Femorofemoral Crossover Graft Research Articles

Outcomes of Omniflow® II prosthesis used for revascularization in the femoral tract both in infected and non-infected setting.

Evidence regarding the outcomes of Omniflow® II prosthesis in peripheral arterial revascularization at different anatomical sites and for different indications is scarce. Therefore, the aim of this study was to evaluate the outcomes of the Omniflow® II used at various positions within the femoral tract both in infected and non-infected setting. Patients who underwent reconstructive lower leg vascular surgery with implantation of an Omniflow® II from 2014 until 2021 at five medical centers were retrospectively included (N.=142). Patients were subdivided into the following categories: femoro-femoral crossover (N.=19), femoral interposition (N.=18), femoro-popliteal (above-the-knee [N.=25; AK] or below-the-knee [N.=47; BK]), and femoro-crural bypass grafts (N.=33). Primary outcome was primary patency and secondary outcomes included primary assisted patency, secondary patency, major amputation, vascular graft infection, and mortality. Outcomes were compared according to different subgroups and the surgical setting (infected versus non-infected). The median follow-up was 35.0 (17.5-54.3) months. Three years primary patency of 58% was observed for femoro-femoral crossover bypass, 75% for femoral interposition graft, 44% for femoro-popliteal above-the-knee bypass, 42% for femoro-popliteal below-the-knee bypass, and 27% in the femoro-crural position (P=0.006). Freedom from major amputation at three years were 84% for femoro-femoral crossover bypass, 88% for femoral interposition bypass, 90% for femoro-popliteal AK bypass, 83% for femoro-popliteal BK bypass, and 50% for femoro-crural bypass (P<0.001). This study demonstrates the safety and feasibility of the use of Omniflow® II for femoro-femoral crossover-, femoral interposition-, and femoro-popliteal (AK and BK) bypass. Omniflow® II seems to be less suitable for femoro-crural bypass with a significantly lower patency compared to other positions.

Use of Omniflow® II Biosynthetic Graft for the Treatment of Vascular Graft and Endograft Infections

Vascular graft/endograft infection is a rare but life-threatening complication of cardiovascular surgery and remains a surgical challenge. Several different graft materials are available for the treatment of vascular graft/endograft infection, each having its own advantages and disadvantages. Biosynthetic vascular grafts have shown low reinfection rates and could be a potential second best after autologous veins in the treatment of vascular graft/endograft infection. Therefore, the aim of our study was to evaluate the efficacy and morbidity of Omniflow® II for the treatment of vascular graft/endograft infection. A multicenter retrospective cohort study was performed to evaluate the use of Omniflow® II in the abdominal and peripheral region to treat vascular graft/endograft infection between January 2014 and December 2021. Primary outcome was recurrent vascular graft infection. Secondary outcomes included primary patency, primary assisted patency, secondary patency, all-cause mortality, and major amputation. Fifty-two patients were included with a median follow-up duration of 26.5 (10.8-54.8) months. Nine (17%) grafts were implanted in intracavitary position and 43 (83%) in peripheral position. Most grafts were used as femoral interposition (n=12, 23%), femoro-femoral crossover (n=10, 19%), femoro-popliteal (n=8, 15%), and aorto-bifemoral (n=8, 15%) graft. Fifteen (29%) grafts were implanted extra-anatomically and 37 (71%) in situ. Eight patients (15%) presented with reinfection during follow-up, most of these patients received an aorto-bifemoral graft (n=3, 38%). Intracavitary vascular grafting had a 33% (n=3) reinfection rate and peripheral grafting 12% (n=5; p=0.025). The estimated primary patencies at 1, 2, and 3 years were 75%, 72%, and 72% for peripherally located grafts and 58% (at all timepoints) for intracavitary grafts (p=0.815). Secondary patencies at 1, 2, and 3 years were 77% (at all timepoints) for peripherally located prostheses and 75% (at all timepoints) for intracavitary prostheses (p=0.731). A significantly higher mortality during follow-up was observed in patients who received a intracavitary graft compared to patients with a peripheral graft (p=0.003). This study highlights the efficacy and safety of the Omniflow® II biosynthetic prosthesis for the treatment of vascular graft/endograft infection, in absence of suitable venous material, with acceptable reinfection, patency, and freedom of amputation prevalences, especially in replacing peripheral vascular graft/endograft infection. However, a control group with either venous reconstruction or another alternative graft is needed to make firmer conclusions.

