu Shadat Mohammad Saem Khan, Romena Rahman, Muhammad Asif Ahsan Chowdhury, Imran Ahmed, Wahida Salam, Md Monzur Hossain, Tanvir Hossain, and Md Amirul Islam. "Anaortic off-pump Complete Arterial Revascularization Using Composite LIMA RIMA Y grafts: 1 Year Outcome." Bangladesh Heart Journal 37, no. 1 (June 20, 2022): 27–33. http://dx.doi.org/10.3329/bhj.v37i1.60101.
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Objective: The aim was to evaluate the early outcome of off-pump coronary artery bypass grafting (OPCABG) with a bilateral internal mammary artery (BIMA) Y configuration graft to achieve total arterial myocardial revascularization. Materials and Methods: From March 2018 to March 2020 total 30 cases of off pump CABG surgery using LIMA RIMA Y sequential grafts to achieve total arterial myocardial revascularization. Comparisons between LIMA + SVG and BIMA Y grafts were not made here. Result: The average age of the patients was 43.51±2.58 years. Most of them were male (93.34%). A total of 28 (93.34%) cases had triple-vessel disease. Double-vessel disease was found in 2 (6.66%) cases. The skeletonization skill was used to harvest the two IMAs and then the free right internal mammary artery was anastomosed end-to-side to the in situ left internal mammary artery to composite a Y configuration graft. Off-pump and sequential anastomosis methods were used to perform coronary artery bypass surgery for the patients. Graft patency was assessed by doing CT angiogram. All distal and proximal Y anastomoses were patent at 1 year follow up. There were no perioperative deaths. Conclusion: OPCABG by using LIMA RIMA Y graft is an effective option for total arterial revascularization and avoid surgical complications regarding the ascending aorta manupulation. Bangladesh Heart Journal 2022; 37(1): 27-33
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Lawton, Michael T., and Alfredo Quiñones-Hinojosa. "Double Reimplantation Technique to Reconstruct Arterial Bifurcations with Giant Aneurysms." Operative Neurosurgery 58, suppl_4 (April 1, 2006): ONS—347—ONS—354. http://dx.doi.org/10.1227/01.neu.0000209026.15232.ca.
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Abstract Objective: To introduce the double implantation technique, a variation of standard radial artery or saphenous vein bypass that can be used to reconstruct arterial bifurcations in the management of giant aneurysms with complex branch arteries. Methods: This technique was applied in two patients with giant aneurysms. A 74-year-old woman presented with a ruptured thrombotic middle cerebral artery aneurysm, and a 24-year-old man presented with an enlarging infectious aneurysm of the distal anterior cerebral artery (ACA). Results: In the first case, a saphenous vein graft was anastomosed end-to-end to the external carotid artery. The temporal M2 middle cerebral artery trunk was disconnected from the aneurysm and reimplanted onto the graft with an end-to-side anastomosis. The graft was anastomosed end-to-side to the frontal M2 middle cerebral artery trunk, and the aneurysm was trapped. Similarly, in the second case, a radial artery graft was connected to a proximal ACA branch (anterior internal frontal artery) and to the distal pericallosal artery, with reimplantation of the callosomarginal artery onto the graft. The aneurysm was occluded proximally with a clip. Conclusion: The combination of two arterial reimplantations onto a bypass graft connected to a proximal donor artery (3 anastomoses overall) reconstructs an arterial bifurcation and enables the exclusion of a giant aneurysm. Ischemia times are minimized by completing the proximal anastomosis first, successively reimplanting efferent arterial trunks distally, and restoring cerebral perfusion to reimplanted arteries while other anastomoses are performed. This technique may be indicated when critical efferent arteries require revascularization, conventional donor arteries are diminutive, the aneurysm has ruptured, or intraluminal thrombus requires debulking.
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Asai, Megumi, Olivier Van Houtte, Terry R. Sullivan, Mauricio Garrido, and Danielle M. Pineda. "Endovascular Repair of Three Concurrent Mycotic Pseudoaneurysms." Vascular and Endovascular Surgery 52, no. 6 (May 1, 2018): 473–77. http://dx.doi.org/10.1177/1538574418772458.
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Introduction: Mycotic pseudoaneurysm has traditionally been repaired surgically with excision of the infected artery and revascularization via extra-anatomical or in situ bypass. There have been reports of endovascular repair for high-risk patients for formal surgical repair. We present a case of a patient with 3 large pseudoaneurysms arising from the right subclavian artery, descending thoracic aorta, and right popliteal artery treated with endovascular and hybrid intervention. Case: A 74-year-old male with remote history of coronary artery bypass graft and recent sternoclavicular joint abscess developed 3 concurrent pseudoaneurysms arising from the right subclavian artery, distal descending thoracic aorta, and right popliteal artery. He underwent right axillary to common carotid bypass with endovascular stent graft placement in the distal innominate and proximal subclavian artery, and subsequently had thoracic endovascular aortic repair and right popliteal stent graft. Four months later, he presented with hemoptysis due to compression of the lung secondary to the pseudoaneurysm. He underwent right anterior thoracotomy and debridement of the pseudoaneurysm. Patient recovered from the procedure and discharged. Conclusion: Endovascular repair of mycotic pseudoaneurysm is an acceptable alternative for high-risk patients. Even when open approach became necessarily, endovascular stent graft decreased blood loss and morbidity.
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Nezic, Dusko, Aleksandar Knezevic, Milan Cirkovic, Miomir Jovic, Ljupco Mangovski, and Predrag Milojevic. "In situ pedicle graft and coronary-coronary bypass grafting using internal thoracic artery in management of multiple lesions of the left anterior descending coronary artery." Medical review 57, no. 11-12 (2004): 601–4. http://dx.doi.org/10.2298/mpns0412601n.
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Introduction Nowadays, coronary-coronary bypass grafting (CCBG) has been applied in patients with heavily calcified ascending aorta or due to lack of graft material. Case report We describe a case in which the patient's large left anterior descending (LAD) coronary artery, running well over the cardiac apex, presented with proximal and distal stenosis. Although the pedicled left internal thoracic artery (ITA) graft is sometimes too short for sequential bypass in cases of distal stenosis of the LAD coronary artery, we used a free, short segment of the pedicled left ITA for coronary-coronary bypass grafting. The in situ remnant of the left pedicled ITA was used to bypass the proximal LAD stenosis. The patient's postoperative course was uneventful. Predischarge angiogram (on the 9th postoperative day) showed an in situ left ITA graft as well as a free coronary-coronary ITA graft. The patient had a regular follow-up after 3 months, and was classified as New York Heart Association (NYHA) class I. Discussion Primarily used in aorto-coronary bypass surgery (termino-terminal interposition of the saphenous vein between two parts of a resected coronary artery), CCBG was revised latter on, and from hemodynamic point of view the physiologic restoration of coronary blood flow has been confirmed. CCBG might be an attractive approach for bypassing distal lesions of large coronary arteries (combined with arterial or venous grafting of targeted arteries, if proximal stenoses are also present). The proximal remnant of ITA can be used as an in situ or free graft.