Lower extremity arterial revascularization using conditioned small-diameter great saphenous vein (original) (raw)
Related papers
Journal of International Medical Research
Objectives External valvuloplasty (eVP) is a reconstructive surgical method to repair the function of the terminal and preterminal valves. We evaluated the 6-month outcomes of eVP regarding the diameter of the great saphenous vein (GSV). Methods Patients from five vein centres were included in this observational study. Follow-up involved detailed duplex sonography of the GSV. The venous clinical severity score (VCSS) and the C class of the clinical, aetiologic, anatomic and pathophysiologic (CEAP) classification were recorded. Results We enrolled 210 patients, with a follow-up rate of 58%; eVP was sufficient in 95.24% of the patients. The GSV diameters decreased significantly from 4.4 mm (standard deviation (SD): 1.39) to 3.9 (SD: 1.12), 4 cm distal to the saphenofemoral junction (SFJ); from 3.7 mm (SD: 1.10) to 3.5 mm (SD: 1.02) at the mid-thigh; from 3.6 mm (SD: 1.14) to 3.3 mm (SD: 0.94) at the knee and from 3.1 mm (SD: 0.99) to 2.9 mm (SD: 0.78) at the mid-calf. VCSS decreased s...
In Situ Saphenous Vein Bypass: Prevention and Management of Early Complications
ANZ Journal of Surgery, 1988
Since adopting the in siru, non-reversed saphenous vein technique for bypass procedures in the leg early in 1986, SO bypasses have been performed in selected patients, primarily for limb salvage. A Mills valvulotome was used for retrograde disruption of the saphenous valves, after exposure of the whole length of vein. Significant peri-operative complications occurred in nine patients and were strongly associated with technical factors. Early graft occlusion (n = 2) and residual arteriovenous fistulae (n = 2) were revised by timely reoperation, resulting in early (30 day) patency of all but one graft. In seven patients, angioscopic visualization of the valve division process was tested as a method of ensuring complete valvulotomy, while avoiding trauma to the vein wall. Distal anastomosis to the popliteal artery above the knee or close below the knee caused a considerable degree of graft angulation, which was exacerbated by flexion of the leg, whereas anastomosis to the more distal popliteal artery or tibia1 vessels resulted in a favourable curvature of the graft. Lessons learned during this initial experience and aspects of technique for prevention of complications are presented.
Vasa
Summary: Background: Varicosis of the great saphenous vein (GSV) is a common disease. Most of the therapeutic concepts attempt to remove or destroy the truncal vein. However, the absence of the GSV could be harmful for further treatments of artherosclerotic disease as the GSV is often used as bypass graft in lower extremity or coronary artery revascularisations. External valvuloplasty (EV) is one of the vein-sparing treatment options. The aim of this clinical study was to describe the outcome, safety and complications of this procedure in a prospective multicentre trial. Patients and methods: The function of the terminal and preterminal valve was restored by external valvuloplasty. Furthermore, multiple phlebectomies of tributaries were performed. Patients were reinvestigated six weeks after surgery. Primary endpoint was the function of the external valvuloplasty measured by diameter of the GSV and the prevalence of reflux in the GSV. The eligibility of the vein as a potential bypas...
Journal of Vascular Surgery, 2013
Objective: Lower extremity computed tomography angiography (CTA) is frequently used for anatomic assessment of lower extremity peripheral arterial disease. When lower extremity bypass is planned, duplex ultrasound (DUS) is routinely obtained to evaluate the great saphenous vein (GSV) for use as conduit. Although GSV can be visualized on CTA images, diameter assessment is not routinely included in formal study interpretation. We hypothesized that CTA images could be used to measure GSV diameters and that CTA-based diameters would correlate with measurements obtained using DUS. Methods: Consecutive patients undergoing lower extremity arterial bypass who were evaluated preoperatively with both CTA and DUS vein mapping were identified at a single hospital. Minimum above-and below-knee GSV diameters were measured from electronically archived CTA images by two independent observers. CTAs were performed using standard arterial phase protocol without additional venous phase imaging. Between-observer reproducibility of CTA-based diameter measurements was evaluated using intraclass correlation coefficients. Correlation between CTA and DUS-based GSV diameters was evaluated with Spearman correlation coefficients. CTA diameter cut-points for identification of adequate GSV bypass conduit, defined as DUS-based minimum GSV diameter > 3 mm, were determined using receiver-operating characteristic curves. , and mean below-knee diameter was 2.6 ؎ 0.1 mm (range, 1.3-4.0 mm). When GSV was visible and exceeded the minimum diameter threshold for CTA measurement, correlation between CTA-and DUS-based diameters was both positive and highly significant ( ؍ 0.595; P < .0001). CTA-based diameters also had excellent reliability between observers (r [95% CI]: 0.88 [0.85-0.91]). For identification of adequate bypass conduit using CTA, above-knee GSV diameter > 3.9 mm was 67% sensitive and 73% specific; below-knee GSV diameter >3.0 mm was 75% sensitive and 84% specific. Conclusions: CTA-based GSV diameter measurements have good reproducibility and highly significant correlation with DUS-based diameters. CTA-based GSV diameter is a specific but relatively insensitive indicator of adequate bypass conduit. When CTA-based diameters indicate inadequate GSV bypass conduit, confirmatory DUS vein mapping is warranted. Confirmatory DUS vein mapping may be unnecessary when adequate vein diameter is identified on CTA. ( J Vasc Surg 2013;57:50-5.)