Management of Lower Limb Ischemia During Operative Repair of Acute Type A Aortic Dissection by Distal Crossover Grafts: a Case Series.

ObjectiveTo describe our experience of nine patients with extra-anatomical bypass for clinically ischemic distal limb during repair of acute Type A aortic dissection (ATAAD).MethodsWe retrospectively examined a series of nine patients who underwent surgery for ATAAD. We identified a subset of the patients who presented with concomitant radiographic and clinical signs of lower limb ischemia. All but one patient (axillobifemoral bypass) underwent femorofemoral crossover grafting by the cardiac surgeon during cooling.ResultsOne hundred eighty-one cases of ATAAD underwent surgery during the study period with a mortality of 19.3%. Nine patients had persistent clinical evidence of lower limb ischemia (4.9%) and underwent extra-anatomical bypass during cooling. Two patients underwent additional fasciotomies. Mean delay from symptoms to surgery in these nine patients was 9.5 hours. Two patients had bilateral amputations despite revascularisation and, of note, had long delays in presentation for surgery (> 12 hours). There were no mortalities during these inpatient episodes. Outpatient radiographic follow-up at the first opportunity demonstrated 100% patency.ConclusionOur experience suggests that, during complicated aortic dissection, limb ischemia may have a devastating outcome including amputation when diagnosis and referral are delayed. Early diagnosis and surgery are crucial in preventing this potentially devastating complication.

Re-interventions After Endovascular Repair for Infrarenal Abdominal Aortic Aneurysms

Introduction: Morbidity and mortality after endovascular abdominal aortic aneurysm repair (EVAR) is significantly lower than open repair. Reintervention rates and late complications after EVAR however have been reported to be higher compared to open repair in the international literature. The aim of this study was to identify and document all re-interventions after EVAR performed for intact abdominal aortic aneurysm at a single center since the introduction of EVAR in this center in 2009 Methods: This is a retrospective single-centre cohort study of re-interventions after standard EVAR. Consecutive patients (n=113) who were treated for non ruptured infrarenal aneurysms between 2009 and 2018 were included in this study. All patients undergoing EVAR were routinely followed up with a duplex scan and a CT angiogram six weeks post EVAR, which were then repeated yearly if the initial results were satisfactory. Results: In total, 22 re-interventions were performed in 19 patients during follow-up. None of the interventions were access related. In all cases, the femoral arteries were exposed via open cutdown. The most common indications for reintervention were thrombosis or stenosis of a graft limb (n=18), type I endoleak (n=3) and type II endoleak (n=1). The most frequent procedures were femoro-femoral crossover graft (n=10), thrombectomy +/- angioplasty of the EVAR graft body or limb (n=5), stenting (n=2) or extension of graft limb (n=2), proximal extension (n=1), embolisation of type II endoleak (n=1). Endovascular technique was used in 27.3% of the re-interventions Conclusion: None of our re-interventions were done for access related complications but non-access-related intervention rates are still considerable after EVAR. In our centre, the commonest indication for intervention was graft limb thrombosis or stenosis. The commonest procedure was femoro-femoral crossover graft, followed by thrombectomy +/- angioplasty of the EVAR graft limb. Re-intervention rates are identical to reintervention rates reported in the literature. No aneurysm ruptures were recorded. Disclosure: Nothing to disclose

Venous Conduits Have Superior Patency Compared with Prosthetic Grafts for Femorofemoral Bypass

