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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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Snegirev, M. A., A. A. Paivin, and D. O. Denisyuk. "AORTIC VALVE REPLACEMENT IN PATIENT WITH FUNCTIONING CORONARY ARTERY BYPASS GRAFTS." Grekov's Bulletin of Surgery 178, no. 6 (March 18, 2020): 53–55. http://dx.doi.org/10.24884/0042-4625-2019-178-6-53-55.
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We report the clinical case of aortic valve replacement for severe aortic insufficiency in patient who previously was subjected to coronary bypass grafting, with functioning grafts, including internal thoracic artery graft. The procedure was performed from the upper ministernotomy with peripheral (femoral) cardiopulmonary bypass.
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Zahangir, NM, Md Nazmul, TMNS Khan, RA Chowdury, and Z. Haider. "Rare Vascular Surgery in Apollo Hospitals, Dhaka - Right Popletial to Dorsalis pedis Artery Anastomosis and Axillary Bi Femoral Bi Poplileal Bypass Grafting - limb salvage procedure." Pulse 5, no. 2 (August 31, 2014): 65–71. http://dx.doi.org/10.3329/pulse.v5i2.20270.
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Bypass grafts to the dorsalis pedis artery provide excellent revascularization to ischemic foot. It is a durable and effective procedure for limb salvage. Axillo femoral-popliteal procedure offers a reasonable alternative in high-risk patients. We are reporting 2 cases of such procedures from Apollo hospitals, Dhaka. Right Popletial to Dorsalis pedis artery anastomosis was done in a 32 years old man. Interposition venous graft was done from the right popliteal artery to dorsalis pedis artery. Axillo-Bi Femoral-Bi Poplileal Bypass Grafting: was done in a 59 years old man. Knitted fabric strength graft was used. Both the patients were doing well in postoperative period. DOI: http://dx.doi.org/10.3329/pulse.v5i2.20270 Pulse Vol.5 July 2011 p.65-71
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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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Campbell, T., R. Cole, and M. Davies. "Pressure induced restenosis of femoral artery bypass grafts." Journal of Biomechanics 39 (January 2006): S328. http://dx.doi.org/10.1016/s0021-9290(06)84292-2.
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Sapienza, Paolo, Andrea Mingoli, Richard J. Feldhaus, Filippo Napoli, André Marsan, Marco Franceschini, Luca di Marzo, and Antonino Cavallaro. "Descending thoracic aorta-to-femoral artery bypass grafts." American Journal of Surgery 174, no. 6 (December 1997): 662–66. http://dx.doi.org/10.1016/s0002-9610(97)00184-0.
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Lazarides, Tzilalis, Georgiadis, Georgopoulos, and Arvanitis. "Femorodistale Rekonstruktionen auf die A. tibialis anterior mit PTFE-Prothesen und Venencuff: Alternativen der Bypassführung." Vasa 32, no. 1 (February 1, 2003): 22–25. http://dx.doi.org/10.1024/0301-1526.32.1.22.
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Background: The anterior tibial is the less often used artery for distal anastomosis in infrapopliteal bypass with synthetic grafts; however, several investigators argue against even an attempt to use non-autologous material for such distal reconstructions. Only few studies report patency rates mixing-up popliteal below-knee and various crural bypasses. Patients and methods: Nineteen consecutive femoral-anterior tibial cuffed PTFE bypass grafts, either via the lateral (n = 15) or interosseous (n = 4) route, were inserted in a 10-years period. Results: The 1-year and 2-year primary patency rate was 71% and 53%, respectively. It is noteworthy that in one patient a graft positioned via the lateral route remained patent for ten years. No complications were observed regarding the routing methods, whatever increased operating time was required in the interosseous route cases. The 3-year cumulative survival rate for this particular group of patients was 32%. Conclusions: Our data indicate that femoral-anterior tibial bypasses using cuffed PTFE grafts via the lateral route result in an acceptable medium-term patency. As such patients have a limited life expectancy, these procedures should be performed when an autologous vein is not available, as opposed to primary amputation.
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de Niet, A., and J. H. Van Uchelen. "Hypothenar hammer syndrome: long-term follow-up after ulnar artery reconstruction with the lateral circumflex femoral artery." Journal of Hand Surgery (European Volume) 42, no. 5 (December 19, 2015): 507–10. http://dx.doi.org/10.1177/1753193415622592.
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In symptomatic patients with hypothenar hammer syndrome, the occluded part of the ulnar artery can be reconstructed with an autologous graft. Venous grafts are used frequently, but they are known for their low patency rate. Arterial grafts show better patency rates than venous grafts in coronary bypass surgery. We performed 11 ulnar artery reconstructions with the descending branch of the lateral circumflex femoral artery and compared these with previously performed venous reconstructions. All patients with an arterial graft reconstruction had a patent graft at a mean follow-up of 63 months. In addition, nine out of 11 patients reported improvement in their symptoms. The patency rate of venous reconstructions in hypothenar hammer syndrome is significantly lower. Arterial grafting for hypothenar hammer syndrome has superior patency compared with venous grafting; we recommend it as the surgical treatment of choice for symptomatic hypothenar hammer syndrome. Level of evidence: 4.
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Ghobrial, Mina S. A., Kamal Khan, Mohamed Baguneid, and Richard D. Levy. "Transcatheter aortic valve implantation facilitated by right common carotid cut-down and innominate artery angioplasty with simultaneous right coronary artery vein graft percutaneous coronary intervention in a patient with mid aortic syndrome: a case report." European Heart Journal - Case Reports 4, no. 4 (May 26, 2020): 1–5. http://dx.doi.org/10.1093/ehjcr/ytaa134.
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Abstract Background Transcatheter aortic valve implantation (TAVI) is most commonly performed via the femoral approach. Small caliber ilio-femoral arteries, severe calcification and tortuosity are often prohibitive reasons for TAVI via the femoral approach. Mid-aortic syndrome is a rare condition describing congenital or acquired coarctation of the abdominal aorta. Case summary To the best of our knowledge, this case report describes the world’s first TAVI in a patient with mid-aortic syndrome with challenging vascular access that would preclude conventional TAVI access routes. A 76-year-old woman with intermittent claudication, underwent work-up for axillo-bifemoral bypass, underwent a TAVI for incidental severe asymptomatic severe aortic stenosis via right common carotid TAVI facilitated by innominate artery angioplasty achieved vascular access for TAVI. Percutaneous coronary intervention to a right coronary artery vein graft was simultaneously performed via a left brachial artery cut down. Discussion We demonstrate that complex angioplasty to coronary artery bypass grafts and the innominate artery alongside TAVI via a variety of arterial access sites is both safe and feasible.
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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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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., Joshua Bakhsheshian, Robert C. Rennert, Vance L. Fredrickson, Jordan Lam, Arun Amar, William Mack, Joseph Carey, and Jonathan J. Russin. "Descending Branch of the Lateral Circumflex Femoral Artery Graft for Posterior Inferior Cerebellar Artery Revascularization." Operative Neurosurgery 15, no. 3 (March 21, 2018): 285–91. http://dx.doi.org/10.1093/ons/opx241.
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Abstract BACKGROUND Posterior inferior cerebellar artery (PICA) revascularization can be achieved with relative ease when a contralateral PICA is present. However, without a contralateral PICA, identification of a suitable vessel alternative can be challenging due to a size mismatch. OBJECTIVE To propose the descending branch of the lateral circumflex femoral artery (DLCFA) to be an acceptable, if not preferred, arterial graft for PICA revascularization. METHODS Data from patients who underwent PICA revascularization with DLCFA grafts were obtained from an institutional review board-approved prospectively maintained database with informed consent from the patients. RESULTS Three patients, all presenting with ruptured aneurysms, were treated with PICA revascularization using the DLCFA. All cases achieved bypass patency and no ischemic events occurred during the bypass procedures. Graft spasm occurred in 2 patients. Two patients that presented with neurological deficits achieved excellent neurological outcomes and 1 suffered an anterior spinal artery stroke during a repeat endovascular treatment 1 wk after revascularization. CONCLUSION The DLCFA is favorable for PICA revascularization when a contralateral PICA is not a viable option.
