Terms Of Patency Research Articles

Vasectomy reversal: Unilateral versus bilateral vasovasostomy.

The aim of this study was to evaluate and compare the efficiencies of unilateral and bilateral vasovasostomies as the vasectomy reversal procedures. A total of 95 patients with a history of bilateral vasectomy were evaluated. 42 of them had undergone unilateral surgery, and bilateral surgery had been done for the other 53 patients. Their information including the age, the time interval between the initial vasectomy to the reversal surgery and other underlying illnesses or medications was gathered. Patency rates in the unilateral and bilateral groups were 88.1% (38 patients) and 88.7% (48 patients), respectively, the difference of which was not statistically significant (p=.907). Successful pregnancies occurred in 22 (52.4%) and 29 (54.7%) patients, respectively, which did not show any statistically significant difference too (p=.713). Based on the multivariate logistic regression model, only the time interval between vasectomy and the reversal (duration of obstruction) was predictive of patency (OR=1.112, p=.037). The outcomes of the unilateral and bilateral vasovasostomies in terms of patency and pregnancy rates were not significantly different. We suggest that performing unilateral, instead of bilateral, vasovasostomy can reduce the time of anaesthesia and surgery and save costs and consumables without having a significant negative impact on the surgical outcomes.

Cost-effectiveness analysis of radiobasilic and brachiobasilic arteriovenous fistulas in hemodialysis patients.

We evaluated the cost and efficacy of radiobasilic and brachiobasilic arteriovenous fistula (AVF) methods in terms of forearm autogenous arteriovenous access in hemodialysis patients. We used a decision tree to compare the cost-effectiveness of proximal radiobasilic AVF (pRBAVF) and brachiobasilic AVF (BBAVF), considering the mean direct medical costs and patency rates. The overall mean cost of pRBAVF per patient (1767.59 Turkish lira [TL]) was lower than that of BBAVF (1877.99 TL). Also, the mean patency duration per patient was higher for pRBAVF (25.72 months) than BBAVF (20.21 months). The incremental cost-effectiveness ratio (ICER) showed that pRBAVF was 20.04-fold more effective than BBAVF. The monthly ICERs also favored pRBAVF, which was less costly and more effective. The pRBAVF provided clinical and economic benefits for hemodialysis patients requiring forearm autogenous arteriovenous access. pRBAVF was more effective in terms of patency than BBAVF, and was also less expensive.

"Ranger BTK" a Prospective Single-Centre Cohort Study on a New Drug-Coated Balloon for Below the Knee Lesions in Patients with Critical Limb Ischemia.

Restenosis remains a limitation of endovascular angioplasty with a patency of 30% in BTK at 12months. Several studies on drug-coated balloons have not demonstrated any improvements in terms of patency and target lesions revascularization in BTK lesions. This prospective single-centre cohort study evaluates the safety and efficacy of a new generation low-dose drug-coated balloon (DCB) with a reduced crystalline structure to treat below the knee (BTK) lesions in patients with critical limb ischemia (CLI). Between November 2016 and November 2017, 30 consecutive patients (mean 68.8 ± 12.7years, 6 female) with BTK lesions and CLI were included in this single-centre, prospective non-randomized cohort study. All patients with rest pain and/or ischemic wound associated with BTK lesions were included in the study. Mean lesion length was 133.6 ± 94.5mm and 18(60%) were chronic total occlusions. The primary safety outcome parameter was a composite of all-cause mortality and major amputation at 6months. The primary efficacy outcome parameter was the primary angiographic patency at 6months (defined as freedom from clinically driven target lesion revascularization and the absence of significant restenosis (> 50%) as determined by core laboratory angiography assessment. Immediate technical success, late lumen loss (LLL), clinical target lesion revascularization (TLR) and ulcer healing rates at 12months were also evaluated. Immediate technical success was 97%(29/30): one patient had an acute thrombosis at the completion of index procedure. Primary safety outcome parameter was 94%(28/30): one patient underwent major amputation and one patient died of other comorbidities at 2months. Another patient had a major amputation at 7.5months. Angiographic follow-up was available in 20 patients. Primary angiographic patency was 57%(12/21 lesions), and LLL was 0.99 ± 0.68mm at 6months. Freedom from TLR was 89% at 12months. The rate of ulcer healing was 76% at 12months. Ranger DCB balloons to treat CLI patients demonstrated a positive trend with good safety outcomes parameters. Further randomized studies are needed to understand the usefulness compared to POBA.