The objective of the study was to compare the outcomes of externally supported polytetrafluoroethylene (PTFE) grafts and femoral vein as conduits for femorofemoral crossover grafts. This is a retrospective review of consecutive femorofemoral crossover grafts atourinstitution between January 2005 and March 2016. Patient demographics, indications,complication rates, patency rates, and survival rates were compared between femorofemoral grafts created with either PTFE or femoral vein conduits, autogenous or cryopreserved. One hundred nineteen femorofemoral crossover bypasses (89 PTFE, 30 vein [18 autogenous and 12 cryopreserved femoral veins]) were performed. Most patients underwent isolated femorofemoral bypass alone (76% isolated femorofemoral bypass versus 24% axillobifemoral bypass). A greater proportion of patients who received vein grafts were female (PTFE 37% vs. vein 60%, P=0.028) and had prior bypasses (PTFE 33% vs. vein 73%, P<0.001). PTFE bypasses were performed primarily for chronic limb ischemia (61.8%), while most venous bypasses were for infections (80%, P<0.001). Femoral vein conduits were used in cases of infected aortic or extra-anatomical grafts (N=20) or groin infection (N=5). The 30-day complication rate was 38.7% and was not different between groups (36% for PTFE, 44.4% for autologous vein grafts and 50% for cryovein, P=0.33) with wound complications being most frequent (18% PTFE, 27.8% autologous vein, 16.7% cryovein, P=0.25). Patients receiving vein grafts were more likely to receive blood transfusion (34.8% PTFE vs. 70% vein, P=0.001). Overall, median follow-up was 9.8months (range 0-107). Primary patency rates at 1, 2, and 3years were 83.7 %, 73.7% and 69.8%, respectively, for PTFE bypasses, and 100% for all time points for venous grafts, respectively (log rank, P=0.03). Primary-assisted and secondary patency rates were not significantly different between the 2 groups (log rank, P=0.16). Survival rates at 1, 2, and 3years were 82%, 76.4% and 69.7%, respectively, for patients with PTFE grafts versus 76.7%, 73.3%, and 55%, respectively, for patients with vein grafts, respectively (log rank, P=0.17). While the indications for procedure differed in this series, femoral veins in femorofemoral bypasses have overall superior primary patency and similar complication rates compared with PTFE grafts. Based on this series, femoral vein, either autologous or cryopreserved, appears to be a suitable conduit for femorofemoral bypasses, and in some cases, it may be the preferred conduit.

Medium-Term Outcomes Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms with an Unfavourable Proximal Neck.

The purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter. A retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter. The median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93%, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1). EVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities.

Femoro-Femoral Crossover Graft and Simultaneous Reconstruction of the Proximal Deep Femoral Artery

The goal of this study was to describe and review the results of a technique in which reconstruction of the common and profunda femoral arteries is combined with a femoro-femoral crossover graft using the same synthetic graft. A synthetic bifurcated graft (such as the ones used for aortobifemoral reconstruction), in which one limb is cut off, is used, leaving an enlarging patch at the end where the proximal anastomosis will be fashioned. From January 1972 to January 2000, 6 patients underwent this reconstruction for severe limb ischemia. Patients were followed up in the outpatient clinic every 6 months. No postoperative mortality and no major complications were seen. One patient had a superficial wound infection, which resolved with conservative treatment. Five patients had a patent graft at an average follow-up of 39 months. Using the same synthetic graft allows angioplasty of the common and profunda femoral arteries of the donor side and revascularization of the opposite lower limb, with good short- and long-term results.

Role of the femorofemoral crossover graft in acute lower limb ischemia due to acute type B aortic dissection

Acute limb ischemia due to type B aortic dissection is rare and continues to be a management challenge. A case series is presented here with the aim of assessing the outcomes of treatment with a femorofemoral crossover graft with or without thoracic stent graft insertion. This is a combined retrospective and prospective review of nine cases of acute lower limb ischemia secondary to acute type B aortic dissection. The presenting features, radiological findings, treatment and outcomes were reviewed. Five patients had a femorofemoral crossover graft (FFXO) alone, two an FFXO with a thoracic stent graft and the eighth a thoracic and iliac stent. The other case was initially treated conservatively but subsequently required an FFXO. The mean follow-up was 16 (3-51) months. A further two thoracic stents were placed during the follow-up period. Thus five out of nine patients (56%) required aortic stenting. This series suggests that an FFXO is a reliable treatment for acute limb ischemia due to type B aortic dissection. However, these patients are often complex with ischemia in other vascular beds and are at risk of subsequent aneurysmal dilation.

Ultrasound duplex scanning in evaluation of long-term results of reconstructive surgery in patients with peripheral occlusive arterial disease

The most frequently used operations in patients with peripheral occlusive arterial disease are aorto-femoral bypass (AFB) and femoro-popliteal bypass (FPB). In cases non suitable for direct reconstruction femoro-femoral cross-over grafting (FFCG) is used. One of the most frequent causes of unsatisfactory long-term results of reconstructive surgery in patients with peripheral occlusive arterial disease is restenosis in reconstruction area. One of the most frequently used methods of evaluation of reconstruction area alteration is ultrasound duple x scanning (UDS) of arteries of lower extremity. The abstract represents the analysis of efficacy of ultrasound duplex scanning in evaluation of long-term results of reconstructive surgery in patients with peripheral occlusive arterial disease. The study included 52 patients. The patients were divided into three groups according to the method of operative treatment used: AFB was performed in 13 patients, FFCG was performed in 9 patients, FPB was performed in 25 patients.