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Benedetto, Filippo, Domenico Spinelli, Narayana Pipitò, David Barillà, Francesco Stilo, Giovanni De Caridi, Chiara Barillà, and Francesco Spinelli. "Inframalleolar bypass for chronic limb-threatening ischemia." Vascular Medicine 26, no. 2 (January 6, 2021): 187–94. http://dx.doi.org/10.1177/1358863x20978468.
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The aims of this study were to analyze the results of inframalleolar bypass for chronic limb-threatening ischemia (CLTI) and to identify outcome-predicting factors. All consecutive patients undergoing inframalleolar bypass for CLTI between 2015 and 2018 were included in this retrospective, single-center study. Outflow artery was the most proximal patent vessel segment in continuity with inframalleolar arteries. Bypasses originating from the popliteal artery were defined as ‘short bypasses’. Sixty patients underwent inframalleolar bypass, with four patients undergoing bilateral procedures, making a total of 64 limbs included. The mean age was 73 ± 14 and 52 (81%) were male. The great saphenous vein was the preferred conduit ( n = 58, 91%), in a devalvulated fashion ( n = 56, 88%). Superficial femoral artery was the most common inflow artery for ‘long’ grafts ( n = 22, 34%), while popliteal artery was the inflow artery for all ‘short’ grafts ( n = 25, 39%). Dorsalis pedis artery was chosen as an outflow artery in 41 patients (63%). Median follow-up was 21 months. Two-year primary and secondary patency, limb salvage, amputation-free survival, and overall survival rates were 67 ± 6%, 88 ± 4%, 84 ± 4%, 72 ± 6%, and 85 ± 4%, respectively. At multivariate analysis, dialysis was an independent predictor for poor primary patency (HR, 4.6; 95% CI, 1.62–13.05; p = 0.004), whereas a short bypass was independently associated with an increased primary patency (HR, 0.3; 95% CI, 0.10–0.89; p = 0.03). In conclusion, bypass grafting to the inframalleolar arteries resulted in good patency rates, limb salvage and overall survival. Dialysis patients had lower primary patency but still had good limb salvage and survival. Short bypass was a predictor of improved primary patency.
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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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Tran, Kenneth, Vy T. Ho, Nathan K. Itoga, and Jordan R. Stern. "Comparison of mid-term graft patency in common femoral versus superficial femoral artery inflow for infra-geniculate bypass in the vascular quality initiative." Vascular 28, no. 6 (May 14, 2020): 722–30. http://dx.doi.org/10.1177/1708538120924908.
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Objectives The superficial femoral artery can be used as inflow for infra-geniculate bypass, but progressive proximal occlusive disease may affect graft durability. We sought to evaluate the effect of superficial femoral artery versus common femoral artery inflow on infra-geniculate bypass patency within a large contemporary multicenter registry. Methods The vascular quality initiative was queried from 2013 to 2019 to identify patients with >30-day patency follow-up, Rutherford chronic limb ischemia stage 1–6, and an infra-geniculate bypass, excluding those with prior ipsilateral bypass. The cohort was stratified by inflow vessel, with primary, primary-assisted, and secondary patency serving as the primary outcome variables. Multivariate Cox-proportional hazard models and radius-based propensity-score matching were performed to reduce treatment-selection bias due to clinical covariates. Results A total of 11,190 bypass procedures were performed (8378 common femoral artery inflow, 2812 superficial femoral artery) on 10,110 patients, with a mean follow-up of 12.8 months (range 1–98). Patients receiving superficial femoral artery inflow bypasses were more commonly male ( p = 0.002), obese ( p < 0.0001) and had chronic, limb threatening ischemia ( p < 0.0001), whereas those with common femoral artery inflow were older ( p < 0.0004), and had higher baseline comorbidities including smoking ( p < 0.0001), coronary disease ( p < 0.0001), and pulmonary disease ( p < 0.0001). On life-table analysis, there was no significant difference in three year estimated primary (32.1 vs 30.1%, p = 0.928), primary assisted (60.5 vs 65.8%, p = 0.191), or secondary patency (62.5 vs 66.7%, p = 0.139) between superficial femoral artery and common femoral artery inflow groups, respectively. A multivariate Cox model found no significant association between inflow vessel and primary patency (0.96 [0.88–1.04], HR [95%CI]), primary-assisted (1.07 [0.95–1.20], HR [95%CI]), or secondary patency (1.08 [0.96–1.22]). In a propensity-matched cohort ( n = 11,151), there were small but statistically significant differences in primary, primary-assisted, and secondary patency at latest follow-up (non-time-to-event data) between groups. The largest difference was observed when evaluating secondary patency, with common femoral artery inflow having a marginally higher secondary patency of 88.1% compared to 85.6% for those with superficial femoral artery inflow at latest follow-up ( p = 0.009). Conclusions Within the vascular quality initiative, there is no significant difference in life-table determined three-year primary, primary-assisted, and secondary patency between infra-geniculate bypasses using common femoral artery inflow compared to superficial femoral artery inflow. Small, statistically significant differences exist in primary, primary-assisted, and secondary patency favoring common femoral artery inflow after propensity score matching. Long-term follow-up data are required in the vascular quality initiative to better evaluate bypass graft durability as this study was limited by a mean follow-up of one year.
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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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Thang, Duong Ngoc, Nguyen Huu Uoc, Doan Quoc Hung, Phung Duy Hong Son, Hoang Trong Hai, Le Hong Quan, and Tieu Cong Quyet. "Lower extremity revascularization in patient with infection at level of the scarpa's triangle by extra-anatomical bypass: experiences of Vietduc University Hospital." Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam 39 (October 31, 2022): 18–26. http://dx.doi.org/10.47972/vjcts.v39i.799.
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Background: Infected prosthetic arterial grafts at the Scarpa triangle is a serious complication in vascular surgery with high failure results. Extra-anatomic bypass is one of solution in literature, but there is no research in Vietnam yet. This report will share some experiences of Viet Duc hospital.[1] Subjects and methods: 03 patients with infected prosthetic arterial grafts at the Scarpa triangle after lower extremity vascular surgery were treated by femoral artery ligation, perineal femorofemoral bypass or obturator foramen bypass for lower extremity revascularization, on-site wound care. Result: Primary patency rate is 100% after surgery, inguinal incision can be well healed. Re-examination after 6 months without any signs of infection or limb ischemia, the inguinal incision was completely healed. Conclusion: Extra-anatomical bypass is an effective method for revascularization of the lower extremities in the case of infected prosthetic arterial grafts.
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Başkaya, Mustafa K., Mark W. Kiehn, Azam S. Ahmed, Özkan Ateş, and David B. Niemann. "Alternative vascular graft for extracranial–intracranial bypass surgery: descending branch of the lateral circumflex femoral artery." Neurosurgical Focus 24, no. 2 (February 2008): E8. http://dx.doi.org/10.3171/foc/2008/24/2/e8.
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Object Arterial bypass is an important method of treating intracranial disease requiring sacrifice of the parent vessel. The conduits for extracranial–intracranial (EC–IC) bypass surgery include the superficial temporal artery, occipital artery, superior thyroid artery, radial artery, and saphenous vein (long or short). In an aging population with an increased prevalence of vascular disease, conduits for EC–IC bypass may be in short supply in some patients. Herein, the authors describe a case in which the descending branch of the lateral circumflex femoral artery (DLCFA) was utilized as a high-flow conduit for an EC–IC bypass. Methods This 22-year-old woman presented with irregular menstrual periods, secondary amenorrhea, and hypothyroidism. A giant intrasellar and suprasellar mass was found. Angiography confirmed a 3.5 × 2.1–cm fusiform aneurysm involving the cavernous and supraclinoid segments of the right internal carotid artery. A suitable radial artery conduit was not available. The DLCFA was harvested and anastomosed between the M2 segment of the middle cerebral artery and the external carotid artery. Results Durable clinical and angiographic results were apparent at the 2-month follow-up. Conclusions The DLCFA's diameter and length were used successfully in a high-flow EC–IC bypass surgery. The DLCFA may be a good alternative to radial artery and saphenous vein grafts for an EC–IC bypass requiring high flow.