Paclitaxel- and Sirolimus-coated Balloons in Peripheral Artery Disease Treatment: Current Perspectives and Concerns

Drug-coated balloons (DCBs) have become an established therapy for the treatment of above-the-knee peripheral artery disease. The paclitaxel DCB has shown clinical benefit in terms of patency and freedom from re-intervention in multiple randomised trials. However, a recent meta-analysis has suggested an association between mortality and the use of paclitaxel-coated devices. Sirolimus is another potential choice of anti-proliferative agent for use in DCBs because of its wider therapeutic index and lower risk for dose-dependent toxicity. More recently, encapsulating sirolimus in micro-reservoirs or polymers has facilitated the development of effective sirolimus DCBs, some of which are available in Europe and Asia. In this review, the authors focus on paclitaxel and sirolimus DCB technologies from the standpoint of drug characteristics and clinical trials.

Limb Occlusion Rate after EVAR With Individualized Graft Limb Selection and a Liberal Protocol of Primary Relining

This study analyses limb occlusion rates after endovascular aneurysm repair (EVAR) with a strategy including stent-graft limb selection and liberal primary stenting (relining) in anatomies at higher risk for occlusion with uncovered self-expandable or balloon-expandable stents. All patients undergoing elective EVAR with a bifurcated stent-graft between January 2010-August 2018 were included. A protocol involving personalized stent-graft selection and liberal primary relining based on preoperative imaging was followed during the whole period. Primary endpoints were technical success and primary limb patency during follow-up. Secondary endpoints included mortality and limb reintervention rates. Risk factors associated to limb patency and reintervention rates were analyzed. Six hundred and fifteen patients (548 males; mean age 72.9 ± 9 years) were included. Overall technical success was 98.5% (606/615). One (0.16%) patient died during the first 30 days. Of the 1230 limbs, 96 (8%) were deemed at risk for occlusion in view of the anatomy, and primarily relined in 62 patients. Estimated primary limb patency at 6 months, 1 year and 3 years was 99.5 ± 0.2%, 99.2 ± 0.3% and 98.5 ± 0.5%, respectively. Freedom from limb-related reintervention at 6 months, 1 year and 3 years was 98.1 ± 0.4%, 97.4 ± 0.5% and 95.6 ± 0.7%, respectively. Only one (1%) of the 96 relined limbs occluded during follow-up. No differences were found in terms of patency or freedom from reintervention between limbs at risk that were primary stented and limbs without adjunctive stents. Gore Excluder stent-grafts presented better patency (Breslow P = 0.005) and lower reintervention rates (Breslow P = 0.001) than other devices during follow-up. Peripheral artery disease was also a risk factor for reintervention (Breslow P = 0.015). Liberal use of primary limb relining in patients with iliac anatomy at higher risk for occlusion appears to be a safe and effective strategy to preserve limb patency after EVAR. Gore Excluder graft limbs present better patency and lower reintervention rates than other stent-graft types.

Feasibility and safety of percutaneous hydrodynamic thrombolysis techniques in management of acute proximal lower limb deep vein thrombosis

Introduction Currently, there are different treatment options of deep vein thrombosis (DVT) available, and all of which have their own associated adverse effects. Pharmacomechanical thrombolysis (PMT) is a minimally invasive catheter-based intervention that uses a retrograde-directed saline jet under pressure to fragment, macerate, or disrupt the occlusive venous thrombus after lacing it with thrombolytic drugs followed by aspiration of the thrombus material. Patients and methods This is a prospective study examining the use of PMT in management of unilateral acute lower limb DVT for some cohort of patients with no contraindication to thrombolysis who presented to our vascular surgery units in the period from December 2019 to June 2020. Results A total of 25 patients with acute proximal lower limb DVT were selected for PMT, with an average age of 43.2 years (range: 27–53 years). There were 13 (52%) females and 12 (48%) males. PMT was found to be successful in 21 (84%) patients. The procedure time ranged from 28 to 55 min (average 45 min), and in all patients, the access was gained via the ipsilateral popliteal vein. At first month, the patency rate was found to be 84% (21/25) and 76% at the sixth month (19/25). Conclusion In selected group of patients with no contraindications to thrombolysis, PMT can be safely used with good results in terms of patency and lower incidence of developing postthrombotic limb symptoms.