On-table endovascular intervention combined with infrainguinal bypass surgery—A district general hospital experience

To evaluate our practice of simultaneous on-table iliac angioplasty or stenting with infrainguinal bypass surgery in selected group of patients, we reviewed all patients who underwent on-table endovascular procedure combined with infrainguinal bypass surgery between 1995 and 1999. The procedures were performed in the absence of a radiologist. During the study period, 52 patients (mean age 64) underwent a combined procedure for disabling claudication, rest pain or ulceration. All patients were found to have multisegment disease on initial arteriogram with 65% having good distal run off. Patients underwent an endovascular procedure (63% on-table iliac angioplasty and 37% on-table iliac stenting) combined with femoro-popliteal bypass (52%), femoro-femoral crossover graft (36%), femoral endarterectomy (10%) and femoro-distal bypass (2%). Two thirds of patients had improvement in symptoms and ankle brachial pressure index during the early follow-up period (6 weeks). At the time of performing the audit, 7 patients (13%) have required further operations for limb salvage, and 3 patients (6%) underwent amputation. Patients with multilevel vascular disease may require multiple admissions for iliac stenting or angioplasty followed by distal vascular reconstruction. Vascular surgeons performing a combined procedure under one general anaesthetic can reduce the number of hospital admissions and interventions.

Pseudo Aneurysm of a 21 Year Old ePTFE Femoro-Femoral Crossover Graft: Successful Endovascular Repair Using an ePTFE Lined Nitinol Stent Graft

With the advancement of technology and manufacturing of prosthetic grafts, non- anastomotic pseudoaneurysm arising from a graft is now uncommon. Here we report a case of non-anastomotic pseudo aneurysm occurring 21 years after implantation of ePTFE femoro-femoral crossover graft. An 80 year old female with a previous history of a femoro- femoral cross-over bypass surgery performed using a10 mm reinforced polytetrafluoroethylene graft presented with a pulsatile lump in her right groin. CT angiography showed a fusiform type non-ruptured false aneurysm of 6.4 cm maximum diameter and was arising directly from the graft. Because of the risk of rupture, the patient was treated endovascularly with 13 mm * 8 cm Viabahn self-expanding covered stent across the pseudo aneurysm. The final angiographic results were excellent and showed resolution of the aneurysm with good flow through the graft and distal vessel. This type of complication is easily diagnosed by clinical examination and imaging studies, which display an aneurysm of the graft remote from the anastomosis. Percutaneous intervention with covered stent may offer an easy and safe way to treat this type of aneurysm.

Endovascular Management of Delayed Complete Graft Thrombosis After Endovascular Aneurysm Repair

Graft thrombosis rates after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms vary widely in published series. When thrombosis does occur, it usually involves a single limb and occurs within 3 months of stent-graft insertion. If the entire endoprosthesis is thrombosed, treatment may be challenging because femoro-femoral crossover graft insertion is not an option and a greater volume of thrombus is present, thus making thrombolysis more difficult. We present two cases of delayed thrombosis after EVAR involving the entire stent-graft. These were successfully treated by a combined surgical and endovascular technique, and patency has been maintained in both cases to date.

Caesarean delivery in a parturient with a femoro-femoral crossover graft and congenital aortic stenosis repaired by the Ross procedure

We report a case of a patient with congenital aortic stenosis previously repaired using the Ross procedure, who presented to our unit for urgent caesarean delivery. Management was complicated by moderate residual cardiac disease and the presence of a suprapubic femoro-femoral crossover graft. Following application of five-lead electrocardiogram and invasive blood pressure monitoring, anaesthesia was induced via combined spinal-epidural with epidural volume extension. A high transverse surgical approach avoided the course of the vascular graft, while further precautions included the immediate availability of vascular surgeons and cell salvage. Our anaesthetic technique was tailored to minimise disruption to cardiovascular function, and in particular to limit regurgitant flow across the pulmonary valve. This case highlights the value of early identification of high-risk parturients and multidisciplinary involvement at delivery. Risk stratification in the patient with grown-up congenital heart disease is based upon timely evaluation of the underlying congenital pathology, surgical history and subsequent functional status.

