Short-term Patency Rates Research Articles

Three-Dimensional Bio-Printed Tubular Tissue Using Dermal Fibroblast Cells as a New Tissue-Engineered Vascular Graft for Venous Replacement.

The current study was a preliminary evaluation of the feasibility and biologic features of three-dimensionally bio-printed tissue-engineered (3D bio-printed) vascular grafts comprising dermal fibroblast spheroids for venous replacement in rats and swine. The scaffold-free tubular tissue was made by the 3D bio-printer with normal human dermal fibroblasts. The tubular tissues were implanted into the infrarenal inferior vena cava of 4 male F344-rnu/rnu athymic nude rats and the short-term patency and histologic features were analyzed. A larger 3D bio-printed swine dermal fibroblast-derived prototype of tubular tissue was implanted into the right jugular vein of a swine and patency was evaluated at 4 weeks. The short-term patency rate was 100%. Immunohistochemistry analysis showed von Willebrand factor positivity on day 2, with more limited positivity observed on the luminal surface on day 5. Although the cross-sectional area of the wall differed significantly between preimplantation and days 2 and 5, suggesting swelling of the tubular tissue wall (both p < 0.01), the luminal diameter of the tubular tissues was not significantly altered during this period. The 3D bio-printed scaffold-free tubular tissues using human dermal or swine fibroblast spheroids may produce better tissue-engineered vascular grafts for venous replacement in rats or swine.

Short-term patency of iliofemoral to tibial bypass with vascular allografts in a minority population: A retrospective analysis of a single center acute care facility.

The aim of this study was to examine the short-term patency rates and associated factors of open lower limb, iliofemoral to tibial bypass using cryopreserved saphenous vein (CSV) in a minority population at an acute care hospital in New York City. A retrospective analysis of patients undergoing infra-inguinal bypass from iliofemoral vessels to tibial arteries with CSV between March 2020-April 2022 at an acute care facility (Harlem Hospital Center, Harlem, New York) was performed. Data including patient demographics, comorbidities, type of operation, follow-up surveillance, and salvage procedures were collected. Results were presented in patency line graphs and a life table. Target limb revascularization (TLR) and amputation free survival (AFS) were also calculated. Eleven bypass procedures were included in the analysis. Patients were followed for a mean of 10.8months. Cumulative primary patency rates at 1, 6, and 12months were 72.7%, 54.5%, and 40.9%, respectively. TLR was 36.4% and the AFS was 66.67% at the mean 10.8-month follow-up. The patency rates of minority patients undergoing bypass with CSV were analyzed with creation of a life table and calculation of patency rates, TLR and AFS. The short-term primary patency rates and post-operative outcomes were found to be comparable to larger studies in non-minority cohorts. These results suggest that larger studies as well as prospective analyses and randomized controlled trials in this patient cohort and demographic are needed, as well as optimal selection of patients to determine true clinical implications.

Thick silk fibroin vascular graft: A promising tissue-engineered scaffold material for abdominal vein grafts in middle-sized mammals.

Abdominal vein replacement with synthetic tissue-engineered vascular grafts constructed from silk-based scaffold material has not been reported in middle-sized mammals. Fourteen canines that underwent caudal vena cava replacement with a silk fibroin (SF) vascular graft (15 mm long and 8 mm diameter) prepared with natural silk biocompatible thread were allocated to two groups, thin and thick SF groups, based on the graft wall thickness. The short-term patency rate and histologic reactions were compared. The patency rate at 2 weeks after replacement in the thin and thick SF groups was 50% and 88%, respectively (p = 0.04). CD31-positive endothelial cells covered the luminal surface of both groups at 4 weeks. The elastic modulus of the thick SF graft was significantly better than that of the thin SF graft (0.0210 and 0.0007 N/m2, p < 0.01). Roundness of thick SF groups (o = 0.8 mm) was better than thin SF (o = 2.0 mm). There was significant difference between the groups (p = 0.01). SF vascular grafts are a promising tissue-engineered scaffold material for abdominal venous system replacement in middle-sized mammals, with thick-walled grafts being superior to thin-walled grafts.