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Philipsen, Tine E., Inez E. Rodrigus, Marc J. Claeys, and Johan M. Bosmans. "Alternative Access in Transcatheter Aortic Valve Implantation: Brachiocephalic Artery Access." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 7, no. 5 (September 2012): 372–75. http://dx.doi.org/10.1097/imi.0b013e31827e5934.
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Direct ascending aortic access is an accepted alternative approach for transcatheter aortic valve implantation (TAVI) that can be preferred in case of excessive atherosclerosis or small caliber of femoral and subclavian vessels or after previous coronary artery bypass grafting with a patent left internal mammary artery graft. However, not all patients are suitable for this direct aortic approach. In these patients, we now use direct access through the brachiocephalic artery. The direct brachiocephalic access can be obtained with or without partial upper sternotomy, depending on the anatomy, which should be evaluated by preprocedural angiographic computed tomography scan. During the procedure, the cerebral tissue oxygen saturation is continuously monitored. We treated two patients with severe aortic valve stenosis, classified as not suitable for surgical aortic valve replacement, by means of TAVI through the brachiocephalic artery. Both patients had excessive iliac atherosclerotic disease. One had patent left internal mammary artery and venous grafts after previous coronary artery bypass grafting so the femoral, direct aortic, nor left subclavian access was suitable; the other had a severely atheromatous and calcified aorta. No procedural or late complications were seen. If transfemoral, subclavian, and direct aortic accesses for TAVI are contraindicated, the direct brachiocephalic access seems to be a safe and feasible alternative.
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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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Papadimitriou, Dimitrios, Dieter Mayer, Mario Lachat, Felice Pecoraro, Thomas Frauenfelder, Thomas Pfammatter, Hideki Ueda, Konstantinos Donas, Frank J. Veith, and Zoran Rancic. "A clampless and sutureless aortic anastomosis technique using an endograft connector for aortoiliac occlusive disease in which the aorta cannot be clamped or sewn due to calcification or scarring." Vascular 20, no. 5 (September 14, 2012): 262–67. http://dx.doi.org/10.1258/vasc.2011.oa0328.
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Bypass surgery in aortoiliac or aortofemoral occlusive disease can be technically demanding and hazardous due to huge calcifications and/or patient co-morbidities. We report about mid-term results of a telescoping sutureless aortic anastomosis technique using endografts as connectors to address such challenging situations. This is a single-center experience (2004–2011) in seven patients (63 ± 6 years) requiring aortoiliac (three) or aortofemoral (four) bypass surgery. In six cases, an aortic stent graft was telescoped into the infrarenal aorta and partly deployed within the aorta and partly outside the aorta. In the first case, a bifurcated stent graft was deployed and the iliac legs were prolonged extra-anatomically with surgical grafts to reach the femoral bifurcation. In the following five cases, a tapered tubular stent graft was deployed through the aortic wall, landing inside a bifurcated surgical graft that was extra-anatomically connected to the iliac or femoral arteries. In the last case, which presented a hostile abdomen and high-risk for extensive surgery, a similar technique was used, but on the iliac artery level. In that case, an iliac stent graft re-loaded ‘upside down’ was deployed through the left common iliac wall, landing distally inside a hand-made 10 × 10 mm bifurcated surgical graft that was extra-anatomically connected to the left external iliac artery and to the right femoral artery. The distal anastomoses on the seven cases were performed either with running sutures (ten) or with VORTEC (four). Telescoping aortic and/or iliac anastomosis was successful in all patients. There was no perioperative mortality. One patient developed postoperative hyperperfusion of the left leg and necessitated fasciotomy. During a mean follow-up of 1.8 ± 2 years (minimum: 270 days, maximum: 7.1 years), all of the grafts remained patent and there was neither stent-graft migration nor stenosis on the level of the aortic or iliofemoral connection. One patient showed disease progression and required percutaneous transluminal angioplasty on the external iliac artery during follow-up. The uneventful perioperative course in these seven patients, with a follow-up of up to six years, underscores that this new technique can be considered in patients with aortoiliac or aortofemoral occlusive disease and in whom clamping and/or anastomosis is expected to be cumbersome or impossible.
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Matoussevitch, Aleksic, Gawenda, and Brunkwall. "Primary extraanatomical revascularization for groin infections in drug addicts." Vasa 36, no. 3 (August 1, 2007): 210–14. http://dx.doi.org/10.1024/0301-1526.36.3.210.
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Background: Arterial groin infections in drug addicts are associated with a risk of amputation and are potentially lethal. Primary revascularization with an obturator bypass represents a potential alternative to local revision and arterial ligation alone. We report our experience with this approach. Patients and methods: From January 1999 until December 2005 twelve drug addicts were treated due to arterial infections in the groin. In eight patients (seven men, one woman, 31 years old on average), the defect in the artery could not be repaired and ligation of the femoral vessels led to critical ischemia. Therefore, an iliaco-popliteal bypass via the foramen obturatorium was implanted either primarily or secondarily. In three patients a cryopreserved homologous vein was used, five patients received alloplastic grafts. Results: Four of eight obturator bypasses were implanted primarily. In the other four patients the initial treatment was limited to local debridement and artery ligation and an obturator bypass was implanted at a later date. Two grafts occluded within the first 30 days. Thereof, one was successful thrombectomized. The other patient had no critical ischemia and he refused further surgery. Three more grafts occluded at 74, 90 and 103 days after surgery. No patient demonstrated signs of graft infection and all groin incisions healed uneventfully. A lower limb amputation became necessary in one patient even though the reconstruction was patent due to embolisation of mycotic material. All patients remained drug dependent throughout the follow-up time which was 3 months on average and ranged from one to 40 months. Conclusions: The patency of obturator bypasses was 75% at one month. This appears low, especially if one considers the youthful age of the patients and the absence of arterial occlusive disease. Nevertheless, the amputation rate also remained low. Therefore, we feel that this technique may contribute to limb salvage in groin infections in drug addicts.
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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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Cracowski, Jean-Luc, Françoise Stanke-Labesque, Carmine Sessa, Mark Hunt, Olivier Chavanon, Philippe Devillier, and Germain Bessard. "Functional comparison of the human isolated femoral artery, internal mammary artery, gastroepiploic artery, and saphenous vein." Canadian Journal of Physiology and Pharmacology 77, no. 10 (October 15, 1999): 770–76. http://dx.doi.org/10.1139/y99-063.
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Human femoral, internal mammary, and gastroepiploic arteries and saphenous veins are used as bypass grafts for coronary surgery or for reconstruction in arterial occlusive disease. We have characterized the contractile responses of these vessels to various agents that are liberated during cardiac or vascular surgery. In organ baths, U46619 (a stable thromboxane A2 mimetic), norepinephrine, endothelin-1, angiotensin II, and KCl caused concentration-dependent contractions in all vessels tested. Leukotriene C4 did not induce any contraction in the arteries, whereas a contraction was obtained in the saphenous vein rings. U46619 induced the most powerful contraction in all vessels tested. The pD2 values for each agent did not differ among the different vessels. When responses were expressed as a percentage of KCl-induced contraction, the contraction of endothelin-1 (151 ± 5%) and leukotriene C4 (43 ± 5%) was more significant on saphenous veins than on arteries. In conclusion, thromboxane A2 appears to be the most potent endogenous constricting agent on different human vascular beds. Our second finding is that saphenous veins are more sensitive to contract to leukotriene C4 and endothelin-1 than arteries. These properties may influence early and (or) long-term vein graft patency.Key words: femoral arteries, vascular reactivity, thromboxane A2, endothelin-1, leukotrienes.
