Straight configuration saphenous vein transposition to popliteal artery for vascular access

2017 ◽  
Vol 18 (2) ◽  
pp. e15-e17 ◽  
Author(s):  
Gentian Caco ◽  
Dhurata Golemi ◽  
Eriola Likaj
Keyword(s):  
Upper Extremity ◽  
Vascular Access ◽  
Saphenous Vein ◽  
Popliteal Artery ◽  
Lower Limb ◽  
Vascular Graft ◽  
Arteriovenous Graft ◽  
Early Complications ◽  
Peripheral Artery

Introduction The saphenous vein is commonly used as a vascular graft in peripheral artery surgery but rarely used for vascular access. The literature on straight configuration saphenous vein transposition to the popliteal artery is scarce. Here we present two cases of straight configuration saphenous vein transposition to the popliteal artery for vascular access, the surgical technique and respective follow-up. Case report Two young men, aged 29 and 36 years, were chosen for lower-limb vascular access for hemodialysis. The first patient was paraplegic since birth. He used his arms to move so upper extremity vascular access was avoided. The second patient presented with an infected upper extremity arteriovenous graft (AVG) and after multiple closed AVFs he had no more available arm veins. Both patients received autologous lower extremity straight configuration saphenous vein transpositions to the popliteal artery under spinal anesthesia in May and October 2012, respectively. Cannulation of the fistula was allowed after one month. There were no early complications. Slight swelling on the leg appeared in one of the patients. Both fistulas were still functional after 36 and 32 months, respectively. Conclusions The straight configuration saphenous vein transposition to popliteal artery is simple to perform, offers a long and straight segment for cannulation and may be a suitable autologous vascular access in selected patients.

Evaluation of heparin-bonded ePTFE grafts for forearm loop vascular access: Comparison between Gore® PROPATEN vascular graft and ACUSEAL vascular graft

2021 ◽  
pp. 112972982199852
Author(s):  
Takeshi Baba ◽  
Takao Ohki ◽  
Koji Maeda ◽  
Eisaku Ito ◽  
Masamichi Momose ◽  
...  
Keyword(s):  
Vascular Access ◽  
Vascular Graft ◽  
Primary Patency ◽  
Secondary Patency ◽  
Arteriovenous Graft ◽  
Primary Endpoints ◽  
Secondary Endpoints ◽  
Group A ◽  
Different Characteristics

Background: This retrospective study evaluates the clinical outcomes of two heparin-bonded expanded polytetrafluoroethylene grafts, PROPATEN and ACUSEAL (W. L. Gore & Associates, Flagstaff, AZ, USA), for forearm loop vascular access. Methods: We prospectively collected data on 60 patients who had undergone arteriovenous graft of the forearm loop type between January 2015 and December 2019. The primary endpoints were graft primary, assisted primary, and secondary patency rates. Secondary endpoints were time to first cannulation and postoperative complications. Results: We enrolled 36 patients in the PROPATEN group (Group P) and 24 in the ACUSEAL group (Group A). All procedures were successful without any 30-day mortality. The median times to first cannulation were 16.5 days and 3 days in Groups P and A, respectively ( p < 0.001). Mean follow-up periods were 13.4 ± 14.5 and 17.3 ± 9.3 months, respectively. Primary patency rates were 81% and 64%, respectively, at 6 months, and 60% and 40%, respectively, at 12 months ( p = 0.008). Assisted primary patency rates were 96% and 83% at 6 months, 91% and 73% at 12 months, and 81% and 35% at 24 months ( p = 0.044). Secondary patency rates were 96% and 81% at 12 months, and 87% and 62% at 24 months ( p = 0.207). As a remote-period complication, disruption of the luminal layer of the graft was observed in two patients (4.2%) in Group A due to puncture and thrombectomy. Conclusions: Although the ACUSEAL graft offers the advantage of early cannulation, its primary and assisted primary patency outcomes were inferior to those of the PROPATEN graft. It is important for physicians to be aware of the different characteristics of each graft to select the best option for each patient.

scholarly journals Comprehensive Comparison of the Performance of Autogenous Brachial-Basilic Transposition Arteriovenous Fistula and Prosthetic Forearm Loop Arteriovenous Graft in a Multiethnic Asian Hemodialysis Population

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Koy Min Chue ◽  
Kyi Zin Thant ◽  
Hai Dong Luo ◽  
Yu Hang Rodney Soh ◽  
Pei Ho
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Secondary Patency ◽  
Arteriovenous Graft ◽  
Central Venous ◽  
Maturation Time ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Comprehensive Comparison

Aim.For patients who have exhausted cephalic vein arteriovenous fistula (AVF) options, controversy exists on whether brachial-basilic AVF with transposition (BBTAVF) or a forearm arteriovenous graft (AVG) should be the next vascular access of choice. This study compared the outcomes of these two modalities.Methods.A retrospective study of 122 Asian multiethnic patients who underwent either a BBTAVF (81) or an AVG (41). Maturation time and intervention rates were analyzed. Functional primary, secondary, and overall patency rates were evaluated.Results.The maturation time for BBTAVFs was significantly longer than AVGs. There was also a longer deliberation time before surgeons abandon a failing BBTAVF compared to an AVG. Both functional primary and secondary patency rates were significantly higher in the BBTAVF group at 1-year follow-up: 73.2% versus 34.1% (p<0.001) and 71.8% versus 54.3% (p=0.022), respectively. AVGs also required more interventions to maintain patency. When maturation rates were considered, the overall patency of AVGs was initially superior in the first 25 weeks after creation and then became inferior afterwards.Conclusion.BBTAVFs had superior primary and functional patency and required less salvage interventions. The forearm AVG might have a role in patients who require early vascular access due to complications from central venous catheters or with limited life expectancy.