COMPARATIVE STUDY OF THE CLINICAL OUTCOMES OF FUNCTIONAL SIDE TO SIDE ANASTOMOSIS AND TRADITIONAL END TO SIDE ANASTOMOSIS IN RADIO CEPHALIC FISTULA FOR DIALYSIS ACCESS

Background : End stage renal disease is a major public health problem, incidence of which is increasing every year. The signicant mortality and morbidity associated with end stage renal disease is directly related to vascular access for hemodialysis. Hence, in this study we attempt to compare the outcomes of functional side to side anastomosis and traditional end to side anastomosis in radio cephalic AVF. Methods : Totally 60 patients with CKD receiving radial artery-cephalic vein arteriovenous shunt for hemodialysis were randomly divided into 2 groups, namely, the functional side-side anastomosis and the traditional end-side anastomosis. All parameters related to success rate and patency rate of the two methods were compared and analyzed. Comparative analysis of mean Results : cephalic vein diameter at 2nd and 6th week between ETS and STS groups showed statistically signicant difference(p value &lt;0.0001). But, at 12th week, mean diameter was not statistically signicant. Flow rate across anastomosis in both groups were kept on increasing, but was less in STS than ETS. The short-term patency rates are similar between haemodialysis patients undergoing functional and traditional end-to-side anastomosis for radial artery-cephalic vein arteriovenous stula. Although not all Conclusion : the results of the study were statistically conclusive but the parameters of Flow rate across anastomosis and cephalic vein diameter across anastomosis in the Functional STS group show statistically signicant results thus fullling two important criteria for stula maturation in accordance with ― The Rule of Sixe. The Functional side-to-side technique can be denitely applied for initiating renal replacement therapy with some advantages over end-to-side technique, and without increasing the risk of primary failure of the stula

The role of vacuum-assisted mechanical thrombectomy in the management of acutely thrombosed arteriovenous fistulas and grafts.

The purpose of this study is to evaluate the safety and efficacy of the mechanical thrombectomy with the Indigo System in the treatment of thrombosed arteriovenous fistulas and grafts. A retrospective search of endovascular procedures performed from November 2018 to June 2020 was conducted. Inclusion criteria were: acute arteriovenous fistula or graft thrombosis that underwent endovascular mechanical thrombectomy with Indigo System. The following information was collected from each case: sex, age, fistula modality, fistula location, treatment modality, and outcomes. Endpoints evaluated were: technical and clinical success rates; primary, assisted primary, and secondary patency rates; complication rates. Twenty-six mechanical thrombectomy procedures for declotting of arteriovenous fistula thrombosis, using the Indigo System, were performed in 22 patients. Technical and clinical success was achieved in 23/26 cases (88%). Mean follow-up was 9 months (range 11-539 days). The 6-month primary, primary assisted, and secondary patency rates were 71%, 86%, 93% and the 12-month primary, primary assisted, and secondary patency rates were 71%, 72%, 80%, respectively. No technical or device-related complications were observed during thrombectomy, however two venous ruptures occurred on the angioplasty of the underlying stenosis. In conclusion, vacuum-assisted thrombectomy of acutely thrombosed arteriovenous fistulas and grafts with Indigo System is safe and effective, providing good short term patency rates.

No-Touch Sequential Saphenous Venous Harvesting Technique in Off-Pump Bypass Surgery: A Retrospective Study.

BackgroundIn the mid-1990s, the Swedish expert team proposed saphenous vein graft (SVG) harvesting with pedicle tissue. The short-term and long-term patency rates of the great saphenous vein obtained by the no-touch (NT) were higher than those obtained by the conventional (CON). In the past, NT harvesting was mainly used in on-pump coronary artery bypass grafting (CABG), and vein grafts were mostly single vein grafts. In this study, we retrospectively analyzed the safety and effectiveness of sequential vein grafts using NT harvesting in off-pump CABG.MethodsFrom 2017 to 2019, a total of 505 patients were included in the study. There were 150 patients in the NT group and 355 patients in the CON group. After applying propensity score matching (1:1 matching), 148 patients were included in each group. Baseline data, graft patency, post-operative complications, leg wound complications and 1-year major adverse cardiac and cerebrovascular events (MACCEs) were compared between the two groups.ResultsThere was no significant difference in the patency rate of sequential venous grafts between the two groups 1 year after the operation either before [NT: 7.1% (10/141) vs. CON: 11.5% (38/331), p = 0.149) or after matching (NT: 7.1% (10/140) vs. CON: 7.3% (9/124), p = 0.971]. There was no significant difference in the composite clinical endpoint between the two groups either before [NT: 3 (2.3%) vs. CON: 9 (2.8%), p = 1.000] or after matching [NT: 3 (2.3%) vs. CON: 3 (2.5%), p = 1.000]. There were differences in leg wound complications between the two groups both before [NT: 9 (6.9%) vs. CON: 6 (1.9%), p = 0.007] and after matching [NT: 9 (6.9%) vs. CON: 2 (1.7%), p = 0.043].ConclusionsThe application of the NT harvesting in off-pump CABG with sequential vein grafts is safe and effective. NT method has disadvantages in leg wound.