Vascular surgery
Previous research has suggested that arterial aneurysm might result from a systemic tendency to dilatation. This systemic effect would involve both arterial and venous dilatation. The authors investigated whether venous grafts implanted to bypass popliteal artery aneurysms (PAA) had larger diameters than those implanted to treat peripheral arterial occlusive disease (PAOD). They compared representative diameters of 20 vein grafts implanted for PAA with matched bypass grafts implanted for PAOD. Graft diameters were obtained by means of CVI-Q M-mode ultrasound imaging. Each PAA patient/graft was matched to an equivalent PAOD patient/graft based on the patient's gender and age and the vein graft type and distal anastomosis. Secondarily, graft proximal anastomosis was matched in 60% (12/20) of the cases. Age was matched if the difference was < or = 4 years. Average age at the time of surgery was 68 +/-12 years for PAA and 68 +/-13 for PAOD groups. There were 11 reversed greater s...
The great saphenous vein (GSV) often presents partial hypoplasty. The present study elucidates the frequency of hypoplasty and the positional tendency with which GSVs present hypoplasty. GSVs taken from 41 lower limbs of embalmed cadavers were divided into four types according to the positions of their hypoplastic parts. They are, Type 1: GSVs that don’t present hypoplasty; Type 2a: GSVs in which hypoplasty is located in the upper thigh; Type 2b: GSVs in which hypoplasty is located in the lower thigh; Type 2c: GSVs in which hypoplasty extends to both the upper thigh and lower thigh. The numbers of the specimens of these anatomical types were counted. For types presenting with partial hypoplasty, length of the hypoplastic parts and the distances between the hypoplastic parts and the knee were evaluated. The anatomical types occurred in descending frequency as follows: Type 2b (65.8%), Type 1 (24.3%), Type 2a (7.3%), and Type 2c (2.4%). The average length of hypoplastic parts was 10±3.3SD cm for Type 2b and 5.8±2.3SD cm for Type 2a. The average distance of the hypoplastic parts from the knee was 10.0±5.2SD cm for Type 2b and 10.5±6.5SD cm for Type 2a. A majority (75.6%) of GSVs present partial hypoplasty. For successful performance of bypass surgery for critically ischemic limbs, care should be taken not to include hypoplastic parts in conduits. The findings of the present study are useful to avoid hypoplastic parts when creating bypass conduits.
Journal of Vascular Surgery, 2002
Purpose: The purposes of this study were to evaluate the long-term results of different autogenous conduits used for infrainguinal bypass when ipsilateral greater saphenous vein (IGSV) is absent or inadequate and to determine the impact on the contralateral lower extremity. Methods: The study was performed as a retrospective evaluation of a prospective vascular registry together with review of patient records and telephone follow-up. Results: From January 1990 to June 2000, 226 autogenous infrainguinal reconstructions were performed in 203 patients without adequate IGSV. The patients consisted of 128 men and 98 women, with a mean age of 69 years. Prevalent risk factors included diabetes (51%) and prior coronary bypass (46%). Limb salvage was the predominant indication (93%), and 59% of the procedures were secondary reconstructions. All bypasses were completed with autogenous vein, which included contralateral greater saphenous vein (CGSV; 31%), single-segment lesser saphenous vein (5%), single-segment arm vein (19%), and autogenous composite vein (45%). Bypasses were performed to the tibial and pedal arteries in 84% of the cases. The 30-day mortality and graft occlusion rates were 1% and 9%, respectively. The overall postoperative morbidity rate was 24%, with a 7% rate of major complications. Follow-up was complete in 95% of patients over a mean period of 24 months (range, 0.1 to 106 months). The 5-year primary patency rates were significantly better for CGSV compared with autogenous composite vein grafts (61% ؎ 7% versus 39% ؎ 6%; P < .009). The 5-year secondary patency (60% to 73%) and limb salvage (78% to 81%) rates did not differ significantly between the three groups. Follow-up of the contralateral lower limb revealed that nine of 226 limbs (4%) were amputated at a mean of 36 months after the ipsilateral bypass. The overall 5-year contralateral limb preservation rate was 90% ؎ 3%. Contralateral vein harvest and the presence of diabetes did not affect the need for bypass or amputation of the contralateral limb. Conclusion: For most patients with inadequate IGSV, the CGSV is the alternative conduit of choice because of its length, superior performance, ease of harvest, and minimal risk to the donor limb. (J Vasc Surg 2002;35:1085-92.) From the Division of Vascular Surgery, Brigham and Women's Hospital, Harvard Medical School. Competition of interest: nil.
