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Dalio MB, Gomes KEB, Bohatch Júnior MS, Joviliano EE. Tapered reinforced graft and vein cuff in the distal anastomosis as adjunct strategies for infrapopliteal prosthetic bypass graft in chronic limb-threatening ischemia: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231204575. [PMID: 37829350 PMCID: PMC10566265 DOI: 10.1177/2050313x231204575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023] Open
Abstract
The great saphenous vein is the optimal conduit for infrapopliteal bypass surgery in chronic limb-threatening ischemia. A prosthetic bypass graft is an acceptable option when the autologous vein is unavailable and the anatomy is not favorable for endovascular therapy. However, the low patency rate of prosthetic grafts calls for adjunct strategies to improve the outcomes. Tapered reinforced grafts and vein cuffs are proposed measures. We herein present a case of a 78-year-old man with chronic limb-threatening ischemia and an extensive necrotic lesion on the dorsum of the left foot. He was successfully treated with a prosthetic bypass using two adjunct strategies to help improve patency: a tapered reinforced graft and a vein cuff in the distal anastomosis. After debridement and partial skin grafting, the wound healed completely in 2 months. The bypass graft was patent for 1 year.
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Thomas B, Lacroix H, Nevelsteen A, Suy R. Factors Influencing Patency of Infrainguinal Bypasses with Polytetrafluoroethylene. Acta Chir Belg 2020. [DOI: 10.1080/00015458.1999.12098486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- B. Thomas
- Department of Vascular surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - H. Lacroix
- Department of Vascular surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - A. Nevelsteen
- Department of Vascular surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - R. Suy
- Department of Vascular surgery, University Hospital Gasthuisberg, Leuven, Belgium
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Ayón Guzmán A, Guzmán Delgado N, Ibáñez Rodríguez J, López Ortiz F, García Solís O, Heredia Plaza L. Aplicabilidad del sistema de puntuación PREVENT III en cirugía de derivación vascular infragenicular con injerto compuesto o sintético. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2015.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Oberhuber A, Benecke B, Orend KH, Hutschenreiter S, Muehling BM. The diabetic patient has a higher benefit from infrapopliteal revascularization than the non-diabetic patient: a 10-year retrospective study. Diab Vasc Dis Res 2013; 10:78-83. [PMID: 22505398 DOI: 10.1177/1479164112442076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objective of this article is to evaluate the limb salvage and patency rates after crural arterial revascularization, differences between graft material and co-morbidities. PATIENTS AND METHODS All patients with crural artery bypasses were analysed retrospectively in a single centre (Department of Vascular Surgery, Thüringen Kliniken Saalfeld, Rudolstadt, Germany) over a 10-year period (1996-2006); 157 patients with 170 consecutive arterial reconstructions could be included. RESULTS Follow-up time was 55 months (6-119). Median age of the 56 women and the 101 men at the time of operation was 70 years (45.6-93.6). The five-year secondary patency rates were 71.5 ± 6.22% (vein), 44.3 ± 10.8% (composite; p = 0.0011), 52.6 ± 13.4% (prosthetic graft with distal vein cuff/patch; p = 0.00953) and 42 ± 12% (prosthetic graft without distal vein cuff/patch; p = 0.00443). Limb salvage rates after five years were 79.5 ± 5.8%, 61.6 ± 10.3%, 77.9 ± 11.3% and 70.1 ± 14.7%, respectively. Cumulative limb salvage rate was significantly higher in diabetic patients (78.9 ± 4.9%), than in non-diabetic patients (66.6 ± 6.8); p = 0.023. CONCLUSION Crural reconstruction is a suitable method for peripheral arterial occlusive disease to prevent amputation, particularly in diabetics.
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Affiliation(s)
- Alexander Oberhuber
- Department of Vascular Surgery, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
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Baumann F, Engelberger RP, Makaloski V, Do DD, Baumgartner I, Diehm N. Single-center experience in endovascular treatment for infrainguinal bypass obstructions. J Vasc Interv Radiol 2012; 23:1055-62. [PMID: 22840804 DOI: 10.1016/j.jvir.2012.05.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 05/05/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To evaluate patency and clinical efficacy of endovascular therapy for infrainguinal bypass obstructions. MATERIALS AND METHODS Patients were categorized with regard to symptoms (asymptomatic/intermittent claudication [IC] vs critical limb ischemia [CLI]), bypass graft material used (autologous vs prosthetic graft), and localization of distal anastomoses (femoropopliteal vs femorodistal bypass). Primary patency was defined as absence of sonographically verified stenosis greater than 50%. Assisted primary patency was applied to secondary revisions to prevent impending occlusion. Secondary patency refers to repeat interventions aimed at restoring bypass patency after occlusion. Primary sustained clinical improvement in IC was defined as an upward shift of at least one category per Rutherford classification, accordingly to a level of claudication in patients with CLI. RESULTS A total of 54 patients (54 limbs, 12 with CLI) were included. At 1 year, primary patency rates were 74% in IC and 27% in CLI (P = .001), primary assisted patency rates were 85% in IC and 68% in CLI (P = .05), and secondary patency rates were 89% in IC and 100% in CLI (P = .32). Accordingly, primary sustained clinical improvement rates were 64% in IC and 25% in CLI (P = .018). After adjustment for confounding factors, CLI (hazard ratio [HR], 7.8; 95% CI, 2.3-26.32; P = .001) and impaired patent runoff (ie, less than three crural runoff vessels; HR, 0.16; 95% CI, 0.03-0.96; P = .045) were independently associated with impaired primary patency. CONCLUSIONS Endovascular revascularization is a reasonable treatment option to prevent impending bypass occlusion. Presence of CLI and impaired crural runoff are independent risk factors for lower patency rates.