Early Outcomes of Complex Vascular Reconstructions in Lower Extremities Using Spiral and Panel Vein Grafts

Spiral saphenous vein grafts (SSVG) or paneled vein grafts (PVG) can be used when the diameter of the autologous great saphenous vein does not match the vessel that needs to be repaired. This study aimed to present early results of complex vascular reconstruction with SSVGs and PVGs in the lower extremities. From May 2019 through January 2021, 6 SSVGs and 3 PVGs were used for vascular reconstruction in 9 patients. Patient data were collected retrospectively, including age, gender, cause of vascular pathology, target vessels, concomitant injury, surgical method, additional surgical methods, and hemodynamic status. The Kaplan-Meier method was used to calculate the rate of freedom from reintervention. Among these patients, 7 had trauma, 1 had graft infection, and 1 had vascular reconstruction after tumor excision. The mean duration of follow-up was 6 ± 6.6 months (range 1-19 months). The rate of freedom from reintervention for any reason was 77.8% at 1 year. Two patients underwent amputation after vascular reconstruction with patent vascular reconstructions. One of the 2 amputations was performed because of infection, and the other was due to ischemia >24 hr. The success rate of reconstruction was 100%, and the primary patency rate was 100%. The rate of limb salvage was 77.8%. There was no death, bleeding, embolism, skin ulcers, graft-related complication, or aneurysmal dilation during follow-up. SSVG and PVG were associated with low infection rates and satisfactory short-term patency rates. Both 2 grafts may be good choices when there is a diameter mismatch in vascular reconstructions.

Comparison of Brachiobasilic Transposition Arteriovenous Fistula Outcomes among Diabetic and Non-diabetic Patients: A Case Controlled Study.

Diabetes is considered a risk factor for arteriovenous fistula failure and increased perioperative complications; but this view is not proven for patients undergoing brachiobasilic transposition arteriovenous fistula (BBT-AVF). Fifty-one (68.9%) diabetic and 23 (31.08%) non-diabetic patients undergoing single-stage BBT-AVF were compared in terms of perioperative complications, access maturation and patency rates at The Aga Khan University Hospital from between January 2016 to December 2017. Diabetics were elder and more obese. The perioperative complications 19 (37.2%) vs. 8 (34.7%), and access maturation rates were compared (93.2% vs. 95.5%) between the two groups. At 6 months, access patency in diabetics was lower compared to non-diabetics (64.7% vs. 87.0%). Similar trend was noted at 12 and 24 months in both groups. This study showed that the diabetic and non-diabetic were comparable in terms of perioperative complications and maturation rate. However, short term patency rate was lower in diabetics compared to non-diabetics. Key Words: Brachiobasilic AVF, Complications, Diabetes mellitus, Patency.

The Short-Term Patency Rate of a Saphenous Vein Bridge Using the No-Touch Technique in off-Pump Coronary Artery Bypass Grafting in Vein Harvesting.

ObjectiveThis study aimed to examine the short-term effect of the no-touch technique on the patency rate of a great saphenous vein (GSV) bridge used during off-pump coronary artery bypass grafting (OPCABG).MethodsBetween June 2018 and September 2020, 140 patients undergoing OPCABG, with grafts obtained from the GSV using the “no-touch” technique or the left internal mammary artery (LIMA), were enrolled in this study. The early clinical results and short-term patency rate of the OPCABG were evaluated at a three-month follow-up by comparing the patency rate of the LIMA bridge and the GSV bridge obtained by the no-touch technique. This study also analyzed the impacts of the postoperative complications of the lower limbs and the distribution area of diseased vessels on the patency rate of a GSV bridge obtained by the no-touch technique at an early stage.ResultsNo perioperative death or adverse cardiovascular or cerebrovascular events occurred in the 140 patients undergoing OPCABG. The difference in the early patency rate between the GSV bridge obtained by the no-touch technique and the LIMA bridge was not statistically significant (95.9% vs 97.1%, p = 0.501). There was no significant difference in the patency rate between an end-to-side anastomosed venous bridge and a LIMA bridge (95.0% [248/261] vs 97.1% [136/140], p = 0.314). The overall patency rate of a no-touch vein bridge in the right coronary artery region was lower than it was in the left coronary artery region (93.8% [165/176] vs 97.9% [183/187], p = 0.049).ConclusionThe no-touch technique may improve the early patency rate of a GSV bridge, and its effect is similar to that of a LIMA bridge.