Results of Endovascular Repair of Abdominal Aortic Aneurysms with an Unfavorable Proximal Neck Using Large Stent-Grafts

The purpose of this study was to evaluate the early outcome of endovascular repair of abdominal aortic aneurysms (EVAR) with an unfavorable neck anatomy using extralarge stent-grafts. We carried out a retrospective review of all patients who underwent elective EVAR using large diameter stent-grafts between June 2006 and February 2008. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. All patients were followed up with CTA at 3 and 12 months and annual duplex thereafter when appropriate. This analysis included 25 patients (23 men, 2 woman; median age, 76 years; age range, 60-88 years). The median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Extralarge Cook-Zenith stent-grafts were used in all patients, with a top-end diameter of 36 mm (n=23) and 40 mm (n=2). The follow-up period ranged from 3 to 24 months, with a median of 6 months. Primary and assisted primary technical success rates were 80% and 96%, respectively. Reintervention was required to treat proximal type I endoleak (n=1), iliac limb kink (n=2), and occluded femorofemoral crossover graft (n=1). These early results show that EVAR using extralarge stent-grafts with suprarenal fixation can be a reliable modality to treat infrarenal aortic aneurysms with an unfavorable neck anatomy.

Treatment of a Common Iliac Aneurysm by Endovascular Exclusion Using the Amplatzer Vascular Plug and Femorofemoral Crossover Graft

We report our initial experience using the Amplatzer Vascular Plug II (AVP2) in the treatment of a left common iliac aneurysm. Following investigation by computerized tomographic angiography and catheter angiography, a 79-year-old man was found to have a markedly tortuous iliac system, with a left common iliac artery aneurysm that measured 48 mm in maximal diameter. Due to the patient's age and comorbidities the surgical opinion was that conventional open repair was not suitable. However, due to the tortuous nature of the aneurysm and iliac vessels, standard endovascular repair, using either a bifurcated or an aorto-uni-iliac stent graft, was also not possible. A combined approach was used by embolizing the ipsilateral internal iliac artery using coils and excluding the aneurysm using two AVP2 occlusion devices, followed by femorofemoral crossover grafting. Total aneurysm occlusion was achieved using this method and this allowed the patient to have a much less invasive surgical procedure than with conventional open repair of common iliac aneurysms, thus avoiding potential comorbidity and mortality.

Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries

The purpose of this study is to report outcomes following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with ectatic common iliac arteries (CIAs). Of 117 AAA patients treated by EVAR between 1998 and 2005, 87 (74%) had CIAs diameters <18 mm and 30 (26%) patients had one or more CIA diameters >18 but <25 mm. All patients were treated with Talent stent-grafts, 114 bifurcated and 3 AUI devices. Departmental databases and patient records were reviewed to assess outcomes. Technical success, iliac-related outcome, and iliac-related reintervention (IRSI) were analyzed. Patients with EVAR extending into the external iliac artery were excluded. Median (range) follow-up for the study group was 24 (1-84) months. Initial technical success was 98% for CIAs <18 mm and 100% for CIAs >/=18 mm (p = 0.551). There were three distal type I endoleaks (two in the ectatic group) and six iliac limb occlusions (one in an ectatic patient); there were no statistically significant differences between groups (p = 0.4). There were nine IRSIs (three stent-graft extensions, six femorofemoral crossover grafts); three of these patients had one or both CIAs >/=18 mm (p = 0.232). One-year freedom from IRSI was 92% +/- 3% and 84% +/- 9% for the <18-mm and >/=18-mm CIA groups, respectively (p = 0.232). We conclude that the treatment of AAA by EVAR in patients with CIAs 18-24 mm appears to be safe and effective, however, it may be associated with more frequent reinterventions.

Limb Graft Occlusion Following EVAR: Clinical Pattern, Outcomes and Predictive Factors of Occurrence

