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Giusti JCG, Rossi FH, Cury MVM, Godoy MR, Palomo AT, Sacilotto R, Brochado Neto FC, Izukawa NM. Efficacy and safety of iliofemoral bypass using arm veins as an alternative conduit for chronic limb-threatening ischemia. J Vasc Surg 2023; 78:1021-1029.e3. [PMID: 37343730 DOI: 10.1016/j.jvs.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE The use of basilic vein in iliofemoral revascularizations was previously described in the literature as an autologous option for the treatment of vascular prosthesis infection and as a primary conduit in patients at high risk of infectious surgical complications. However, the publications available include several different indications and are limited to case reports. Therefore, the aim of this study was to evaluate the outcomes of the use of arm veins as a safe and effective autologous alternative for iliofemoral reconstruction in patients with chronic limb-threatening ischemia (CLTI) and at high risk of prosthesis infection. METHODS We performed a multicenter, retrospective cohort study with 53 consecutive iliofemoral bypasses using arm veins as an alternative conduit. The procedures were performed between November 2013 and November 2021, exclusively for patients with CLTI classified as TASC aortoiliac C or D with increased risk of postoperative surgical infection. Demographic, clinical variables, and outcomes were collected from a prospective database. Main endpoints were amputation-free survival (AFS) and major adverse cardiovascular events. Secondary endpoints included primary and secondary patencies and overall survival. Cox regression analysis was used to identify the predictors of AFS. Postoperative surgical complications and 30-day mortality were also assessed. RESULTS The mean age was 64.2 ± 8.4 years, with a predominance of male gender. The median follow-up period was 615 days. All patients had CLTI, with a predominance of tissue loss (n = 51; 96.2%) and a median ankle-brachial index of 0.28. The basilic vein was utilized in most procedures (69.8%). Thirty-day major adverse cardiovascular events occurred in five cases (9.4%), and the 30-day mortality rate was 3.8%. The AFS, primary patency, secondary patency, and overall survival in 720 days were 71%, 72%, 89%, and 75%, respectively. Cox regression analysis revealed no association between the variables analyzed for AFS. There was no graft late infection nor pseudoaneurysmal degeneration. CONCLUSIONS Iliofemoral bypass using arm veins as an autologous conduit proved to be an effective and safe procedure with low incidence of postoperative cardiovascular complications and high rates of AFS in patients with CLTI. Also, this suggests that arm veins can be an interesting and suitable autologous alternative conduit for iliofemoral reconstructions, especially in cases in which a prosthesis should be avoided or when it is not available.
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Affiliation(s)
- Júlio César Gomes Giusti
- Department of Vascular and Endovascular Surgery, Hospital Municipal Dr. Carmino Caricchio - HMCC, São Paulo, São Paulo, Brazil.