Short-term assessment of radial artery grafts with multidetector computed tomography

BackgroundThe clinical use of the radial artery (RA) in coronary artery bypass grafting (CABG) is still limited worldwide, although it has been recommended by several guidelines. Multidetector computed tomography (MDCT) is widely used to evaluate graft patency, as invasive coronary angiography could cause potentially serious risks including bleeding, dissection and stroke. This study aims to report the short-term results of the RA in CABG with MDCT.MethodsThe study population consists of 41 consecutive patients undergoing elective CABG with the RA graft between 2017 to 2018, with MDCT performed to evaluate graft patency during follow-up, and target vessels for the RA were non-left anterior descending coronary arteries with > 70% stenosis.ResultsA total of 150 grafts were assessed by MDCT during follow-up (mean, 8.9 ± 5.1 months). MDCT could clearly show the structure and patency of grafts, even for complex coronary artery revascularization. Graft patency of the left internal mammary artery was 92.9% (39/42), with the RA patency of 84.4% (38/45) and the patency of the saphenous vein graft of 81.1% (30/37). And the RA anastomosed to the left coronary artery system might have better patency than the RA anastomosed to the right coronary artery system (25/29, 86.2% vs 13/16, 81.3%, p = 0.686).ConclusionsThe short-term patency rate of RA grafts is good, and the RA might be associated with better patency when anastomosed to the left but not the right coronary artery. MDCT could provide excellent visualization of grafts in CABG.

Use of the Ranger Paclitaxel-Coated Balloon in Patients With Chronic Limb-Threatening Ischemia: Short-Term Safety and Efficacy Results From Singapore

Chronic limb-threatening ischemia, also known as critical limb ischemia (CLI), is the most advanced stage of peripheral arterial disease (PAD), and patients have high risk of major lower-limb amputation and mortality. An endovascular-first approach has become the preferred revascularization strategy for these patients. The aim of the study was to evaluate the safety and short-term efficacy of the Ranger paclitaxel-coated balloon (PCB; Boston Scientific) in the setting of CLI. Methods. This was a single-center, single-arm, multi-investigator, prospective study of CLI patients who underwent endovascular revascularization using the Ranger PCB from July 2019 to November 2019 at Singapore General Hospital in Singapore. Data were retrieved from the Vascular Quality Initiative database recently set up at this institution. Primary lesion patency, amputation-free survival (AFS), freedom from target-lesion revascularization (TLR), and complete wound healing were the efficacy endpoints of interest at 6 months post intervention. Results. A total of 84 patients (87 limbs; 229 lesions) were enrolled. Fifty-one of the 84 patients (60.7%) were men. Baseline characteristics included diabetes mellitus in 76/84 patients (90.5%), chronic renal impairment in 25/84 patients (29.8%), and Rutherford category 6 foot wounds in 22/87 limbs (24.7%). TASC D lesions were present in 63/229 lesions (27.9%) and moderate/severe vessel wall calcification was present in 167/229 lesions (72.9%). Immediate technical success was achieved in 218/229 lesions (95.2%) with no device-related mortality at 30 days. Primary patency rates at 3 months and 6 months were 76/82 (92.7%) and 69/81 (85.2%), respectively. Six-month primary patency rates of below-the-knee (BTK) lesions treated with and without Ranger balloons were 89/94 (94.7%) and 34/41 (82.9%), respectively (P=.03). Six-month AFS occurred in 68/78 (87.2%) and freedom from TLR occurred in 73/81 (90.1%). Six-month complete wound healing rate was respectable, at 28/50 (56.0%). Conclusion. Use of the Ranger PCB showed favorable outcomes and short-term patency rates, especially in the BTK region, in what is an otherwise challenging patient cohort. Extended follow-up is awaited to evaluate the long-term safety and efficacy of the balloon.