We reviewed our experience with limb occlusion after EVAR in order (1) to assess the clinical pattern and treatment options (2) to assess outcomes and (3) to identify predictive factors of occurrence. Between 1995 and 2005, 460 AAA patients were electively treated with a variety of commercially available stent grafts. There were 369 bifurcated and 91 aortouniiliac grafts (829 limbs). Follow-up included physical examination, plain X-ray, Duplex ultrasonography, and spiral computed tomographic scans at 1, 6, 12 months and annually thereafter. All pertinent data were collected prospectively and analysed retrospectively. The follow-up period ranged from Day 0 to 104 months, with a median follow-up of 23.4 months. 36 limbs in 33 patients (7.2%) occluded between Day 0 and 71 months (average: 9.5 months) after EVAR. Presentation was acute ischemia in 11 cases, rest pain in 9, claudication in ten. Four occlusions remained asymptomatic and two occurred intraoperatively. Treatment was femoro-femoral cross-over graft in 19 cases, axillo-femoral bypass in three, thrombectomy and stent in three, thrombolysis and stent in nine, and conservative in two. One patient (3%) died of multiple organ failure after thrombolysis. There was no amputation. Reocclusions occurred in two patients (6.1%). Multivariate logistic regression showed that kinking (odds ratio [OR] 11.9; confidence interval [CI] 3.39-42.1; p=0.0001), first graft generation (OR 2.87; CI 1.25-6.62; p=0.017) and younger age (OR 1.05; CI 1.00-1.09; p=0.034) were independently related to the occurrence of graft limb occlusion. Acute graft limb occlusion is not rare after EVAR. The frequency of limb occlusion has declined with current stent grafts generation. Although surgery and endovascular treatments are efficient and safe, development of a graft limb kink should lead to aggressive pre-emptive treatment to prevent occlusion.

Endovascular conversion with femorofemoral bypass as a treatment of endotension and aneurysm sac enlargement

We report a case of a patient treated with a Gore Excluder endograft for AAA in November 2003 with subsequent aneurysm sac enlargement in the absence of an identified endoleak. The patient had a Type I endoleak treated with a Palmaz stent at the neck and later developed a Type II endoleak treated with translumbar coil embolization. This was successful with absence of pressure in the sac after the procedure and stable aneurysm size over the next nine months. Surveillance of the patient with both CT and ultrasound then revealed an increase in the aortic sac diameter in the absence of endoleak. A Cook Zenith converter was used to reline this PTFE endograft. Subsequently, imaging showed aneurysm sac shrinkage. This is a report of endotension with aneurysm expansion following Gore Excluder placement which was treated successfully with a dacron endograft.