| | - Fabio Henrique Rossi
- Department of Vascular and Endovascular Surgery, Instituto Dante Pazzanese de Cardiologia - IDPC, São Paulo, São Paulo, Brazil
| | - Marcus Vinicius Martins Cury
- Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual - HSPE, São Paulo, São Paulo, Brazil
| | - Marcos Roberto Godoy
- Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual - HSPE, São Paulo, São Paulo, Brazil
| | - Amanda Thurler Palomo
- Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual - HSPE, São Paulo, São Paulo, Brazil
| | - Roberto Sacilotto
- Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual - HSPE, São Paulo, São Paulo, Brazil
| | - Francisco Cardoso Brochado Neto
- Department of Vascular and Endovascular Surgery, Hospital Municipal Dr. Carmino Caricchio - HMCC, São Paulo, São Paulo, Brazil; Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual - HSPE, São Paulo, São Paulo, Brazil
| | - Nilo Mitsuru Izukawa
- Department of Vascular and Endovascular Surgery, Instituto Dante Pazzanese de Cardiologia - IDPC, São Paulo, São Paulo, Brazil
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Illuminati G, Calio' FG, Pizzardi G, Pasqua R, Masci F, Frezzotti F, Palumbo P, Vietri F. Results of Infrageniculate Bypasses Using the Profunda Femoris Artery as Inflow Source. Ann Vasc Surg 2017; 47:188-194. [PMID: 28943485 DOI: 10.1016/j.avsg.2017.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND When the common femoral artery is not accessible for infrainguinal bypass grafting, the profunda femoris artery (PFA) can be a valuable alternative inflow source for distal arterial revascularization. The purpose of this retrospective study was to evaluate the results of infrageniculate bypass grafting via the PFA as inflow source for critical limb ischemia. METHODS Between 1994 and 2016, 68 patients, 51 men of a mean age of 74 years, underwent an infrageniculate arterial bypass grafting for critical limb ischemia, using the PFA as inflow site. PFA was exposed at the Scarpa's triangle in 38 patients (56%) and at its medio-crural segment in 30 patients (44%). The distal anastomosis was performed on the infragenicular popliteal artery in 33 patients (48%), the peroneal artery in 14 patients (20%), the tibioperoneal trunk in 8 patients (12%), the posterior tibial artery in 8 patients (12%), and the dorsalis pedis artery in 5 patients (8%). The graft material consisted of a reversed great saphenous vein (GSV) in 62 patients (91%) and a 6-mm polytetrafluoroethylene graft in 6 patients (9%). The median duration of follow-up was 51 months (range, 6-72 months). As main results, postoperative mortality and morbidity, overall late patients' survival, primary grafts' patency, and limb salvage rate were considered. RESULTS Operative mortality and morbidity were 3% and 4%, respectively. Overall patients' survival, primary patency and limb salvage rate, at 36 and 60 months were, respectively, 62% and 53%, 66% and 59%, and 92% and 77%. CONCLUSIONS The PFA, both exposed at the Scarpa's triangle and at mid-thigh, is an excellent inflow source for infrageniculate revascularizations. It should remain an important part of the technical armamentarium of vascular surgeons, even in the endovascular era.
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Affiliation(s)
- Giulio Illuminati
- The Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy.
| | | | - Giulia Pizzardi
- The Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Rocco Pasqua
- The Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Federica Masci
- The Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Francesca Frezzotti
- The Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Piergaspare Palumbo
- The Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Francesco Vietri
- The Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
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Dorweiler B, Friess T, Duenschede F, Doemland M, Espinola-Klein C, Vahl CF. Value of the deep femoral artery as alternative inflow source in infrainguinal bypass surgery. Ann Vasc Surg 2013; 28:633-9. [PMID: 24360628 DOI: 10.1016/j.avsg.2013.04.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/23/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to analyze the long-term results of infrainguinal bypass surgery using the deep femoral artery (DFA) as the inflow source. METHODS Between 1998 and 2011, 88 bypasses of the lower limb were placed in 86 patients (mean age 71 years) using the deep femoral artery as inflow. Patients' records were retrieved from a computerized database and analyzed retrospectively. RESULTS Critical limb ischemia (rest pain/tissue loss) was the indication in the majority (87.5%) of cases. The distal anastomosis of the bypass grafts was located at the popliteal level in 32 cases and the tibial (pedal) level in 52 cases, respectively, with the autologous vein as conduit in 94% of cases. Perioperative mortality was 2.3% and 77 patients (79 limbs) were followed over a mean period of 48 months. Overall primary, primary assisted, and secondary patency rates of 64.2%, 74.9%, and 92.3% were noted at 60 months, respectively. The limb salvage rate was 97%, with an overall survival of 48.7% at 60 months. CONCLUSIONS The deep femoral artery can serve as reliable inflow source for infrainguinal bypass surgery in difficult situations like redo groin surgery, limited conduit length, and circumferential nonobstructive calcification of the common femoral artery.