Outcomes of balloon angioplasty for failing upper extremity dialysis access

Background Percutaneous transluminal angioplasty (PTA) is the mainstay of treatment in stenosed hemodialysis access. Being less invasive and outpatient procedure, PTA is a safe and useful intervention to maintain access patency in patients with failing hemodialysis arteriovenous fistulas (AVFs). The aim of this study was to evaluate the efficacy of balloon angioplasty in treatment of patients with failing upper extremity hemodialysis access. Methods This is a prospective study of all adult patients who underwent balloon angioplasty for the treatment of patients with symptoms of a failing dialysis access due to presence of significant stenosis in dialysis access circuit. The study conducted at the Department of Vascular and Endovascular Surgery, Assiut University Hospital (a tertiary referral hospital), between January 2017 and December 2018. Both the primary and assisted primary patency rates were analyzed by the Kaplan-Meier plot method. Results 149 patients underwent PTA for treatment of failing dialysis access symptoms. The most common site of stenosis in our study was the juxta-anastomotic site (49 %). The overall success rate was 96.6%. Balloon angioplasty was performed in all patients without stent placement. Sixteen (10.7%) complications were encountered in the study. At 1 year, the primary patency and the assisted primary patency rates was 60.5% and 80%, respectively. Age of the fistula (P=0.017), presence of multiple lesions (P=0.016), total lesion length >5cm (P=0.030), and diabetes mellitus (P=0.012) were significant independent predictors of loss of primary patency. Conclusions Balloon angioplasty is safe and effective treatment modality for treatment of stenosis in failing hemodialysis access patients with good technical success and acceptable short-term primary patency rates. Repeated interventions are required to maintain patency.

Assessment of the Endovascular Management of Flush Superficial Femoral Artery (SFA) Total Occlusion

Background: Involvement of the superficial femoral artery (SFA) in occlusive peripheral arterial disease (PAD) is extremely common representing 80% of the symptomatic patients undergoing angiography. Objectives: This study aimed to assess the endovascular management of flush SFA total occlusion in patients with PAD and with critical chronic lower limb ischemia due to flush occlusion of the SFA in the Vascular Surgery Department in Al-Azhar University Hospitals. Patients and Methods: Patients with chronic PAD and aged 40–65 years, with SFA flush total occlusion including heavily calcified, long, and fibrotic lesions, and the occlusions up to 15 cm long in the SFA were included in the current study. Patients were subjected either to contralateral approach, ipsilateral antegrade approach, ipsilateral horizontal puncture, or retrograde access to the SFA via popliteal or dorsalis pedis. Results: An overall 20 patients were enrolled in the current study with a mean age of 59.5± 6.77 years. There were 55% females and 45% males. The risk factors distribution among the studied group were diabetes mellitus (100%), hypertension (65%), smoking (65%), chronic hepatic disease (65%), dyslipidemia (55%), and only 5% had chronic vascular disease. Patients were clinically presented by toe gangrene (35%), followed by foot gangrene (25%), as the main presentation. Conclusion: Endovascular management strategies of flush SFA total occlusion in patients with PAD due to SFA total occlusion can be safely used with acceptable technical success, short term patency rates, and limb salvage.

Assessment of the Endovascular Management of Flush Superficial Femoral Artery (SFA) Total Occlusion

Background: Involvement of the superficial femoral artery (SFA) in occlusive peripheral arterial disease (PAD) is extremely common representing 80% of the symptomatic patients undergoing angiography. Objectives: This study aimed to assess the endovascular management of flush SFA total occlusion in patients with PAD and with critical chronic lower limb ischemia due to flush occlusion of the SFA in the Vascular Surgery Department in Al-Azhar University Hospitals. Patients and Methods: Patients with chronic PAD and aged 40–65 years, with SFA flush total occlusion including heavily calcified, long, and fibrotic lesions, and the occlusions up to 15 cm long in the SFA were included in the current study. Patients were subjected either to contralateral approach, ipsilateral antegrade approach, ipsilateral horizontal puncture, or retrograde access to the SFA via popliteal or dorsalis pedis. Results: An overall 20 patients were enrolled in the current study with a mean age of 59.5± 6.77 years. There were 55% females and 45% males. The risk factors distribution among the studied group were diabetes mellitus (100%), hypertension (65%), smoking (65%), chronic hepatic disease (65%), dyslipidemia (55%), and only 5% had chronic vascular disease. Patients were clinically presented by toe gangrene (35%), followed by foot gangrene (25%), as the main presentation. Conclusion: Endovascular management strategies of flush SFA total occlusion in patients with PAD due to SFA total occlusion can be safely used with acceptable technical success, short term patency rates, and limb salvage.