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Affiliation(s)
- Frederic Baumann
- Department of General Internal Medicine, Inselspital, University Hospital of Bern, Freiburgstrasse, Bern, Switzerland
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Neufang A, Espinola-Klein C, Dorweiler B, Savvidis S, Schmiedt W, Vahl CF. Infrapopliteal composite bypass with autologous vein and second generation glutaraldehyde stabilized human umbilical vein (HUV) for critical lower limb ischaemia. Eur J Vasc Endovasc Surg 2007; 34:583-9. [PMID: 17574877 DOI: 10.1016/j.ejvs.2007.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Accepted: 04/11/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To audit a single center consecutive series of infrapopliteal composite bypasses with second generation glutaraldehyde stabilized human umbilical vein. DESIGN Retrospective study. PATIENTS From January 1996 to July 2006 89 femoro-distal bypasses were constructed in 85 patients with HUV and residual vein segments as composite grafts in the absence of sufficient length of autologous vein. METHODS All patients with infrainguinal bypass operations were registered prospectively. Bypasses to infrapopliteal arteries performed with HUV-composite grafts were reviewed for graft patency, limb salvage, patient survival and possible biodegeneration of the HUV. RESULTS Early graft thrombosis was noted in 21.3%, necessitating revision surgery. Primary, primary assisted and secondary patency rates were 35%, 40% and 42% respectively, with a limb salvage rate of 87% after 5 years. Graft infection occurred in 7 limbs. Aneurysmal HUV graft degeneration was not detected by duplex scanning. CONCLUSION HUV-composite bypasses provide acceptable patency and favorable limb salvage rates. Patency was similar to previous series using PTFE-composite bypasses but was significantly inferior to vein bypass. Possible biodegradation of the HUV grafts seems to be of minor clinical relevance.
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Affiliation(s)
- A Neufang
- Departments of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University School of Medicine, Mainz, Germany
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Abstract
The interventional radiologist plays an important role in the detection and prevention of infrainguinal bypass failure. Early detection and evaluation of flow-limiting lesions effectively preserve graft (venous bypass and polyester or expanded polytetrafluoroethylene bypass) patency by identifying stenoses before occlusion occurs. Delay in treatment of the at-risk graft may result in graft failure and a reduced chance of successful revascularization. For this reason, surveillance protocols form an important part of follow-up after infrainguinal bypass surgery. As well as having an understanding of the application of imaging techniques including ultrasound, MR angiography, CT angiography and digital subtraction angiography, the interventional radiologist should have detailed knowledge of the minimally invasive therapeutic options. Percutaneous transluminal angioplasty (PTA), or alternatively cutting balloon angioplasty, is the interventional treatment of choice in prevention of graft failure and occlusion. Further alternatives include metallic stent placement, fibrinolysis, and mechanical thrombectomy. Primary assisted patency rates following PTA can be up to 65% at 5 years. When the endovascular approach is unsuccessful, these therapeutic options are complemented by surgical procedures including vein patch revision, jump grafting, or placement of a new graft.
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Affiliation(s)
- S Müller-Hülsbeck
- Department of Radiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 9, 24105 Kiel, Germany.