Using a Glidewire Cheater and Flow Switch to Temporarily Secure Purse-String Sutures

2018 ◽  
Author(s):  
Adam N. Plotnik ◽  
Stephen Kee
Keyword(s):  
Vascular Access ◽  
Extended Period ◽  
Arteriovenous Graft ◽  
Manual Compression ◽  
Purse String ◽  
Angiography Suite ◽  
Flow Switch

Following completion of an arteriovenous graft or fistula intervention, various methods exist by which an interventionalist may achieve hemostasis. Manual compression is the simplest technique but often requires an extended period of time. Many interventionalists will place purse-string sutures at the site of vascular access to achieve hemostasis, with the sutures left in place when the patient leaves the angiography suite. Consequently, these sutures may stay in for an extended period of time and even be present at follow-up interventions many months later or, worse, may get infected. The glidewire cheater and flow switch technique is a method by which hemostasis can be achieved, and it obviates the need for the sutures to be left in place after the patient leaves the angiography suite.

scholarly journals Results of in situ femoropopliteal (tibial) bypass in patients with extended lower limbs arterial bed lesion and critical ischemia

2015 ◽  
Vol 96 (6) ◽  
pp. 942-949 ◽  
Author(s):  
N V Krepkogorskiy ◽  
D G Bulatov
Keyword(s):  
Quality Control ◽  
Saphenous Vein ◽  
Lower Limb ◽  
Great Saphenous Vein ◽  
Limb Ischemia ◽  
Critical Ischemia ◽  
Shunt Thrombosis ◽  
Bypass Patency

Aim. To specify the indications for in situ femoropopliteal (tibial) bypass, to study complications rate immediately after, within 1 and 2 years of the surgery. Methods. The study group included 33 patients with symptoms of critical lower limb ischemia, who underwent femoral-popliteal or femoral-tibial bypass. 4 (12.1%) cases of type C and 29 (87.9%) cases of type D arterial bed lesions according to TASC II classification were revealed after investigation. Patients were followed up for 2 years period. Shunt thrombosis rate, condition of the trophic ulcers, chronic arterial ischemia stage before and after the surgery, mortality, lower limb amputation were measured outcomes. Results. Repeated reconstructions rate for primary shunt thrombosis immediately after surgery was 30.3±8.0%. Shunt thrombosis (secondary) occurred in only three (9.1±5.0%) patients. The main causes which led to the shunt thrombosis during or at the 1st day after the surgery, were absence of intraoperative valvulotomy quality control and presence of unligated great saphenous vein tributaries. Trophic defects healing was observed in 3 (30.0±14.5%) of 10 patients with ulcers immediately after surgery and in all cases (100.0%) by the end of 1 year follow-up. The total number of high-level amputations within 2 years was 25.8±7.9%, the overall mortality rate within 2 years was 6.1±4.2%. Femoral-popliteal or femoral-tibial bypass surgery allowed to preserve the limb in 74.2% of patients within 2 years of follow-up. Bypass patency was preserved in 41.7% of patients out of 24 in situ bypass surgeries for the follow-up time. In our opinion critical limb ischemia with significant and extended arterial bed lesions of D and C types (according to TASC II score) is one of the indications for in situ femoropopliteal (tibial) bypass as for the surgery of the first choice. Endovascular treatment is also impossible for this type of lesion, as alternative surgeries using reversed autovein and synthetic explant do not meet all the requirements for an extended bypass. Conclusion. The lack of adequate intraoperative valvulotomy quality control and presence of unligated great saphenous vein tributaries may be the causes of early postoperative shunt thrombosis; despite the low femoropopliteal (tibial) bypass patency rate in patients with critical ischemia, the surgery was recognized as efficient as it allowed to preserve the limbs in 74.2% of patients.

scholarly journals Surgical Revascularization of Lower Limb for Chronic Occlusive Arterial Diseases - Outcome of 35 Patients

1970 ◽  
Vol 6 (2) ◽  
pp. 82-85
Author(s):  
Rezwanul Hoque ◽  
Md Aslam Hossain ◽  
Sabrina Sharmeen Husain ◽  
Mahmudur Rahman Khandoker ◽  
Mostafa Nuruzzaman ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Patency Rate ◽  
Clinical Success ◽  
Limb Ischemia ◽  
Rest Pain ◽  
Surgical Revascularization ◽  
Lower Limb Ischemia ◽  
Good Patency