University Heart Journal, 2011
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 intervent...
Il Giornale di chirurgia
Aim of this paper is to evaluate the safety and the patency rate of the infrapopliteal bypass grafts performed with the great saphenous vein (GSV) with small (<2.5 mm) or large calibre (>5 mm). Between January 2003 and May 2007, 73 infra-genicular bypass with autologous saphenous vein were performed in patients affected by atherosclerotic femoropopliteal disease. In 8 cases a bypass grafts with small saphenous vein (diameter 2.2-2.5 mm) were performed, in 4 cases a bypass with segmental varicose saphenous vein (diameter 5.7-6.4 mm ) were carried out. In 64 cases the bypass was carried out with the reversed technique, in 9 cases with the in situ technique. Thirty day mortality was 3/82 (3.6%) and 30 day cumulative patency rate was 95.1% (78/82) with limb salvage of 96.3% (79/82). All the patients with small diameter vein showed a normal patency at the follow-up and at the duplex scan examination no complications occurred. The mean calibre of the arterialized vein increased to 2...
Infrainguinal arterial reconstruction with nonreversed greater saphenous vein
Journal of Vascular Surgery, 1996
This study was undertaken to examine the effectiveness and the possible advantages of infrainguinal arterial reconstruction with nonreversed greater saphenous vein (NRGSV) grafts. We reviewed the results achieved with 189 consecutive NRGSV bypass procedures from July 1, 1985, to August 31, 1995, and compared them with 568 consecutive in situ greater saphenous vein (INGSV) bypass procedures completed over the same interval. NRGSV bypass procedures were performed by selecting the optimum inflow and outflow vessels and then excising the best available appropriate-length segment of greater saphenous vein. The valves were lysed with a Mills valvulotome using gentle antegrade distention with an isotonic electrolyte solution containing heparin (1000 U/500 ml) and papaverine (60 mg/500 ml). The graft was then translocated to the inflow site, where the proximal and distal anastomoses were sequentially completed, followed by a completion arteriography. Demographic and risk factor characteristics did not differ between patients who underwent NRGSV and those who underwent INGSV bypass. Compared with INGSV bypasses, NRGSV bypasses were more commonly secondary procedures (26% vs 8%; p &amp;lt; 0.001) and were more often performed for limb salvage indications (89% vs 68%; p &amp;lt; 0.001). NRGSV bypasses also had more distal inflow vessels (23% superficial femoral artery [SFA] and 28% popliteal artery [POP] vs 10% SFA and 1% POP; p &amp;lt; 0.001) and more distal outflow vessels (52% tibial and 22% pedal artery vs 47% tibial and 3% pedal artery; p &amp;lt; 0.001) than did INGSV bypasses. Despite the higher incidence of secondary bypass procedures and more distal outflow vessels in the NRGSV group, the overall results achieved at 5 years did not differ between the two groups. The 5-year primary patency rates were 65% +/- 5% for NRGSV and 72% +/- 3% for INGSV (p &amp;lt; 0.12), and the 5-year secondary patency rates were 74% +/- 5% and 82% +/- 2% (p &amp;lt; 0.08), respectively. Similarly, the 5-year limb salvage rate among bypass procedures performed for limb salvage indications did not differ for NRGSV (82% +/- 5%) and INGSV (90% +/- 2%; p &amp;lt; 0.06). The application of the NRGSV bypass graft preserves the INGSV&amp;#39;s main advantage of optimal size match between artery and vein at each anastomosis, but facilitaties the tailoring of the procedure to the patients anatomy and the completion of the bypass with the shortest, best-quality conduit available. Our application of the NRGSV in a more challenging series of bypass procedures produced equivalent results to those achieved in a concurrent series of INGSV bypass procedures.