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Milas, Zvonimir L., Thomas F. Dodson, and Richard R. Ricketts. "Pediatric Blunt Trauma Resulting in Major Arterial Injuries." American Surgeon 70, no. 5 (May 2004): 443–47. http://dx.doi.org/10.1177/000313480407000513.
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Ten children, aged 4 to 14 years, sustaining blunt arterial trauma from motor vehicle collisions (6), bicycle accidents (2), and falls (2) were identified over a 10-year period. The arteries injured included the common iliac (3), abdominal aorta (2), carotid (2), brachial (2), and the subclavian, renal, and femoral artery (1 each). One patient had three arterial injuries. Six patients had associated injuries including a pelvic and lumbar spine fracture, Horner's syndrome, liver laceration, skull fracture, open humerus fracture, small bowel serosal tear, and a brachial plexus injury. Definitive diagnosis was made using arteriography (6), computed tomography (CT) scan (2), and physical examination (2). The types of arterial injuries found included incomplete transection, complete transection with pseudo-aneurysm formation, traumatic arteriovenous (AV) fistulas, complete occlusion, and dissection. Repair was accomplished by hypogastric artery interposition or bypass grafting, synthetic grafting with polytetrafluoroethylene (PTFE), reverse saphenous vein grafting, or primary repair, depending on the circumstances. An AV fistula between the carotid artery and cavernous sinus was embolized. All grafts remained patent with exception of the aorto-renal bypass graft at follow-up ranging from 1 month to 3 years. The principles for repairing vascular injuries in children are slightly different than those in adults. Every effort should be made to use autogenous tissue such as the hypogastric artery or saphenous vein for repair if possible. If not, PTFE grafts can be used, although the long-term patency of these grafts in growing children is not known.
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Hartman, Alan R., Kenneth S. Fried, Ismail Khalil, and Thomas S. Riles. "Late axillary artery thrombosis in patients with occluded axillary-femoral bypass grafts." Journal of Vascular Surgery 2, no. 2 (March 1985): 285–87. http://dx.doi.org/10.1067/mva.1985.avs0020285.
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Pinkerton, Cass A., John D. Slack, Charles M. Orr, and James W. Vantassel. "Percutaneous transluminal angioplasty involving internal mammary artery bypass grafts: A femoral approach." Catheterization and Cardiovascular Diagnosis 13, no. 6 (November 1987): 414–18. http://dx.doi.org/10.1002/ccd.1810130612.
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Hartman, Alan R., Kenneth S. Fried, Ismail Khalil, and Thomas S. Riles. "Late axillary artery thrombosis in patients with occluded axillary-femoral bypass grafts." Journal of Vascular Surgery 2, no. 2 (March 1985): 285–87. http://dx.doi.org/10.1016/0741-5214(85)90066-7.
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Blaisdell, F. William. "Late axillary artery thrombosis in patients with occluded axillary-femoral bypass grafts." Journal of Vascular Surgery 2, no. 6 (November 1985): 925. http://dx.doi.org/10.1016/0741-5214(85)90148-x.
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Djoric, Predrag, Lazar Davidovic, Dragica Jadranin, Miroslav Markovic, Igor Koncar, Jelena Zeleskov-Djoric, and Ilijas Cinara. "Factors influencing early results of femoro-femoral crossover bypass." Srpski arhiv za celokupno lekarstvo 139, no. 3-4 (2011): 143–48. http://dx.doi.org/10.2298/sarh1104143d.
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Introduction. Femoro-femoral crossover bypass is an extraanatomic reconstruction used for revascularization of lower limb with contralatateral femoral artery as an inflow vessel, and the graft placed in the suprapubic region. We perform this procedure when anatomic reconstruction is not possible or is contraindicated. Objective. To analyze the influence of different risk factors on early patency of femoro-femoral crossover bypass. Methods. This retrospective study analyzed the results of 88 femoro-femoral bypass grafting during an 11-year period. There were 66 (75%) males and 22 (25%) females of average age 64.93 years (42-79 years). In 76 patients the operations were performed due to critical limb ischemia. Revascularization was urgent in 12 patients, while 76 patients were elective. Dacron prosthesis was used in 81 patients, while PTFE was used in 7 patients. Statistical analysis was made by logistic regression. Results. During hospitalisation the graft remained patent in 82 patients, and graft thrombosis occurred in 6 patients. Limb salvage rate was 90.91%. Early morbidity rate (within the first post-operative month) was 13.64%, while early mortality rate was 4.55%. Using logistic regression we established that early graft patency was statistically more significant in males (p<0.05). Age (p=0.07) and hypertension (p=0.08) appeared to be predicting influence of the graft patency on the border of the accepted statistical significance level. Conclusion. Femoro-femoral crossover bypass is a good alternative for revascularization in high risk patients for standard anatomic reconstructions due to comorbid conditions or local problems.
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Patel, Ajay, Spence M. Taylor, Eugene M. Langan, Bruce A. Snyder, David L. Cull, Timothy M. Sullivan, Jerry R. Youkey, Bruce H. Gray, and Christopher G. Carsten. "Obturator Bypass: A Classic Approach for the Treatment of Contemporary Groin Infection." American Surgeon 68, no. 8 (August 2002): 653–59. http://dx.doi.org/10.1177/000313480206800801.
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As the number of cardiac and interventional radiologic procedures has risen, the frequency with which surgeons are called to treat groin complications has increased. Infectious groin problems that often involve foreign prosthetic material or remnants of percutaneous femoral closure devices are particularly challenging and require control of bleeding, removal of foreign material, wide debridement, and sometimes arterial resection. Management of the consequential limb ischemia in such cases is controversial. The purpose of this study is to review the utility of extra-anatomic common femoral bypass through the obturator foramen (obturator bypass) as a method of treating limb ischemia after arterial groin infection. From July 1992 through June 2001 a total of 12 patients (six male) presented with severe vascular infections of the groin and underwent obturator bypass. Infections occurred as a consequence of an isolated vascular graft infection (nine) or after a percutaneous interventional femoral access procedure (three). Patients presented with systemic sepsis and a draining sinus (six), infected pseudoaneurysm (two), or hemorrhage (four). Treatment included debridement of the groin wound, sartorius muscle flap coverage of the femoral vessels, antibiotics and synthetic (eight polytetrafluoroethylene and four Dacron) obturator bypass via a lower abdominal extraperitoneal incision from an aortobifemoral bypass graft limb to the superficial femoral artery (six), native iliac to femoral artery (three), iliac to popliteal artery (two), and aortobifemoral bypass limb to the popliteal artery (one). Graft patency and limb salvage were assessed by Kaplan-Meier life table analysis. There were two (17%) deaths (multisystem organ failure at postoperative days 9 and 6) and four major complications (25%) requiring reoperation in the first 30 days. Ten patients (83%) survived, healed their groin wounds, and are infection free. With a mean follow-up of 37 months graft patency and limb salvage at 60 months were 80 and 60 per cent, respectively. There were no late graft infections. We conclude that the obturator bypass is an effective and durable means of revascularization in the presence of the septic groin. This procedure belongs in the armamentarium of all surgeons managing these complications.
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Hayoz, Daniel, Do-Dai Do, Felix Mahler, Jürgen Triller, and François Spertini. "Acute Inflammatory Reaction Associated with Endoluminal Bypass Grafts." Journal of Endovascular Therapy 4, no. 4 (November 1997): 354–60. http://dx.doi.org/10.1177/152660289700400406.
