Autogenous Saphenous Vein Bypass Research Articles

Simulation of Anastomosis in Coronary Artery Bypass Surgery.

Developing cardiac surgical skills and experience takes years of practice. Cardiac trainees need to develop technical proficiency in order to enhance quality of care and patient safety. Simulation-based models are common resources for teaching procedural skills in both undergraduate and postgraduate medical education. Suitable and accessible educational platforms can play a progressively important role in the training process for young surgeons in the area of cardiac surgery. Coronary artery bypass graft (CABG) surgery consists of a wide range of pathologic anatomies and surgical techniques. In this paper we introduce a novel, synthetic, biomimetic platform that allows for the realistic practice of the CABG surgery. The prototype uses a polyvinyl alcohol hydrogel which has been designed to mimic the geometric properties of vasculature. The proposed models look and feel like human tissue and possess somewhat consistent mechanical properties. In this study, we apply the platform to simulate a case of autogenous saphenous vein bypass grafting of a patient. An autogenous saphenous vein graft is placed from the aorta to the left anterior descending coronary artery. The standard procedures of the coronary artery bypass surgery were successfully simulated. Using the proposed technology, other complicated surgeries such as end to end, side to end, and sequential anastomoses can be simulated such that these models lend themselves very well to various types of anastomoses.

Recanalization of Failed Autogenous Conduit Utilizing Laser Revascularization

The traditional approach for the treatment of restenosis of autogenous vein bypass has been revision of bypass with vein patch angioplasty, interposition jump graft, or thrombectomy procedures for those patients with extensive occlusive disease and limb-threatening ischemia. Endovascular intervention traditionally involves angioplasty of the graft; however, vessels with diffuse disease or extensive longitudinal lesions are generally difficult to revascularize utilizing this technique. Surgical revision of a threatened autogenous vein graft may carry a morbidity rate as high as 13.6%. We present a series of cases in which excimer laser atherectomy (LA) was used to recanalize an occluded autogenous saphenous vein bypass. Of the occluded vein bypasses failed angioplasty and were successfully atherectomized with LA measuring lengths of 35 and 30 cm, respectively. The infrainguinal has a 6-month follow-up, while the infragencular has a follow-up of 1 year, with resolution of presenting symptoms.

Repair of ventricle free wall rupture after acute myocardial infarction: a case report

IntroductionAcute myocardial infarction (AMI) may culminate in sudden death by ventricular fibrillation, cardiogenic shock, and cardiac rupture. We present a case of postinfarction rupture treated by direct closure and coronary artery bypass grafting after thrombolytic therapy.Case reportA 67-year-old woman with cardiac risk factors of hypertension, diabetes mellitus, and being post-menopausal was admitted complaining of chest pain and sweating. Thrombolytic therapy with streptokinase was started due to acute myocardial infarction. But, reperfusion criteria were not achieved. Echocardiography revealed a moderate pericardial effusion with mild right chamber collapse and pericardial thrombus. Cardiac catheterization revealed totally occluded left anterior descending (LAD) and circumflex coronary arteries. She was taken to the operating-room immediately. The pericardium was opened and a large amount of blood with thrombus was removed. Her hemodynamic indices improved immediately. There was active bleeding from multiple sites with a 4 mm rupture. Cardiopulmonary bypass was established. Direct closure of rupture was carried out. Reversed autogenous saphenous vein bypass grafts were placed to the LAD and second obtuse margin coronary arteries. Postoperative recovery was uneventful and she was discharged from hospital in good condition. She remained asymptomatic during first year following the surgery.ConclusionThis case demonstrates that left ventricular free wall rupture is not always fatal and that early diagnosis and emergency surgical therapy may be successful. The combination of surgical repair with revascularization should be considered, because 80% of patients who experience LVFWR have multivessel coronary artery disease.

