Distal Anastomotic Stenosis Research Articles

Contribution of routine intraoperative completion arteriography to early infrainguinal bypass patency

To determine the clinical utility of routine intraoperative completion arteriography, we prospectively evaluated 214 consecutive infrainguinal bypass grafts (209 reversed-vein and 5 polytetrafluoroethylene grafts) performed from July 1987 to August 1991. Visual inspection, pulse palpation, and continuous-wave Doppler examination were performed in all cases. At least 1 completion arteriogram was obtained in 213 cases (99%). The bypasses were to the popliteal artery in 130 cases and to the tibial or pedal arteries in 84 cases. Graft patency was confirmed at 30 days in all patients by ankle-brachial index determinations (greater than 0.2 increase) and duplex scan-derived peak-systolic flow velocities (greater than 45 cm/s). Significant technical problems requiring revision were identified in 18 grafts (8%), including 6% of popliteal grafts and 12% of tibial/pedal grafts. Only three of these problems were suspected by pulse palpation or continuous-wave Doppler examination. The intraoperative angiographic findings leading to revision included distal anastomotic stenoses (n = 6), distal arterial disease requiring sequential bypass (n = 4), mid-graft valvular or branch ligature stenoses (n = 4), distal arterial thrombosis (n = 2), and graft kink or twist (n = 2). Thirty-day primary patency was 99% (129 of 130) for femoropopliteal grafts and 93% (78 of 84) for femorodistal grafts. Secondary patency was 100% (130 of 130) and 96% (81 of 84), respectively. Primary patency was 89% (16 of 18) for those grafts that required intraoperative revision based on arteriographic findings. We conclude that routine completion arteriography is an excellent method of ensuring the intraoperative technical adequacy of infrainguinal bypass. The test is easy to perform, reproducible, and should be considered the "gold standard" for intraoperative bypass assessment. Prior to adopting angioscopy or duplex scanning for intraoperative surveillance, randomized, controlled validation studies against angiography should be performed.

Standby percutaneous transluminal coronary angioplasty for coronary artery bypass surgery

AbstractUrgent PTCA of a distal anastomotic stenosis in a saphenous vein aortocoronary bypass graft was successful in relieving recurrent ischemia within 24 h of CABG surgery.

Renal Artery Revascularization with Polytetrafluoroethylene Bypass Graft

Between January 1979 and December 1986, a total of 74 renal revascularizations were performed in 68 patients using the reinforced expanded polytetrafluoroethylene prosthetic graft. These 74 revascularizations represent 29% of 251 surgical renal revascularizations performed during the same period of time. Eight patients had a total of nine revascularizations in the emergency setting (group I) for ruptured suprarenal aneurysm or acute thrombosis of the renal arteries. Only one patient survived and six years later, his anatomic and functional results are satisfactory. Sixty-five revascularizations were performed electively in 60 patients (group II). This group consisted of 19 renal revascularizations alone, and 46 combined aortic and renal revascularizations. One patient died of respiratory complications two months after operation after his thoracoabdominal aneurysm was cured. Early repeat postoperative arteriography showed that six reconstructions had occluded (three major renal arteries, three polar arteries). One patient was lost to follow-up. The remaining patients were followed for a mean of 41 months. Follow-up arteriograms obtained during 1987 showed that there were two late occlusions and two distal anastomotic stenoses. Actuarial patency was 85 +/- 10% at 72 months. Polytetrafluoroethylene prosthetic grafts constitute a reliable material for renal revascularization and combined aortic and renal reconstruction in certain anatomic conditions.

Percutaneous transluminal angioplasty of left internal mammary artery grafts: two years' experience with a femoral approach.

Percutaneous transluminal angioplasty via the femoral approach was attempted through internal mammary artery grafts in 11 patients who presented with distal anastomotic stenoses or distal native coronary artery stenoses and angina pectoris. The procedure was technically successful in 10 patients and no major complications occurred. During follow up there was one late death, but all 10 surviving patients showed functional improvement. Percutaneous transluminal angioplasty seems to be a safe and effective treatment for stenoses of internal mammary artery grafts. This is an effective technique for treating the increasing number of patients who are likely to present with stenoses of these grafts.

Intraoperative arteriography in femoropopliteal and femorotibial bypass grafts.

We reviewed our experience with intraoperative arteriography following femoropopliteal and femorotibial reconstruction during a five-year period beginning in January 1975. During 171 of 250 procedures an intraoperative arteriogram was performed. In nine (5.2%) instances, a correctable abnormality was detected. These consisted of three cases of distal anastomotic stenoses, two cases of intimal flaps, three cases of poor inflow, and one case of clot. Intraoperative arteriography may reveal a correctable abnormality in 5% of femoropopliteal and femorotibial bypass grafts and thus prevent early graft failure. The false-positive rate was 0.06%. In our experience, routine intraoperative arteriography has been a safe, easy to perform, and effective method of assessing technical problems in femoropopliteal and femorotibial reconstruction.