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Purpose: Nonspecific inflammatory reactions characterized by local tenderness, fever, and flu-like discomfort have been seen in patients undergoing endoluminal graft placement in the abdominal aorta or the femoral arteries. We undertook a study to assess the clinical and laboratory parameters of this inflammation. Methods: Ten patients with femoropopliteal artery (n = 9) or aortic (n = 1) lesions were treated with EndoPro System 1 stent-grafts made of nitinol alloy and covered with a polyester (Dacron) fabric. Eleven patients implanted with a bare nitinol stent served as the control group. Results: In the stent-graft group, four patients showed clinical signs of acute inflammation manifested by fever and local tenderness. Three of these patients suffered thrombosis of the stent-grafts during the first month of follow-up. Plasma levels of interleukin-1β and interleukin-6 in all stent-graft patients were markedly increased 1 day after intervention (7.3 ± 2.8 versus 90.2 ± 34.1 pg/mL and 15.6 ± 5.8 versus 175.5 ± 66.3 pg/mL, respectively; p < 0.01). This was followed by an increase in fibrinogen (3.0 ± 0.2 versus 5.0 ± 0.2 g/L; p < 0.05) and C-reactive protein (14.6 ± 3.3 versus 77.5 ± 15.0 mg/L; p < 0.01) at 1 week. No direct correlation between the inflammatory markers and symptoms could be found. In vitro analysis showed that individual components of the stent-graft did not activate human neutrophils, whereas the intact stent-graft itself induced a marked neutrophil activation. Conclusions: The component of the self-expanding stent-graft responsible for the nonspecific inflammatory reaction was not identified in this study. It is likely that the stent-graft itself or some as yet unrecognized element of the device other than the Dacron fabric or metal alloy may be a potent in vivo inducer of cytokine reaction by neutrophils.
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Shrestha, Kajan Raj, Dinesh Gurung, Nischal Khanal, and Uttam Krishna Shrestha. "Femoral Pseudoaneurysm in IV Drug Abusers: Single-center Study Experience." Journal of Nepal Health Research Council 18, no. 3 (November 14, 2020): 478–82. http://dx.doi.org/10.33314/jnhrc.v18i3.2507.
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Background: Pseudoaneurysm of the femoral artery is the most common complication among IV drug abusers who inject drugs in groin. These are usually infective and potentially fatal so it requires astute clinical recognition and prompt treatment, possessing a significant challenge to vascular surgeons.
Methods: We present a retrospective descriptive study and the prevalent practice of their management covering the period from 2013 July- December 2019 at our center. Data regarding demography, presentation, surgical management, and the outcome was analyzed.
Results: Among 368 femoral pseudoaneurysm operated during the period, groin swelling with pulsatile mass was the most frequent presentation accounting 304 (82.61%) patients. About 67.12% (247 patients) of the pseudoaneurysm has purulent discharge and 60.07% (221 patients) had bleeding at presentation out of which 211patients had hepatitis C (HCV), hepatitis B (HBsAg) and/or Human Immunodeficiency virus (HIV) status positive. Thirty six patients (9.78%) presented with femoral pseudoaneurysm in both groins. Ligation and excision of the pseudoaneurysm were done in all cases while delayed revascularization was done in eight patients with expanded Polytetrafluoroethylene (ePTFE) graft in one patient and venous bypass grafts in other 7 cases. All patients after bypass had no major limb loss and two patients had a patent graft at five years follow up. There were nine mortalities and thirty two patients underwent amputation.
Conclusions: Infected femoral pseudoaneurysm can be managed by ligation of the involved artery with delayed revascularization if required without major limb and life loss.
Keywords: Delayed revascularization; drug abuser; infected pseudoaneurysm; ligation
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Rennert, Robert C., Ben A. Strickland, Kristine Ravina, Joshua Bakhsheshian, Vance Fredrickson, Matthew Tenser, Arun Amar, William Mack, Joseph Carey, and Jonathan J. Russin. "Efficacy and Outcomes of Posterior Inferior Cerebellar Artery (PICA) Bypass for Proximal PICA and Vertebral Artery-PICA Aneurysms: A Case Series." Operative Neurosurgery 15, no. 4 (February 16, 2018): 395–403. http://dx.doi.org/10.1093/ons/opx277.
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Abstract BACKGROUND Nonsaccular vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms have high morbidity and mortality rates and are difficult to treat using standard microsurgical or endovascular techniques. Definitive revascularization can require clip trapping and/or vessel sacrifice, with PICA bypass. The published surgical experience with these approaches is limited. We herein review our recent surgical experience with PICA revascularization for complex PICA and VA/PICA aneurysms. OBJECTIVE To determine the efficacy and outcomes of PICA bypass for revascularization of nonsaccular PICA and VA/PICA aneurysms. METHODS Retrospective analysis of an institutional review board-approved, prospective database was performed to identify patients with PICA and VA/PICA aneurysms treated with PICA bypass at a single institution. Demographic information, aneurysm characteristics, temporary clip time, and neurological outcomes were recorded. RESULTS Ten cases of PICA revascularization were performed for both ruptured (n = 8) and unruptured (n = 2) nonsaccular proximal PICA or VA/PICA aneurysms. Seven cases were performed without vessel grafts; 3 cases required harvest of the descending branch of the lateral femoral circumflex artery. Mean temporary clip time was 38 min (range 27-50 min). Good outcomes (Glasgow Outcomes Scale score of 5) were achieved in 70% (n = 7) of patients at time of discharge; the remaining patients had a Glasgow Outcomes Scale of 3. Two bypass-related complications occurred in this series; a hematoma at the graft harvest site requiring evacuation, and severe bypass graft spasm requiring multiple endovascular treatments. CONCLUSION PICA bypass can be a safe, effective, and highly customizable tool for the revascularization of patients with nonsaccular proximal PICA and VA/PICA aneurysms.
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Davidovic, Lazar, Milan Mitric, Dusan Kostic, Zivan Maksimovic, Slobodan Cvetkovic, Ilijas Cinara, Andreja Dimic, and Nikola Ilic. "Axillobifemoral bypass grafting." Srpski arhiv za celokupno lekarstvo 132, no. 5-6 (2004): 157–62. http://dx.doi.org/10.2298/sarh0406157d.
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INTRODUCTION Axillo-femoral bypass (AxF) means connecting the axillar and femoral artery with the graft that is placed subcutaneously [1]. Usually, this graft is connected with contralateral femoral artery via one accessory subcutaneous graft, and this connection is known as axillobifemoral bypass (AxFF). This extra-anatomic procedure is an alternative method to the standard reconstruction of aortoiliac region when there are contraindications for general or local reasons. OBJECTIVE The objective of this paper is to show early and late results of AxFF bypass grafting as well as to show the indications for AxFF bypass. METHODS The sample consisted of 37 patients. The procedure was performed in 28 patients who suffered from aortoiliac occlusive disease and who were at high risk due to the comorbidity- in one patient with the rupture of juxtarenal aneurysm of abdominal aorta; in five patients with aortoenteric fistula, in two patients with iatrogenic lesion of abdominal aorta and in one female patient with anus preternaturalis definitivus who was treated for rectovaginal fistula. Donor's right axillary artery was used in 26 cases (70.3%), and donor's left axillary artery was used in 9 cases (29.7%). Dacron graft was used in 34 patients and Polytetrafluo-roethlylene graft was used in three patients. Simultaneously, profundo-plastic was done in four patients and femoro-popliteal bypass was performed in three patients. In five patients who suffered from aortoenteric fistula, simultaneous intervention of gastrointerstinal system has been done, x2 test was used for statistical evaluation and life table method was used for verification of late graft patency. RESULTS The rate of early postoperative mortality was 13.5%. The causes of death were: sepsis -1, MOFS - 3, and infarct myocardium -1. The mean follow up period was 40.1 months, ranging from six months to 17 years. During the follow up period, an early graft thrombosis was identified in two and late graft occlusion was reported in four patients. As the cause of occlusion, the progression of occlusive disease of receptive artery was identified in three patients, while anastomotic neointimae hyperplasia of recipient artery was identified in one patient. Three patients died during the follow up period. As the cause of death, CVI was reported in two patients and malignancy of the urinary tract was fpund in one patient. The other complications were - artery angulation on the level of proximal anastomosis in one patient (Figure 1), false aneurysm in one patient, perigraft seroma in one patient and graft infection in three patients. Life table method has shown that cumulative rate of late graft patency is 80.39% after five years (Graph 1). DISCUSSION Our results were analyzed and compared with the results of the study on 283 patients who had undergone aortobifemoral bypass (AFF) operation due to the aortoiliac occlusive disease. This study was completed in 1995 (18). The results showed that there was no statistically significant differences between AxFF and AFF group (p>0.05), considering early mortality rate and late graft patency (Graph 2). The review of mortality and late patency rate after AxFF bypass grafting in a world well known studies has shown the similar results (Table 1). CONCLUSION The authors suggest that axilobifemoral bypass is indicated when there are contraindications or difficulties to perform anatomic reconstruction due to the abdomen condition (infection, adhesion, comorbidity) as well as in high risk patients with low life expectancy.