Background: Chronic lower limb ischemia is a dreadful disease and may present with intermittent claudication, rest pain and ischemic gangrene. Apart from life style modification and treating risk factors either angioplasty and stenting or surgical bypass are the mainstay of treatment. For infrainguinal bypasses reversed saphenous venous grafts are the conduits of choice because it is autologous , and have good patency rate. Endarterectomy is used in vessels of large caliber and may be added to bypass procedure.Objective: To study the outcome of surgical revascularization of the lower limb for chronic ischemia using reversed saphenous venous grafts.Methods: Thirty five cases of lower limb bypass surgery using reversed saphenous vein grafts were done for critical chronic lower limb ischemia from January, 2004 to December, 2008 and were analyzed for clinical success. The clinical success was defined as freedom from symptoms, avoidance of further revascularization, surgical or interventional or freedom from further amputation. The bypass procedures were femoro-popliteal, femoro-distal, femoral endarterectomy plus bypass, profundoplasty plus bypass. Data were collected, analyzed and results were recorded before discharge from the hospital, at 3 months, at 6 months and thereafter yearly follow up for up to 3 years.Results: The age range was 55 to 72 years (mean 62.34± 05.98 SD), 30 cases were male, 5 cases were female, all male patients were chronic smokers, 28 cases were diabetic, and 26 cases were hypertensive. Altogether 48 procedures were done, femoro-popliteal bypass were done in 30 cases, femoro-distal bypass were done in 7 cases (distal anastomotic sites were anterior tibial, posterior tibial or arteria dorsalis pedis), 9 cases had common femoral endarterectomy after which femoro-popliteal bypass were done, profundoplasty with femoro-popliteal bypass were done in 2 cases, 10 patient had to undergo either toe or transmetatarsal amputation. Three cases were subjected to below knee amputation at 2 to 3 years follow up due to recurrent ischemic rest pain with patchy gangrene. These were patients with femoral endarterectomy cases. The patency rate of grafts at 3 years was 65% for femoro-popliteal, 60% for femoro-distal, 57% for femoral endarterectomy with bypass and 58% for profundoplasty with bypass procedure.Conclusion: The graft patency rate and limb salvage rate for infrainguinal bypass procedure using reversed saphenous vein graft were quite satisfactory. Cessation of smoking, anti platelet and lipid lowering drug therapy, daily brisk walking for one hour and lifestyle modification improved the claudication distance and saved the limb and life in the study population. DOI: 10.3329/uhj.v6i2.7251University Heart Journal Vol. 6, No. 2, July 2010 pp.82-85

scholarly journals A randomized pilot study to evaluate graft versus fistula vascular access strategy in older patients with advanced kidney disease: results of a feasibility study 

2020 ◽  
Author(s):  
Mariana Murea ◽  
Randolph L Geary ◽  
Denise K Houston ◽  
Matthew S Edwards ◽  
Todd W Robinson ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Arteriovenous Graft ◽  
End Stage Kidney Disease ◽  
Arteriovenous Access ◽  
End Stage

Abstract Background. Although older adults encompass almost half of patients with advanced chronic kidney disease, it remains unclear which long-term hemodialysis vascular access type, arteriovenous fistula or arteriovenous graft, is optimal with respect to effectiveness and patient satisfaction. Clinical outcomes based on the initial AV access type have not been evaluated in randomized controlled trials. This pilot study tested the feasibility of randomizing older adults with advanced kidney disease to initial arteriovenous fistula versus graft vascular access surgery.Methods: Patients 65 years or older with pre-dialysis chronic kidney disease or incident end-stage kidney disease and no prior arteriovenous vascular access intervention were randomized in a 1:1 ratio to undergo surgical placement of a fistula or a graft after providing informed consent. Trial feasibility was evaluated as (i) recruitment of ≥70% of eligible participants, (ii) ≥50% to 70% of participants undergo placement of index arteriovenous access within 90 to 180 days of enrollment, respectively, (iii) ≥80% adherence to study-related assessments, and (iv) ≥70% of participants who underwent index arteriovenous access placement will have a follow-up duration of ≥12 months after index surgery date.Results: Between September 2018 and October 2019, 81% (44/54) of eligible participants consented and were enrolled in the study; 11 had pre-dialysis chronic kidney disease and 33 had incident or prevalent end-stage kidney disease. After randomization, 100% (21/21) assigned to arteriovenous fistula surgery and 78% (18/23) assigned to arteriovenous graft surgery underwent index arteriovenous access placement within a median (1st, 3rd quartile) of 5.0 (1.0, 14.0) days and 13.0 (5.0, 44.3) days, respectively, after referral to vascular surgery. The completion rates for study-specific assessments ranged between 40.0 and 88.6%. At median follow-up of 215.0 days, 5 participants expired, 7 completed 12 months of follow-up, and 29 are actively being followed. Assessments of grip strength, functional independence and vascular access satisfaction were completed by >85% of patients who reached pre-specified post-operative assessment time point.Conclusions: Results from this study reveal it is feasible to enroll and randomize older adults with advanced kidney disease to one of two different arteriovenous vascular access placement surgeries. The study can progress with minor protocol adjustments to a multisite clinical trial.Trial registration: Clinical Trials ID: NCT03545113. Registered June 4, 2018.

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