Evolution of Surgical Treatment of Coronary Artery Occlusive Disease

A 42-year-old man had extensive occlusive disease of the coronary artery and angina pectoris. An autogenous saphenous vein bypass from the ascending aorta to the anterior descending coronary artery was performed on Nov 23, 1964. The patient suffered an asymptomatic anterior myocardial infarction during operation but made an uncomplicated recovery. Seven years after the operation, the graft functions with normal left ventricular hemodynamics, while the occlusive process has produced obstruction of the left main coronary artery and almost complete occlusion of the right coronary artery. To our knowledge, this is the first successful case of a saphenous vein-coronary artery bypass with the longest follow-up of a functioning coronary vein bypass graft. See PDF for full text of the original JAMA article .

Aortocoronary bypass with saphenous vein graft. Seven-year follow-up. 1973.

A 42-year-old man had extensive occlusive disease of the coronary artery and angina pectoris. An autogenous saphenous vein bypass from the ascending aorta to the anterior descending coronary artery was performed on Nov 23, 1964. The patient suffered an asymptomatic anterior myocardial infarction during operation but made an uncomplicated recovery. Seven years after the operation, the graft functions with normal left ventricular hemodynamics, while the occlusive process has produced obstruction of the left main coronary artery and almost complete occlusion of the right coronary artery. To our knowledge, this is the first successful case of a saphenous vein-coronary artery bypass with the longest follow-up of a functioning coronary vein bypass graft.

Current techniques for infrainguinal arterial reconstruction

Infrainguinal reconstruction for peripheral vascular occlusive disease comprises an increasingly complex array of interventions which provide unparalleled options for the salvage of threatened limbs. Conventional autogenous saphenous vein bypass remains the most durable revascularization with anticipated graft patency rates approaching 80 percent after five years and excellent long term limb salvage. These excellent results are equally applicable to vein grafts carried to infrapopliteal and even inframalleolar levels, possibly reflecting increased utilization of the in situ method. Although 20 per cent of grafts fail within five years, secondary intervention results in sustained limb salvage in the majority of patients. In the absence of autogenous vein, however, prosthetic material performs poorly such that new interventions consisting of percutaneous transluminal angioplasty, rotary atherectomy devices and laser systems are under aggressive development. Although initial results with these devices are encouraging, long term patency rates remain poor largely due to restenosis. Further progress seems to depend primarily on an increased understanding of the natural healing response of the injured artery.

SURGICAL MANAGEMENT OF ARTERIOSCLEROTIC BILATERAL FEMORAL AND RIGHT POPLITEAL ANEURYSMS

Multiple peripheral arterial aneurysms have been considered a relatively rare disease. A case is reported of a 70-year old man whose chief complaint was spontaneous pain in the right calf. Preoperative diagnosis by angiography and echography suggested bilateral common femoral and right popliteal aneurysms.The bilateral common femoral arterial aneurysms were treated by excision and Cooley double velour prosthetic interposition for resected aneurysms. In addition, the right popliteal arterial aneurysm was treated by the use of autogenous saphenous vein bypass grafting from above the aneurysm to below, with ligation of the aneurysm to prevent further embolization. Pathological examination indicated atherosclerotic aneurysm. The patient has been well for more than four years after surgery.Elective surgery is considered appropriate in the management of multiple peripheral arterial aneurysms when the surgical risk is reasonable, because of the high morbidity associated with femoral and popliteal arterial aneurysms.

Management of Pediatric Visceral Arterial and Aortic Coarctation

Two unusual pediatric vascular problems have been managed surgically. The first patient is a five-and-a half-year old girl who presented with renal artery stenosis and aneurysm and renovascular hypertension. This was treated by excision of the aneurysm and reimplantation of the right renal artery. The second patient is a two-year old girl with atresia of the abdominal aorta, superior mesenteric artery (SMA) and both renal arteries. She was treated by PTFE patch graft angioplasty of the aorta, SMA reimplantation and bilateral aorto-renal autogenous saphenous vein bypass.