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Chapagain, Dinesh, Kiran Prasad Shrestha, Deepak Thapa Magar, and Kumar Bahadur Shrestha. "Descriptive cohort study of Ligation of femoral artery in infected femoral pseudoanurysm in injectable drug abuser." Nepal Mediciti Medical Journal 1, no. 1 (December 1, 2020): 6–9. http://dx.doi.org/10.3126/nmmj.v1i1.34467.
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Background: Infected femoral pseudoanurysm with impending rupture presents most of the time in the late stage in drug abuser with features of sepsis. These cases are managed immediately by exploration with ligation of femoral artery when bypass is not feasible in emergency.
Methods: This is the retrospective descriptive study of 11 years of bir hospital. Datas were collected from the record and subsequent out patient department visits of the cases having femoral infected pseudoanurysm with impending rupture with sepsis of injectable drug abuser. The data collected were patients profile, type of procedure like ligation of femoral artery, bypass like reverse long saphenous graft and synthetic dacron or ptfe graft and complications were also recorded with subsequent. The type of procedure were compared with amputation as final end point. Datas were analysed by SPSS softwear.
Results: We recorded the datas of 45 patients with almost all were male with very few female having mean age of 27.91 years. Twenty two patients had seropositive status and 13 patients had negative. Thirty five patients had ligation of femoral artery,7 patients had interposition synthetic bypass graft and 3 patients had reversed long saphenous vein graft. Nine patients had undergone revision after graft failure as ligation. No complication in 20 cases .Nine cases had rethrombosis with infection, 7 had minor complication and 1 had severe claudication.
Conclusions: In emergency setting, simple ligation of the femoral artery can be both life and limb saving procedure in difficult situation like infection and sepsis.
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Vardanian, Andrew J., Anthony Chau, William Quinones-Baldrich, and Peter F. Lawrence. "Arterial Allograft Allows In-line Reconstruction of Prosthetic Graft Infection with Low Recurrence Rate and Mortality." American Surgeon 75, no. 10 (October 2009): 1000–1003. http://dx.doi.org/10.1177/000313480907501030.
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Surgical management of infected prosthetic vascular grafts is associated with a significant risk of recurrent infection, limb loss, and mortality. Treatment options include graft excision with extra-anatomic bypass and in-line repair with prosthetic graft, vein, or artery. We hypothesized that inline reconstruction using cryopreserved arterial allografts would be associated with a lower recurrent infection rate, limb loss, and mortality than other alternatives. We reviewed all cases where adults underwent surgical management of infected prosthetic aortic, iliac, or femoral bypass grafts with cryopreserved arterial allograft at our medical center from 2001 to 2008. Cryopreserved arterial allografts were used in 21 patients. There were nearly equal number of men (n = 11, 52%) and women (n = 10, 48%). The median age was 63 years and median time since cryoartery repair was 4 years. There have been no deaths in the follow-up period. Complications (19%) included colon perforation (n = 1), lower extremity compartment syndrome (n = 1), limb ischemia (n = 1), and reinfection with pseudoaneurysm and subsequent limb amputation (n = 1). These positive findings of low morbidity and absence of mortality in high risk patients have resulted in a shift at our institution to the preferential use of cryopreserved arterial allograft with in-line reconstruction for infected prosthetic grafts.
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Vijaykumar, Kalpana, Jia Sheng Tay, Tjun Yip Tang, and Edward Tieng Chek Choke. "Spontaneous Superficial Femoral Artery Mycotic Aneurysm." Case Reports in Surgery 2021 (February 25, 2021): 1–4. http://dx.doi.org/10.1155/2021/6613914.
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Peripheral artery mycotic aneurysms are rare occurrences. In this case, we review a 52-year-old lady with poorly controlled diabetes who developed a spontaneous left superficial artery mycotic aneurysm. She underwent excision and subsequent extra-anatomic bypass with a great saphenous vein graft. She had full functional recovery after a short period of rehabilitation.
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Diethrich, Edward B., and Konstantine Papazoglou. "Endoluminal Grafting for Aneurysmal and Occlusive Disease in the Superficial Femoral Artery: Early Experience." Journal of Endovascular Therapy 2, no. 3 (August 1995): 225–39. http://dx.doi.org/10.1177/152660289500200301.
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Purpose: To examine whether endoluminal grafts (ELGs) of radially expandable polytetrafluoroethylene (PTFE) can successfully form durable internal conduits to revascularize lengthy occlusive disease and exclude aneurysms in the femoropopliteal (FP) arteries. Methods: Under protocol, implantation of an unpredilated PTFE tube ELG anchored with Palmaz stents using a low-profile percutaneous delivery system was attempted in 50 symptomatic patients for a variety of pathologies: (1) restenosis; (2) complex lesions unlikely to be treated successfully with other endoluminal therapies; (3) acute angioplasty failure; and (4) aneurysms. There were 37 occlusions, 14 stenoses, and 2 long, combined stenoticaneurysmal lesions in 47 native arteries, 5 FP grafts, and 1 femorotibial (FT) vein graft. Thirty-two percent of the patients had ≤ 1 vessel runoff. The average lesion length was 20.4 ± 11.4 cm (range 1.5 to 40), and the mean preoperative ankle-brachial index (ABI) at rest was 0.53 ± 0.14. Results: In a 20-month period through April 1995, 50 patients (34 males, 16 females; mean age 69.5 years, range 45 to 87) underwent 54 procedures in 53 limbs; 55 ELGs were successfully deployed in 51 limbs; 2 patients were converted to FP bypass owing to technical problems (96% procedural success). There were 18 inhospital complications: 1 distal wire dissection repaired with an additional ELG; 2 hematomas requiring surgical repair; 1 graft collapse; 1 pseudoaneurysm at the site of a mid-ELG leak; 7 minor access sequelae; and 6 acute ELG thromboses, 4 treated with lytic therapy and balloon dilation, 1 with open thrombectomy, and 1 with bypass grafting. The mean postoperative ABI was 1.01 ± 0.10. During the 30-day postprocedure period, 2 ELGs rethrombosed and 2 other limbs (3 ELGs) occluded; 1 thrombosis and 1 rethrombosis were lysed successfully, but the other 2 patients had an FP bypass. Over the mean 8.3 ± 5.5 month follow-up, 6 additional ELGs occluded and 1 reoccluded; 4 were successfully treated by endovascular techniques for a primary patency of 72% and secondary patency of 84% by life-table analysis. Conclusions: Endovascular grafting is a conceptually attractive technique that has the potential to expand the current boundaries of interventional treatment. This preliminary experience attests to the feasibility and safety of ELG deployment in the superficial femoral arteries. Whether such a device can match the durability of classical revascularization techniques remains to be determined in clinical trials when device configurations and deployment techniques have been standardized.