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Albers M, Battistella VM, Romiti M, Rodrigues AAE, Pereira CAB. Meta-analysis of polytetrafluoroethylene bypass grafts to infrapopliteal arteries. J Vasc Surg 2003; 37:1263-9. [PMID: 12764274 DOI: 10.1016/s0741-5214(02)75332-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
CONTEXT Reports of polytetrafluoroethylene (PTFE) bypass grafting to the infrapopliteal arteries have often used survival analysis of acceptable quality to describe a wide range of long-term results. In theory, these results may be combined if variability between series and time intervals is considered. OBJECTIVE Meta-analysis was performed to gain insight into long-term graft patency and foot preservation after PTFE bypass grafting to infrapopliteal arteries. DATA SOURCE Studies published from 1982 through 2001 were identified from the PubMed database and pertinent original articles. STUDY SELECTION Three investigators selected 43 studies that used survival analysis, reported 2-year patency rates, and included at least 15 bypass procedures. Data extraction and transformation: Based on standard life-tables or survivor curves, an interval success rate was calculated for each month in each series. The monthly success rates were combined across series, enabling construction of pooled survivor curves. DATA SYNTHESIS Random-effects meta-analysis yielded 5-year pooled estimates (SE) of 30.5% (7.6%) for primary graft patency, 39.7% (5.5%) for secondary graft patency, and 55.7% (5.0%) for foot preservation. During the entire follow-up, pooled estimates were slightly higher for series of PTFE grafts with adjunctive procedures compared with series of PTFE grafts only. Sensitivity analysis: A simulation using only unfavorable assumptions showed a decrease of less than 5% at 5 years for all outcomes, and smaller differences at subgroup meta-analysis. Funnel plots suggested that publication bias was unlikely. CONCLUSION This meta-analysis indicated moderate success for PTFE bypass grafts to infrapopliteal arteries, but the role of adjunctive procedures at the distal anastomosis remains uncertain.
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Affiliation(s)
- Maximiano Albers
- Vascular Surgery Section, Department of Surgery, Health and Medical Sciences Sector, Lusiada University Center UNILUS, Lusiada Foundation, Santos and São Paulo, Brazil.
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Tiwari A, Cheng KS, Salacinski H, Hamilton G, Seifalian AM. Improving the patency of vascular bypass grafts: the role of suture materials and surgical techniques on reducing anastomotic compliance mismatch. Eur J Vasc Endovasc Surg 2003; 25:287-95. [PMID: 12651165 DOI: 10.1053/ejvs.2002.1810] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND compliance mismatch is an important factor in the development of myointimal hyperplasia in both coronary and vascular anastomoses. This mismatch may be reduced by the use of newer suture materials and techniques. This review discusses the current techniques and materials used to date in generating anastomoses in both coronary and vascular applications and to correlate these with the degree of inherent compliance achieved. METHODS PubMed, ISIS, CAS and PAS database searches were performed. Other articles were cross-referenced. RESULTS AND CONCLUSION continuous suture is still the most used technique in both cardiac and vascular surgery for the generation of anastomoses due to the reduced time and improved haemostasis. However, continuous suture results in a greater compliance mismatch than the interrupted technique. Vein cuffs and patches improve compliance and transmission of pulsatile blood flow and offer improvement of graft patency. Alternative to sutures are biological glue, clips and laser generated solders all of which have shown promising results, but further work is required before they become applicable for routine use.
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Affiliation(s)
- A Tiwari
- Tissue Engineering Centre, University Department of Surgery, Royal Free and University College Medical School, University College London and The Royal Free Hospital, London, UK
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Katsamouris AN, Giannoukas AD, Alamanos E, Karniadakis S, Petrakis I, Drositis I, Touloupakis E, Mouloudi E, Siatitsas I. Experience with new techniques for extraanatomic arterial reconstruction of the lower limb. Ann Vasc Surg 2000; 14:444-9. [PMID: 10990552 DOI: 10.1007/s100169910087] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aim of this report is to present our experience with new techniques for extraanatomic lower limb arterial reconstruction. Two techniques are described here of construction of an extraanatomical bypass for lower limb revascularization either through the wing of the iliac bone or underneath the iliopsoas fascia through the muscular lacuna close to the anterior superior spine of the iliac crest. Both techniques are recommended for the treatment of a severely injured groin, such as in patients with pelvic malignancy and/or an acute groin bleeding due to postirradiation femoral artery erosion or an infected femoropopliteal bypass graft with severe upper medial thigh sepsis. These techniques were used in nine patients (five with malignancy and four with an infected femoropopliteal bypass graft). Our results showed that the transosseous route through the wing of the iliac bone or underneath the iliopsoas fascia through the muscular lacuna may be considered effective alternate routes for lower limb arterial extraanatomic reconstruction when the common femoral cannot be used for arterial inflow.
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Affiliation(s)
- A N Katsamouris
- Division of Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Crete, Greece
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Lemson MS, Tordoir JH, Daemen MJ, Kitslaar PJ. Intimal hyperplasia in vascular grafts. Eur J Vasc Endovasc Surg 2000; 19:336-50. [PMID: 10801366 DOI: 10.1053/ejvs.1999.1040] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M S Lemson
- Department of Surgery, University Hospital Maastricht, The Netherlands
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Karacagil S, Thelin S, Nilsson L, Ahlström H, Bergqvist D. A long distal prosthetic bypass grafting from descending aorta to distal peroneal artery. Sometimes it works! Eur J Vasc Endovasc Surg 2000; 19:92-3. [PMID: 10706845 DOI: 10.1053/ejvs.1999.0973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Karacagil
- Department of Surgery, University Hospital, Uppsala, Sweden
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