Postoperative Pseudomonas urinary tract infections as a source of bacterial contamination of an autogenous vein graft

The infection of autogenous vascular grafts from blood-borne contaminants is distinctly unusual. Two cases are reported in which a urinary tract infection caused by Pseudomonas aeruginosa occurred after autogenous saphenous vein bypass grafting. Despite appropriate intravenous antibiotic therapy for 10 days with clearing of both blood and urine, the patients subsequently had significant complications from graft infections. The factors thought to have contributed to this are discussed and the literature reviewed. Recommendations are made concerning the modification of the standard therapy in this situation.

B-10 非逆転遊離自家静脈バイパスグラフトの長期遠隔成績と問題点について

B-10 非逆転遊離自家静脈バイパスグラフトの長期遠隔成績と問題点について

Preservation of the ischemic leg by distal vascular bypass.

Autogenous saphenous vein bypass grafts to tibial or personeal vessels have resulted in successful, long-term limb preservation in appropriately selected patients. This success appears to justify an aggressive approach to what has previously been considered end-stage" distal vascular occlusive disease. This report describes the clinical management and long-term follow-up of 41 patients with tibial artery reconstruction.

Tibial and Peroneal Bypass in Severe Occlusive Disease of the Lower Extremities

Symptomatic arteriosclerotic occlusive disease involving the femoral and proximal popliteal arteries is currently best treated by reversed autogenous saphenous vein bypass graft. Severe occlusive disease frequently includes the popliteal and/or origin of the trifurcation vessels with reconstitution of one or more of the vessels in the lower leg. We have used distal bypass 97 times in 90 patients during the past decade. There was only one postoperative death in the series in spite of the advanced age and concurrent disease in the majority of the patients. Our indications for operation continue to be relief of pain or salvage of an extremity. We rely on high quality preoperative angiograms for selection of vessels to receive the bypass. The posterior tibial artery was used in 63 of the cases, while the anterior tibial and peroneal were used in 24 and 10 cases, respectively. There were 11 immediate inhospital failures in this series of 97 cases requiring amputation in five. Three additional patients had amputations during the ensuing several months. Of the 85 grafts functioning at the time of discharge from the hospital, 16 or (18.8%) failed during the first years. Grafts that remained patent for one year have a high incidence of long term patency which is in keeping with other reported series.

Bypass vein grafts in patients with distal popliteal artery occlusion

The results obtained by placing reversed autogenous saphenous vein bypass grafts in either isolated popliteal artery segments or tibial vessels distal to the popliteal artery are compared. Fifty-five patients with arteriosclerotic peripheral vascular disease who were threatened with limb loss were followed up from six months to nine years prior to this report. The success rate at one year was 94 per cent for the isolated popliteal segment grafts and 73 per cent for the tibial vessel grafts. The success rate after four years was 70 per cent for the isolated popliteal segment grafts and 63 per cent for the tibial vessel grafts. The clinical factors associated with the success of isolated popliteal segment bypass grafts and the factors apparently associated with failure of vein grafts in both of these groups with very poor distal arterial outflow are discussed. Our results suggest that either an isolated popliteal artery segment graft or a tibial vessel graft is a satisfactory means of treating these patients; however, a graft to an isolated popliteal segment is probably preferable to a graft to a tibial artery.

Hydraulic and morphologic study of fibrous intimal hyperplasia in autogenous saphenous vein bypass grafts

In certain patients who have had aorto-coronary bypass, the grafts are found to have concentric stenosis at the time of reinvestigation. Subsequent morphologic examination of the excised vein has shown marked intimal fibrous hyperplasia. A simplified aorto-coronary bypass system was simulated by a mathematical computer model, through which the entrance effect of various angles by the anastomosis on the flow in the side branch was studied. By matching the coronary impedance to the aortic pressure wave over a cardiac cycle, the model predicted that the optimal angle to obtain the maximum efficiency is 90 degrees. The pathological findings in a group of 108 patients who underwent aorto-coronary bypass grafting with the saphenous vein were correlated with the clinical course, angiographic findings, and hydraulic features. All four categories of data were available in 8. In all but 1 of the 8 patients who underwent reoperation, there was clinical recurrence of angina an average of 10.6 months after the first operation. Repeat angiography revealed severe narrowing of the vein graft in 6 patients and complete occlusion in 2. The angle 0*** subtended by the vein graft with the aorta was estimated at an average of 45.8 degrees.