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Affiliation(s)
- Bernhard Dorweiler
- Division of Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, Johannes-Gutenberg University, Mainz, Germany.
| | - Tanja Friess
- Division of Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, Johannes-Gutenberg University, Mainz, Germany
| | - Friedrich Duenschede
- Division of Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, Johannes-Gutenberg University, Mainz, Germany
| | - Marco Doemland
- Division of Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, Johannes-Gutenberg University, Mainz, Germany
| | - Christine Espinola-Klein
- Division of Angiology, II Medical Clinic, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
| | - Christian-Friedrich Vahl
- Division of Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, Johannes-Gutenberg University, Mainz, Germany
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Silverberg D, Sheick-Yousif B, Yakubovitch D, Halak M, Schneiderman J. The deep femoral artery, a readily available inflow vessel for lower limb revascularization: a single-center experience. Vascular 2013; 21:75-8. [PMID: 23508396 DOI: 10.1177/1708538113478719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The deep femoral artery (DFA) offers several advantages as an inflow vessel in lower-extremity bypasses. We report a single-center experience using the DFA as an inflow artery for lower-extremity revascularization. We reviewed all patients who underwent a lower-extremity bypass utilizing the DFA as the inflow vessel. Demographics, indications for surgery, indication for use of the DFA, type of conduits and target vessels were recorded. Follow-up data included resolution of symptoms, bypass graft patency, major amputations and survival. Over 2.5 years, 23 patients were treated with a DFA-inflow bypass. Eighteen (78%) suffered from wounds and five (22%) from rest pain. The proximal, middle and distal DFA was used in 8, 14 and 1 patients, respectively. Indications for using the DFA were limited vein conduit (16) and a hostile groin (5). All patients experienced initial resolution of their ischemic symptoms. The primary patency at two years was 93%. The survival rate was 83%. In conclusion, the DFA is an excellent and underutilized alternative inflow artery in patients requiring lower limb revascularization. It offers excellent patency rates and should be considered in patients with hostile groins or insufficient lengths of a vein conduit.
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Affiliation(s)
- Daniel Silverberg
- Department of Vascular Surgery, The Chaim Sheba Medical Center, Affiliated to the Tel Aviv University, Sackler School of Medicine, Tel Hashomer 52621, Israel.
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Krasiński Z, Biskupski P, Dzieciuchowicz Ł, Kaczmarek E, Krasińska B, Staniszewski R, Pawlaczyk K, Stanisić M, Majewski P, Majewski W. The Influence of Elastic Components of the Venous Wall on the Biomechanical Properties of Different Veins Used for Arterial Reconstruction. Eur J Vasc Endovasc Surg 2010; 40:224-9. [DOI: 10.1016/j.ejvs.2010.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 04/10/2010] [Indexed: 10/19/2022]
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De Luccia N, Appolonio F, Santo FRE. Vascular images. Arm vein bypass from distal deep femoral to superior medial genicular artery for limb salvage. J Vasc Surg 2009; 50:1196. [PMID: 19375268 DOI: 10.1016/j.jvs.2009.02.239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 02/24/2009] [Accepted: 02/24/2009] [Indexed: 10/20/2022]