Rapid Development of Multiple Pseudoaneurysms After Arterial Homograft Placement

HomeCirculationVol. 114, No. 5Rapid Development of Multiple Pseudoaneurysms After Arterial Homograft Placement Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBRapid Development of Multiple Pseudoaneurysms After Arterial Homograft Placement Michael Heise, MD, Michael Werk, MD, Inga Husmann, MD, Robert Eisele, MD and Peter Neuhaus, MD Michael HeiseMichael Heise From Charité, University Medicine, Department of General Surgery, Berlin, Germany. Search for more papers by this author , Michael WerkMichael Werk From Charité, University Medicine, Department of General Surgery, Berlin, Germany. Search for more papers by this author , Inga HusmannInga Husmann From Charité, University Medicine, Department of General Surgery, Berlin, Germany. Search for more papers by this author , Robert EiseleRobert Eisele From Charité, University Medicine, Department of General Surgery, Berlin, Germany. Search for more papers by this author and Peter NeuhausPeter Neuhaus From Charité, University Medicine, Department of General Surgery, Berlin, Germany. Search for more papers by this author Originally published1 Aug 2006https://doi.org/10.1161/CIRCULATIONAHA.105.605436Circulation. 2006;114:e80–e81A 52-year-old woman received a preserved aorto-bifemoral homograft to treat an infection of an aorto-bifemoral Dacron graft (Vascutek, Renfrewshire, Scotland) that was implanted 5 years ago. The infected graft was completely removed during the operation. Donor and recipient blood groups were matched. The donor was a 16-year-old boy who died after traumatic brain injury after a car accident. For organ preservation, University-of-Wisconsin solution (Viaspan, Bristol-Myers Squibb, Munich, Germany) was used. The arterial homograft was cryopreserved using a standardized freezing protocol. Immunosuppression was started 2 weeks after the operation and was maintained using the calcineurin inhibitor FK506 (1 mg/d).After an uncomplicated recovery and discharge from the hospital, the patient rapidly developed multiple false aneurysms during the first 3 postoperative months (Figure 1). The aneurysms were detected during routine follow-up ultrasound. Two large pseudoaneurysms emerged at the level of central anastomosis, and 2 false saccular aneurysms developed on the right leg and 4 on the left leg of the homograft (Figure 2). The distal anastomoses remained intact. Because of imminent prosthetic graft reinfection, an endovascular repair approach was used; a unibody stent graft was implanted in combination with a femorofemoral crossover graft for revascularization of the left limb (Figure 2). The patient again recovered smoothly and both grafts remained patent. The histology resembled the typical pattern of arterial homograft degeneration, showing a prominent neointima formation and degenerated media (Figure 3).1 No signs of rejection were present. Therefore, the pseudoaneurysm development was attributed to fractures of the homograft after cryopreservation and thawing.2Download figureDownload PowerPointFigure 1. Multiple saccular pseudoaneurysms developed at site of central anastomosis and at both legs of the aorto-bifemoral homograft 3 months after implantation (intra-arterial digital subtraction angiography).Download figureDownload PowerPointFigure 2. Magnetic resonance angiographies at discharge (A), at the 3-month follow-up (B), and after endovascular repair in combination with a femorofemoral crossover graft (C).Download figureDownload PowerPointFigure 3. Histology of the homograft femoral artery taken after cryopreservation (A) and at surgery after 3 months (B). The homograft wall showed a degenerated media and a prominent neointima formation. NI indicates neointima; M, media.DisclosuresNone.FootnotesCorrespondence to Michael Heise, MD, Charité, University Medicine, Department of General Surgery, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail [email protected]References1 Vogt PR, Stallmach T, Niederhauser U, Schneider J, Zund G, Lachat M, Kunzli A, Turina MI. Explanted cryopreserved allografts: a morphological and immuno-histochemical comparison between arterial allografts and allograft heart valves from infants and adults. Eur J Cardiothorac Surg. 1999; 15: 639–644.CrossrefMedlineGoogle Scholar2 Pegg DE, Wusteman MC, Boylan S. Fractures in cryopreserved elastic arteries. Cryobiology. 1997; 34: 183–192.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Soquet J, Chambon J, Goffin Y and Jashari R (2014) Acute rejection of a cryopreserved arterial homograft, Cell and Tissue Banking, 10.1007/s10561-014-9489-y, 16:3, (331-333), Online publication date: 1-Sep-2015. Bia D, Zócalo Y, Armentano R, Pérez-Cámpos H, Fernández-Pin J, Panuncio A, Saldías M, Mariño A and Álvarez I (2012) Post-implant evaluation of the anastomotic mechanical and geometrical coupling between human native arteries and arterial cryografts implanted in lower-limb, Cryobiology, 10.1016/j.cryobiol.2011.09.133, 64:1, (50-59), Online publication date: 1-Feb-2012. Utsumi T, Ohtsuka M, Uchida E, Yamaguchi H, Nakajima T, Akazawa H, Takano H, Nakaya H and Komuro I (2008) Abdominal aortic pseudoaneurysm caused by prolonged methicillin-resistant Staphylococcus aureus sepsis, International Journal of Cardiology, 10.1016/j.ijcard.2007.06.043, 128:2, (294-295), Online publication date: 1-Aug-2008. August 1, 2006Vol 114, Issue 5 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.105.605436PMID: 16880334 Originally publishedAugust 1, 2006 PDF download Advertisement SubjectsAngiographyCardiovascular SurgeryComputerized Tomography (CT)

Axillofemoral and femorofemoral grafts: a 6-year experience with emphasis on the relationship of peroperative flow measurement to graft survival.

Over a 6-year period 64 axillofemoral bypass and femorofemoral crossover grafts have been performed in 58 patients, most of whom were considered unfit for intra-abdominal surgery. Indications were peripheral ischaemia in 78 per cent and disabling claudication in 22 per cent. The limb salvage rate at 3 years was 75 per cent. No claudicants lost limbs, but only one-third of patients presenting with forefoot gangrene or ulceration avoided amputation. Most patients presenting with ischaemic symptoms at rest had associated femoropopliteal and distal disease, confirmed by the ankle pressure index measurements, and this influenced graft patency. Although the cumulative patency at 3 years for all grafts combined was 57 per cent with similar patencies for both the axillofemoral and femorofemoral grafts, early occlusion was more common in axillofemoral grafts and this may be reduced in bifemoral grafts by the increased flow rate in the vertical limbs. Peroperative electromagnetic flowmeter measurements were made after reconstruction on 55 femoral arteries in 46 of the patients and graft flow velocities were derived from these measurements. Comparison between velocities from those grafts remaining patent and those subsequently occluding showed a high incidence of occlusion in grafts with a maximal velocity after distal vasodilatation of less than 8 cm/s. Graft occlusion after the first postoperative month was more commonly associated with other factors such as continued smoking, severity of distal disease and perigraft infection.