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Goldstein, Kenneth A., Frank J. Veith, Takao Ohki, Nicholas J. Gargiulo, and Evan C. Lipsitz. "Femoral Artery to Prosthetic Graft Anastomotic Dehiscence Owing to Infection: Successful Treatment with Arterial Reconstruction and Limb Salvage." Vascular 13, no. 6 (November 1, 2005): 355–57. http://dx.doi.org/10.1258/rsmvasc.13.6.355.
Full textAbstract:
A 66-year-old man had foot gangrene and a fixed contracture of the knee following two failed femoropopliteal bypasses, one with vein and one with polytetrafluoroethylene (PTFE). An external iliac to anterior tibial artery bypass and skeletal traction via the os calcis resulted in limb salvage and successful normal ambulation. After 3 months, he ruptured the infected femoral anastomosis of the failed PTFE femoropopliteal bypass with external bleeding. The use of arteriography and a balloon catheter to obtain proximal control allowed arterial repair, removal of the graft, and preservation of flow within a patent common and deep femoral artery. This flow preservation maintained the viability and function of the limb when the anterior tibial bypass closed 4 years later, and the limb continues to be fully functional 3 years later. Aggressive secondary attempts at limb salvage are worthwhile even in unfavorable circumstances.
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Pfeiffer, Ralph Burton, Ralph Burton Pfeiffer, Glenn E. Esses, and Benny Watts. "In situ Femoral to Popliteal Bypass Graft Using Superficial Femoral Vein to Popliteal Vein." American Surgeon 70, no. 7 (July 2004): 617–19. http://dx.doi.org/10.1177/000313480407000711.
Full textAbstract:
During the evolution of vascular surgery as a specialty, many conduits have been used to revascularize the lower extremities. Superficial veins and prosthetic materials make up the majority of materials used to bypass diseased segments of native artery. The deep veins of the thigh have also been reported as alternatives for arterial bypass. However, the use of the in situ superficial femoral and popliteal vein bypass has not been reported to our knowledge in current literature. We report a 79-year-old white female with lower extremity rest pain who underwent an in situ femoral popliteal bypass graft for limb salvage.
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Maruf, Mohammad Fazle, Samirul Islam, Nazmul Hossain, Muhammad Abdul Quaium Chowdhury, Tahmina Akter, and Mamunur Rahman. "Femoro-Popliteal Artery Bypass Surgery With Autologous Great Saphenous Vein Graft: 1st Time Experience in Chittagong Medical College Hospital." Journal of Chittagong Medical College Teachers' Association 26, no. 1 (September 13, 2015): 46–51. http://dx.doi.org/10.3329/jcmcta.v26i1.61841.
Full textAbstract:
Peripheral arterial disease affects with loss of limb if untreated. For decades, arterial bypass has been regarded as one of the trustworthy and effective methods for treatment of atherosclerosis in lower limbs. A 65 year old male patient was treated for a worsening short distance intermittent claudication in left calf muscle. Clinical examinations identified occlusion of the superficial femoral artery. Peripheral Angiogram (PAG) revealed popliteal artery had good calibre with distal run off. Left superficial femoral artery to popliteal artery bypass was performed on the patient with autologous reversed great saphenous venous conduit. Post operative course was uneventful. The pulses of the dorsalis pedis and posterir tibial arteries in left leg regained and remain strong. The Ankle Brachial Index (ABI) increased from 0.60 to 1.09. As far as arterial bypass in lower limb is concerned, the efficacy is usually not so desireable because of lack of vascular substitutes, insufficient availability of autologous vessels and also the scarcity of skilled vascular surgeon. Therefore, it becomes our long-lasting desire to find out a safe and endurable graft conduit and also to establish vascular surgery in a city where this type of surgery was absent previously. We have recently succeeded in performing femoro-popliteal bypass surgery in Chittagong Medical College Hospital (CMCH). Probably this was the first successful femoro-popliteal bypass surgery with autologous great saphenous venous conduit for chronic arterial occlusive disease of lower limb in this hospital.
JCMCTA 2015 ; 26 (1) : 46-51
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Kotsis, Thomas, Louizos Alexander Louizos, Evangelos Pappas, and Kassiani Theodoraki. "Complex Common and Internal Iliac or Aortoiliac Aneurysms and Current Approach: Individualised Open-Endovascular or Combined Procedures." International Journal of Vascular Medicine 2014 (2014): 1–14. http://dx.doi.org/10.1155/2014/178610.
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Objective. Bilateral internal iliac artery aneurysms constitute the utmost configuration of infrarenal aortoiliac disease. We detail characteristic aortoiliac disease patterns and reconstructive techniques we have used, along with a visualized decision-making chart and a short review of the literature.Material and Methods. A retrospective, observational study of twelve clinical cases of patients with aortoiliac disease are described. Two patients had a common iliac artery aneurysm and were managed by the application of inversed stent-grafts; another case was repaired by the insertion of a standard bifurcated stent-graft flared in the right common iliac artery and with an iliac branched device in the left iliac arterial axis. Open approach was used in 5 cases and in 4 cases a combination of aortouniliac stent-grafting with femoral-femoral bypass was applied.Results. Technical success was 100%. One endoleak type Ib in a flared iliac limb was observed and corrected by internal iliac embolism and use of an iliac limb stent-graft extension. We report 100% patency rate during 26.3 months of followup.Conclusion. Individualized techniques for the management of isolated iliac or aortoiliac aneurismal desease with special concern in maintaining internal iliac artery perfusion lead to elimination of perioperative complications and long-term durability and patency rates.
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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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Meyer, Alexander, Evgenia Boxberger, Christian-Alexander Behrendt, Shatlyk Yagshyyev, Irina Welk, Werner Lang, and Ulrich Rother. "Long-Term Outcomes of Extra-Anatomic Femoro-Tibial Bypass Reconstructions in Chronic Limb-Threating Ischemia." Journal of Clinical Medicine 11, no. 5 (February 24, 2022): 1237. http://dx.doi.org/10.3390/jcm11051237.
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(1) Background: While tibial bypass surgery still plays a role in the treatment of patients with chronic limb-threatening ischemia and diabetic foot syndrome; only a few centers have recorded considerable numbers of these conditions. The current study aimed to determine contemporary practice with special focus on the performance of extra-anatomic grafting to the infrapopliteal arteries. (2) Methods: A retrospective, single-center study included patients with tibial bypass grafts from 1 January 2008 to 31 December 2019. Primary endpoints were complication rate, graft patency, amputation, overall survival, and major adverse cardiac (MACE) or limb event (MALE). The cohort was stratified by extra-anatomic vs. anatomic position. (3) Results: A total of 455 patients (31% female) with Rutherford stage 4 (12.5%) and 5/6 (69.5%) were included (thereof, 19.5% had high amputation risk according to the Wound Ischemia Foot Infection score). Autologous reconstruction was performed in 316 cases, and prosthetic reconstruction in 131 cases, with a total of 51 (11.2%) extra-anatomic grafts. Early occlusion rate was 9.0% with an in-hospital overall mortality of 2.8%. The in-hospital rate of MACE was 2.4% and of MALE, 1.5%. After one, three and five years, the primary patency of venous bypasses was 74.5%, 68.6% and 61.7%, respectively. For prosthetic grafts, this was 55.1%, 46.0%, and 38.3%, respectively (p < 0.001). The patency of extra-anatomic prosthetic grafts performed significantly better compared with anatomically positioned prosthetic grafts (log-rank p = 0.008). In multivariate analyses, diabetes (hazard ratio, HR 1.314, CI 1.023–1.688, p = 0.032), coronary artery disease (HR 1.343, CI 1.041–1.732, p = 0.023), and dialysis dependency (HR 2.678, CI 1.687–4.250, p < 0.001) were associated with lower odds of survival (4) Conclusion: In this large, single-center cohort, tibial bypass surgery demonstrated satisfactory results with overall low perioperative complication rates and long-term patency rates of 60% and 38%, respectively. Extra-anatomic bypasses represent a feasible alternative to venous grafts in terms of patency. A tailored, patient-centered approach considering predictors such as diabetes, dialysis dependency, and coronary artery disease along with prediction models may further improve the long-term results in the future.