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Brochado Neto FC, Casella IB, Matielo MF, Simões TB, Ricartte AR, Lacerda R, Bergamo LC, Sacilotto R. Artéria femoral profunda: uma opção como origem de fluxo para derivações infrageniculares. J Vasc Bras 2008. [DOI: 10.1590/s1677-54492008000300004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CONTEXTO: Na isquemia crítica, a artéria femoral profunda pode tornar-se a opção mais distal como origem de fluxo para derivações distais em casos de oclusão da origem da artéria femoral superficial associada a prega inguinal hostil. OBJETIVO:Avaliar, retrospectivamente, a artéria femoral profunda como doadora de fluxo para derivações infrageniculares. MÉTODOS: De 2000 a 2005, 129 derivações infrageniculares apresentaram anastomose proximal nas artérias femorais, comum (40), superficial (72) e profunda (17). O presente estudo teve como foco a artéria femoral profunda, e suas indicações foram: prega inguinal hostil (seis casos), limite da extensão do substituto (seis casos) e ambos os fatores (outros cinco casos). Foram abordadas a primeira e a segunda porção em 12 casos e a terceira porção em cinco casos. As cirurgias foram secundárias em 47% dos casos, e os substitutos utilizados foram veias do membro superior em 11 casos, safena interna em cinco e safena externa em um caso. RESULTADOS: No total dos enxertos (129), as estimativas de perviedade primária e salvamento do membro foram: 68,0% e 84,7%, respectivamente, com erro padrão (EP) aceitável (0,1) em 36 meses. Quando o grupo foi estratificado, as artérias femorais comum, superficial e profunda apresentaram resultados comparáveis de perviedade primária (63,3, 70,2 e 64,7%; p = 0,63) e salvamento do membro (83,1, 82,4 e 92,3%; p = 0,78). A perviedade dos enxertos com origem nas porções proximal e distal da artéria femoral profunda, bem como das cirurgias primárias e secundárias, foram comparáveis, sem diferença estatística significante (p = 0,89 e p = 0,77, respectivamente). CONCLUSÃO: A artéria femoral profunda mostrou ser acessível e efetiva como origem de fluxo de enxertos infrageniculares, com resultados satisfatórios de perviedade e salvamento do membro.
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Natale A, Belcastro M, Palleschi A, Baldi I. The mid-distal deep femoral artery: few important centimeters in vascular surgery. Ann Vasc Surg 2007; 21:111-6. [PMID: 17349347 DOI: 10.1016/j.avsg.2006.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2005] [Revised: 06/21/2006] [Accepted: 06/22/2006] [Indexed: 11/17/2022]
Abstract
The deep femoral artery is an important artery in lower-limb revascularization. Employing its initial centimeters as either an inflow or an outflow site has been advocated by many authors. The purpose of this work was to highlight the importance of the mid-distal section of the deep femoral artery, underlining its indications and advantages. From January 1998 to December 2004, we performed, at the Misericordia Hospital Vascular Surgery Unit in Grosseto, Italy, 45 bypasses employing the mid-distal deep femoral artery as an inflow or outflow site. Twenty patients (44.4%) had nonhealing ulcers and/or gangrene, while the remainder (25 patients, 55.6%) presented with rest pain or severe claudication. In 41 cases (91.1%), the mid-distal deep femoral artery was used as the inflow site for peripheral bypasses. In four cases (8.9%), the mid-distal deep femoral artery was employed as the outflow site, twice (4.4%) after aortobifemoral branch thrombosis and twice (4.4%), in the same patient, after inguinal prosthetic infection healing. When the mid-distal deep femoral artery was employed as the inflow site, primary and secondary patency at 1 and 5 years were 92.72% vs. 95.20% and 57.39% vs. 72.81%, respectively. We had two early (<30 days) failures (4.4%) in patients with posterior tibial distal anastomosis, which required above-knee amputation. In two cases (4.4%), we had to perform a transmetatarsal amputation. In one patient, after healing of the inguinal prosthetic infection of an aortobifemoral bypass, we employed the mid-distal deep femoral artery both as inflow and as outflow site. This patient required a monolateral above-knee amputation after 5 months. The mid-distal deep femoral artery is a good outflow and inflow site in patients who have previously undergone surgical interventions in Scarpa's triangle, in those having inadequate vein segment, in those with local inguinal healed infection, and in obese patients. The surgical technique is a practical, easy, elegant, and fast procedure, along with being an optimal alternative to reexploration of scarred inguinal tissue.
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Affiliation(s)
- Armando Natale
- Vascular Surgery Unit, Misericordia Hospital, Grosseto, Italy.
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