Reversed autogenous saphenous vein by-pass from the common to the deep femoral (profunda femoris) artery.

Abstract Extended deep femoral angioplasty is an invaluable method of saving a limb especially where a femoro-popliteal vein by-pass is not possible because of a poor run-off. Atherosclerosis in the deep femoral artery often extends for more than 10 cm. In such cases we have preferred to perform a short vein by-pass than an extensive endarterectomy and patch graft. Our experience is described of 6 such cases, in 5 of whom amputation was avoided.

Aortocoronary Bypass With Saphenous Vein Graft

A 42-year-old man had extensive occlusive disease of the coronary artery and angina pectoris. An autogenous saphenous vein bypass from the ascending aorta to the anterior descending coronary artery was performed on Nov 23, 1964. The patient suffered an asymptomatic anterior myocardial infarction during operation but made an uncomplicated recovery. Seven years after the operation, the graft functions with normal left ventricular hemodynamics, while the occlusive process has produced obstruction of the left main coronary artery and almost complete occlusion of the right coronary artery. To our knowledge, this is the first successful case of a saphenous veincoronary artery bypass with the longest follow-up of a functioning coronary vein bypass graft.

Anomalous origin of left coronary artery from pulmonary artery: Treatment by aorto-left coronary saphenous vein bypass

Definitive surgical therapy is available for the adult or post-infantile form of anomalous origin of the left coronary artery from the pulmonary trunk. Left coronary artery ligation has proved successful because of intercoronary anastomoses; however, more desirable treatment consists of establishing a 2-coronary arterial system, if possible by aorto-left coronary bypass. A 34 year old patient is described in whom aorto-left coronary artery continuity was established using an autogenous saphenous vein bypass graft.

Femoropopliteal Bypass Grafts Utilizing Autogenous Veins

The results of 157 consecutive autogenous saphenous vein bypass grafts followed for periods up to eight and a half years are presented. The operations were performed on 145 patients with the following indications: (1) intermittent claudication (41%); (2) rest pain (25%); (3) gangrene (34%). The early patency rate in patients with intermittent claudication was 83%, and of these 83% remained patent; with rest pain, 74% and of these 86% remained patent; with gangrene, 63% and of these 76% remained patent. The success rate was highest in (1) nondiabetic patients; (2) extremities with two or three patent vessels at the level of the popliteal trifurcation; (3) extremities in which short grafts were used, whether or not the reconstruction crossed the knee joint. Angiograms on 29 patent grafts and 12 thrombosed grafts revealed: (1) absence of atheromatous changes in the grafts; (2) absence of aneurysmal dilatation in the body of the graft; (3) an equal incidence of progression of original disease in patent grafts and in late thrombosed grafts. Autogenous venous bypass grafts function well in the arterial system for prolonged periods. The results continue to support the superiority of vein grafts over both thromboendarterectomies and synthetic-tube bypass grafts in the treatment of femoropopliteal occlusive disease.

Autogenous in situ saphenous vein bypass for femoral-popliteal occlusive disease : A follow-up appraisal

Results have been presented which indicate that the long term (two years) success of in situ autogenous saphenous vein bypass grafting for obstructing disease of the superficial femoral artery exceeds 83 per cent. These results are comparable to or better than those reported for autogenous vein shunts created by removal and reversal of the saphenous vein. Evidence has been presented to show that arteriovenous fistulas are not a complication of the in situ operation if an arteriogram is obtained before completion of the operation. Likewise the status of the valves made incompetent during the in situ operation has been examined grossly and microscopically. When the correct smooth tipped internal stripper is used, the valve is merely reversed upon itself and not torn. The in situ operation is recommended for long obstructive disease of the superficial femoral artery because of its simplicity of performance, preservation of vein viability, long term patency results, absence of foreign material, and lastly because it can be used safely in patients with claudication alone.