Long Term Evaluation of Nanofibrous, Bioabsorbable Polycarbonate Urethane Grafts for Small Diameter Vessel Replacement in Rodents

Biodegradable materials for in situ vascular tissue engineering could meet the increasing clinical demand for sufficient synthetic small diameter vascular substitutes in aortocoronary bypass and peripheral vascular surgery. The aim of this study was to design a new degradable thermoplastic polycarbonate urethane (dPCU) with improved biocompatibility and optimal biomechanical properties. Electrospun conduits made from dPCU were evaluated in short and long term follow up and compared with expanded polytetrafluoroethylene (ePTFE) controls. Both conduits were investigated prior to implantation to assess their biocompatibility and inflammatory potential via real time polymerase chain reaction using a macrophage culture. dPCU grafts (n=28) and ePTFE controls (n=28) were then implanted into the infrarenal abdominal aorta of Sprague-Dawley rats. After seven days, one, six, and 12 months, grafts were analysed by histology and immunohistochemistry (IHC) and assessed biomechanically. Anti-inflammatory signalling was upregulated in dPCU conduits and increased significantly over time invitro. dPCU and ePTFE grafts offered excellent long and short term patency rates (92.9% in both groups at 12 months) in the rat model without dilatation or aneurysm formation. In comparison to ePTFE, dPCU grafts showed transmural ingrowth of vascular specific cells resulting in a structured neovessel formation around the graft. The graft material was slowly reduced, while the compliance of the neovessel increased over time. The newly designed dPCU grafts have the potential to be safely applied for in situ vascular tissue engineering applications. The degradable substitutes showed good invivo performance and revealed desirable characteristics such as biomechanical stability, non-thrombogenicity, and minimal inflammatory response after long term implantation.

SAT-046 RESULTS OF THE GRACZ FISTULA CONSTRUCTED BY THE NEPHROLOGIST

Gracz arteriovenous fistula (AVF) at the elbow involves an end to side anastomosis between the and of the perforating vein to the median cubital vein to the side of brachial artery (Fig 1). The anastomotic site is below the elbow crease. This analysis was aimed to assess fistula patency, maturation and complication rates in Gracz elbow fistulas constructed by the Nephrologist. At our Nephrology centres, all AVF surgeries are performed by the Interventional Nephrologists (SRB and SSS) independently. Case records and follow up data of all patients undergoing Gracz AVF during the study period of April 2014 to March 2016 was retrieved. AVF outcome was assessed by short term fistula patency (first 24 hrs), medium term patency (upto 3 months), fistula maturation and complications. Gracz AVF was constructed whenever operating Nephrologist observed a suitable perforating vein available for anastomosis. In rest of the patients more conventional elbow AVF (side to side median cubital vein to the brachial artery; end to side median cubital to the brachial artery; end to side cephalic vein to the brachial artery or end to side basilic vein to the brachial artery) were contructed. Short term patency rate was defined as a clinically audible bruit with colour doppler evidence of patent AVF. Medium term patency rate was defined as a clinically audible bruit with colour doppler evidence of > 600 ml/min blood flow in cephalic vein in arm. AVF was considered mature if successfully cannulated by 16 G” AVF needle with blood flow rate of >250 ml/min. Surgical steps in Gracz Fistula at elbow : The perforating vein to the brachial vein is identified and tied Brachial artery identified and arteriotomy is done After successful end of the perforating vein to the side of the artery anastomosis During the study period a total of 53 Gracz elbow AVF were constructed which accounted for 10.9 % of all AVF and 30.4 % of all elbow AVF. Of all Gracz fistulae, left elbow was the site for 77.4 % cases. 51 patients had short term patency (96.2 %). Of these, 2 patients died within 3 months period and 4 were lost to follow up. Out of 47 patients available for follow up 43 patients met medium term patency criteria (91.4%). All but 2 AVFs were successfully cannulated 3 weeks after the surgery. One patient had delayed wound healing and one patient had limb edema during the follow up period. The Gracz elbow fistula has very good success rate. Such surgeries can be performed by the Nephrologists independently