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Haga, Makoto, Shinya Motohashi, Hidenori Inoue, Junetsu Akasaka, and Shunya Shindo. "Deep Circumflex Iliac Artery as an Inflow Alternative for Surgical Revascularization: A Case Report." Vascular and Endovascular Surgery 54, no. 1 (September 23, 2019): 85–88. http://dx.doi.org/10.1177/1538574419877730.
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The common femoral artery (CFA) is the most widely used inflow in all types of surgical revascularization in patients with peripheral artery disease. However, the CFA cannot always be used because of calcification, obstruction, or previous dissection. Here, we report a rare case of selecting the deep circumflex iliac artery (DCIA) as a source of inflow to perform a surgical revascularization in a patient with chronic limb-threatening ischemia. A 62-year-old man was admitted to our hospital due to necrotized third and fifth toes with pain at rest. Computed tomography showed severe stenosis of the CFA, superficial femoral artery, and deep femoral artery, and an entirely stented external iliac artery. The DCIA was identified as the only patent artery. Considering the condition of the other arteries, we selected the DCIA as a source of inflow. Deep circumflex iliac–popliteal bypass was performed with a saphenous vein. The bypass graft was patent 9 months after surgery and limb salvage had been achieved.
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Kölbel, Tilo, Christian Detter, Sebastian W. Carpenter, Fiona Rohlffs, Yskert von Kodolitsch, Sabine Wipper, Herrmann Reichenspurner, E. Sebastian Debus, and Nikolaos Tsilimparis. "Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch." Journal of Endovascular Therapy 24, no. 1 (November 23, 2016): 75–80. http://dx.doi.org/10.1177/1526602816680089.
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Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.
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Köksal, Cengiz, Sabit Sarikaya, and Mustafa Zengin. "Thoracofemoral Bypass for Treatment of Juxtarenal Aortic Occlusion." Asian Cardiovascular and Thoracic Annals 10, no. 2 (June 2002): 141–44. http://dx.doi.org/10.1177/021849230201000211.
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Descending thoracic aorta-to-femoral artery bypass grafting is considered a good alternative procedure for revascularization in cases of aortic graft failure, graft infection, and other intraabdominal pathologies not amenable to standard aortofemoral revascularization. Its use as the primary mode of treatment in selected cases is still under investigation. From January 1998 to June 2001, 5 patients underwent descending thoracic aorta-to-femoral artery bypass grafting as primary treatment for juxtarenal aortic occlusion. There was no operative mortality nor major morbidity; a groin incision infection occurred in one case. The mean hospital stay was 8.2 days and intensive care unit stay was 2.6 days. Graft failure was not encountered in the short-term follow-up. In spite of the small number of patients, it was concluded that thoracic aortofemoral bypass offers excellent inflow and reliable patency and may be considered for primary revascularization in cases of juxtarenal aortic occlusion.
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Khan, Saidur Rahman, CM Shaheen Kabir, Mashhud Zia Chowdhury, Md Jabed Iqbal, M. Maksumul Haq, Mohammad Liaquat Ali, and Md Rezaul Karim. "Comparison of Left Radial Versus Femoral Approaches for Coronary Procedures in Patients with Previous Coronary Artery Bypass Grafts." Anwer Khan Modern Medical College Journal 10, no. 1 (October 20, 2019): 11–16. http://dx.doi.org/10.3329/akmmcj.v10i1.43653.
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Aims: Radial approach is gaining the momentum as a default technique for coronary procedures. Limited trails are available for post coronary artery bypass graft (CABG) patients to compare the merits of femoral & radial access.
Methods: It is a single-center study conducted in between January, 2013 to December, 2015. During this study period, post CABG patients were blindly assigned to its five high volume operators. Coronary angiography & intervention procedures were performed by left radial or femoral approach as per assigned operator's choice. Contrast volume was the primary endpoint whereas the procedure & fluoroscopy time, procedural success, access site major bleeding, pre discharge major adverse cardiac event (MACE) were the secondary endpoint both for coronary angiogram (CAG) & percutaneous coronary intervention (PCI).
Results: Total 380 post CABG patients were included in this study period. Radial access (n=155) was lower than femoral access (n=225). Compared with femoral access, diagnostic CAG required relatively lower contrast volume though statistically not significant via radial access (70±34 vs. 72±40 ml, p=0.267). Procedure time (25.2±10.7 vs. 26.9±6.8 min, p=0.735), fluoroscopy time (10.7±5.5 vs. 9.5±4.7 min, p=0.424) were almost similar in both access for CAG. Other secondary clinical endpoints were similar among both groups. Interestingly, adhoc PCI was more frequent in radial group (n=54 out of 155, 34.8%) than in femoral group (n=44 out of 225, 19.6%) with p=0.01. Contrast volume in between two groups was pretty similar with p=0.226. The incidence of other secondary endpoints was also not statistically significant.
Conclusion: Coronary angiography for post CABG patients through left radial approach seems to be effective, non-inferior in terms of contrast volume, procedure & fluoroscopy time & other clinical end points comparing to femoral access.
Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 11-16
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Garbaisz, Dávid, Péter Osztrogonácz, András Mihály Boros, László Hidi, Péter Sótonyi, and Zoltán Szeberin. "Comparison of arterial and venous allograft bypass in chronic limb-threatening ischemia." PLOS ONE 17, no. 10 (October 27, 2022): e0275628. http://dx.doi.org/10.1371/journal.pone.0275628.
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Introduction Femoro-popliteal bypass with autologous vascular graft is a key revascularization method in chronic limb-threatening ischemia (CLTI). However, the lack of suitable autologous conduit may occur in 15–45% of the patients, necessitating the implantation of prosthetic or allogen grafts. Only little data is available on the outcome of allograft use in CLTI. Aims Our objective were to evaluate the long term results of infrainguinal allograft bypass surgery in patients with chronic limb-threatening ischemia (CLTI) and compare the results of arterial and venous allografts. Methods Single center, retrospective study analysing the outcomes of infrainguinal allograft bypass surgery in patients with CLTI between January 2007 and December 2017. Results During a 11-year period, 134 infrainguinal allograft bypasses were performed for CLTI [91 males (67.9%)]. Great saphenous vein (GSV) was implanted in 100 cases, superficial femoral artery (SFA) was implanted in 34 cases. Early postoperative complications appeared in 16.4% of cases and perioperative mortality (<30 days) was 1.4%. Primary patency at one, three and five years was 59%, 44% and 41%, respectively, while secondary patency was 60%, 45% and 41%, respectively. Primary patency of the SFA allografts was significantly higher than GSV allografts (1 year: SFA: 84% vs. GSV: 51% p = 0,001; 3 years: SFA: 76% vs. GSV: 32% p = 0,001; 5 years: SFA: 71% vs. GSV: 30% p = 0.001). Both primary and secondary patency of SFA allograft implanted in below-knee position were significantly higher than GSV bypasses (p = 0.0006; p = 0.0005, respectively). Limb salvage at one, three and five years following surgery was 74%, 64% and 62%, respectively. Long-term survival was 53% at 5 years. Conclusion Allograft implantation is a suitable method for limb salvage in CLTI. The patency of arterial allograft is better than venous allograft patency, especially in below-knee position during infrainguinal allograft bypass surgery.