PC042. Performance of Gore Viabahn VBX Compared With Atrium iCast as Bridging Stents During Fenestrated Endovascular Aortic Repairs

Fenestrated endovascular aneurysm repair (FEVAR) is a well-established, effective technique for complex abdominal and thoracoabdominal aneurysm repair. Among various bridging stents, Atrium iCast (Maquet, Rastatt, Germany) covered stents have been adopted by many as the device of choice, with excellent outcomes. Recently, Gore Viabahn VBX stents (W. L. Gore & Associates, Flagstaff, Ariz) became commercially available in the United States. The aim of our study was to compare our experience with VBX and iCast as bridging stents during FEVAR. A retrospective review was performed of FEVARs for complex abdominal and thoracoabdominal aneurysms at a single institution from 2015 to 2018. All patients were at high risk for open repairs. Custom-manufactured or physician-modified devices were implanted. Bridging stents across reinforced fenestrations were included in the study. VBX and iCast stents were compared for technical success, branch patency, branch-related endoleak, and reinterventions. There were 75 patients who underwent FEVAR during the study period; 10 patients had juxtarenal, 23 had pararenal, and 41 had thoracoabdominal aortic aneurysms, and 1 had a pseudoaneurysm. Twenty-four patients were symptomatic, and three patients presented with rupture. A total of 197 branch vessels were targeted with fenestrations. Of 197 targeted branch vessels, 193 (34 celiac, 55 superior mesenteric artery [SMA], 104 renals) were bridged successfully (98%). Four target vessels (three renals and one dominant intercostal) could not be bridged because of severe aortic tortuosity causing fenestration misalignment. A total of 87 vessels were incorporated with iCast and 106 vessels with VBX. The mean follow-up was 5.5 months (6.7 months for iCast and 3.8 months for VBX). Secondary relining stents were used in 14 (16.1%) iCast branches (1 celiac, 3 SMA, and 10 renals) and 8 (7.5%) VBX stents (4 SMA, and 4 renals; P = .072). The 6-month branch patency for iCast was 96.2%, with one celiac and one renal in-stent stenosis; the 6-month patency for VBX was 97.4%, with one celiac branch occlusion (P = .661). At 6 months, there were no branch-related endoleaks for iCast, whereas six VBX branch (5.7%) vessels had type IC endoleak due to branch stent undersizing (P = .033). There were no type III endoleaks across the fenestration seal in either group. Overall short-term branch-related reintervention rate was 0% for iCast and 2.8% (3/106) for VBX (P = .253). One celiac and two SMA endoleaks were intervened on in the VBX group. Gore Viabahn VBX and Atrium iCast show high short-term patency and low endoleak rates as bridging stents during fenestrated endovascular repair of complex abdominal and thoracoabdominal aneurysms. Longer follow-up is needed to assess late device-related complications.

AA10. Safety, Feasibility, and Efficacy of the Gore Excluder Side Branch Endoprosthesis in the Treatment of Aortobi-Iliac Aneurysms With Preservation of the Internal Iliac Artery in 23 Consecutive Patients

The Gore Excluder (W. L. Gore & Associates, Flagstaff, Ariz) side branch endoprosthesis for iliac arteries (iliac branch endoprosthesis [IBE]) is a new device for the treatment of solitary or combined aortobi-iliac arterial aneurysms, mainly to prevent major complications occurring from an occluded internal iliac artery. The objective of our study was to evaluate the safety, feasibility, and efficacy of the Gore Excluder IBE in the treatment of iliac artery aneurysms. All consecutive patients who underwent iliac artery repair using the Gore Excluder IBE device in our clinic since 2016 were included. Indication, localization, operation time, blood loss, and hospitalization time as well as complication, reintervention, and patency rates were evaluated. All values are given as median (range). Statistical analysis was performed by non parametric paired tests. Between February 2016 and December 2017, there were 29 asymptomatic iliac aneurysms (4 solitary, 25 combined; 5 double sided) treated in 23 consecutive patients (age, 68 [53-82] years; body mass index, 29 [23-29] kg/m2; 1 female) using the Gore Excluder IBE. The implantation was successful in 28 of 29 cases (97%); in one case, implantation failed because of distinctive atherosclerosis of the internal iliac artery. Hospitalization time was 7 (5-15) days, operation time, 179 (80-541) minutes; and blood loss, 400 (100-3000) mL. Hemoglobin concentration was 14 (11-16) g/dL preoperatively and 12 (9-14) g/dL directly postoperatively (P = .0001). The transfusion of two (two patients) and four, respectively, red cell concentrates was necessary in three patients. Creatinine concentration was 1.02 (0.5-1.62) mg/dL preoperatively and 0.88 (0.39-1.51) mg/dL directly postoperatively (P = .07). Perioperative mortality rate and 30-day reintervention rate were 0%. Double platelet aggregation was used for 6 months postoperatively. Major complications were one cholesterol embolism and one contrast agent-induced nephropathy, not requiring dialysis. The median follow-up time was 5 months (2 weeks-1 year), with an overall patency rate of 96% of the IBEs (27/28 devices) as one patient refused the double platelet inhibitor application. The treatment of aortobi-iliac arterial aneurysms using the Gore Excluder IBE is safe and feasible and results in high short-term patency rates. To validate long-term results, long-term follow-up of the treated patients is required, ideally using duplex ultrasound and contrast-enhanced ultrasound or computed tomography angiography.

Outcome of drug-eluting balloon angioplasty versus endarterectomy in common femoral artery occlusive disease

ObjectiveCommon femoral artery (CFA) occlusive disease remains a debatable site for endovascular therapy, and the outcome of drug-eluting balloon (DEB) angioplasty in treating CFA occlusive disease is largely unknown. This study compared the efficacy, safety, and short-term patency rate of DEB angioplasty and femoral endarterectomy for treatment of CFA occlusive disease. MethodsFrom March 2013 to June 2016, there were 100 patients with symptomatic CFA occlusive disease who were retrospectively reviewed. Forty patients were treated with DEB angioplasty and 60 were treated with femoral endarterectomy. Each patient received regular follow-up. Patency rate, ankle-brachial index, target lesion revascularization, and adverse events were assessed. ResultsTechnical success was 100% in all patients. The DEB group had a lower 1-year primary patency rate (75.0% vs 96.7%; P = .003), but the secondary patency rate was similar between the two groups (97.5% vs 98.3%; P = 1.000). At 2-year follow-up, the primary patency was lower in the DEB group (57.1%) than in the endarterectomy group (94.1%; P = .001), whereas the secondary patency rate had no significant difference (90.5% vs 97.1%; P = 1.000). Both groups had significant improvement in ankle-brachial index. Freedom from target lesion revascularization was lower in the DEB group both at 1 year (75.0% vs 96.7%; P = .003) and at 2 years (57.1% vs 94.1%; P = .001). There was no significant difference in the incidence of complications and adverse events. ConclusionsFemoral endarterectomy has a better primary patency rate compared with DEB angioplasty in treating CFA occlusive disease without significant increase in complications. In patients not suitable for endarterectomy, DEB angioplasty provides a similar secondary patency rate and could be considered an alternative treatment.

Explant portal vein for reconstructing middle hepatic vein in right lobe living donor liver transplantation-outcome analysis

BackgroundThe aim of the study was to study the four week patency rates of the reconstructed neo middle hepatic vein specifically using the explant portal vein (PV) in right hemiliver live donor liver transplantation (LDLT). We hypothesized that short term patency of the neo-MHV should result in good graft and patient outcomes. MethodsPre, intra and post operative variables were prospectively collected for 88 consecutive patients undergoing right hemiliver LDLT from January 2014 to October 2015. ResultsExplant PV was used to reconstruct neo-MHV in 76 (86.4%, 76/88) patients. Neo MHV patency rate at 28 days with explant PV was 89.4% (59/66) and with other conduit (PTFE) was 90.9% (10/11). All occlusions were detected after 7 days. There was no impact of the patency of the neo-MHV on the incidence of early allograft dysfunction, sepsis, rejection, morbidity or mortality, despite the contribution of the anterior sector to the graft volume being more than 50% in close to two-thirds of patients. ConclusionThe reconstructed neo-MHV has excellent short term patency rates at 4 weeks. Perhaps due to the absence of early occlusions, there was no impact on graft or patient outcomes in the study population.