Pessary use in patients diagnosed with short cervix and cervical insufficiency

Objective The aim was to evaluate the effectiveness of Arabin pessary use in patients with cervical insufficiency or short cervix before the 24th week of gestation and the impact of cervical examination findings prior to pessary application on the outcome in terms of the gestational week. Materials and methods In our study, among the pregnancies between the 12th and 24th gestational weeks, 60 pregnant women with a preterm delivery history and/or cervical length less than 25 mm were included. Among these 60 patients, 43 of them had a short cervix, 17 of them had cervical insufficiency. Routine medical and obstetric history was obtained. In the vaginal examination, the cervix was evaluated in terms of patency, dilatation, and position. Cervical length, presence of debris, and funneling were evaluated by transvaginal ultrasound. After receiving patients’ approval a cervical pessary was applied to patients. Pessaries of pregnant women with 37 weeks of gestation were removed. Before reaching the 37th gestation week, pessaries were withdrawn in patients who had ongoing vaginal bleeding, premature rupture of membranes, and preterm contractions unresponsive to tocolytic treatment. Results Thirty-one pregnant women (51.7%) out of 60 pregnant women who underwent pessary, delivered at 37 weeks and below. Delivery rates in the short cervical measurement group and cervical insufficiency group at ≤28 weeks, ≤34 weeks and ≤37 weeks were respectively (n = 21) 34.8% vs 36.3% (p = 0.976), (n = 29) 41.8% vs 64.7% (p = 0.111), (n = 31) 44.2% vs 70.6% (p = 0.888). The presence of cervical funneling before pessary application shows a statistically significant difference in terms of patient’s giving birth before or after 28 weeks (p = 0.033). In patients with cervical funneling, there was a significant increase in a birth before 28 weeks. Depending on whether or not patients applying with pain need for tocolysis, it shows the statistically meaningful difference in terms of the patients giving birth before or after 34 weeks (p = 0.001) (OR 7, 61, 95% GA 2.4–24.6). In the group without the need for tocolysis, there is a meaningful increase in birth after 34 weeks. Conclusions Our findings showed that, alongside the defined cervical risk factors, cervical funneling and the need for tocolysis are remarkable prognostic variables in pessary application.

Single Asian Center Experience Using the Flixene™ Early Cannulation Graft for Hemodialysis Access Creation

The aim of this study was to review the efficacy of the Flixene™ (Atrium™, Hudson, NH, USA) hemodialysis arterio-venous graft (AVG) in a multiethnic Asian cohort of patients with end-stage renal failure (ESRF). Primary outcome was graft primary patency rate and secondary end points included graft usability, time to cannulation, reinterventions required for access salvage, complications, and patient mortality. Single-center, single-arm, multi-investigator nonrandomized retrospective study. Patients with ESRF who underwent Flixene™ graft implantation over a two-year period (January 2017 - December 2018) were included to allow at least one-year follow-up. Demographics, procedural and follow-up data were collected from the hospital electronic medical records. About 48 patients (49 AVG) were included. There were 24 (50%) men; mean age 63.7 (IQR 58.2-71.3) years. Technical success rate was 45/49 (91.8%); 4/49 (8.2%) AVG created did not reach cannulation. 11/49 (22.4%) and 28/49 (57.1%) achieved cannulation within 1 and 2weeks, respectively. 6- and 12- month primary patencies were 33.5% and 19.6%, respectively. Primary-assisted patency rates were 46.6% and 29.6% at the same time intervals. Secondary patency rate was 77.6% and 63.9% at 6 and 12months, respectively. There were 6 (12.2%) graft infections requiring explant and one-year mortality was 14%. Our experience with the Flixene™ early cannulation graft is comparable with other AVGs in terms of patency and infection rates. However, early cannulation rates are lower than in other case series.

Retrograde ankle tibial artery approach for endovascular treatment of below-knee chronic critical limb ischemia: appraisal of early outcome and complications

Background Infragenicular arterial total occlusion is a major cause of critical ischemia of the lower limbs (CLTI) treated by endovascular intervention. Retrograde pedal artery access is an alternative method to cross total occlusion from below when antegrade passage fails. The aim of this study was to evaluate the short-term outcome in terms of patency, limb salvage, redoangioplasty rate, and complications. Patients and methods From June 2018 to July 2019, adult patients who had critical lower limb ischemia (Rutherford 4 and 5) were admitted to the vascular surgery unit of Alexandria main university hospital and department of CLTI clinical and experimental surgery at Alexandria medical research institute. They all were planned to be treated by infragenicular angioplasty. After failure of antegrade lesion crossing, angioplasty was done via retrograde access. Patients were followed for outcome and complications for 6 months. Results A total of 20 patients were included, comprising 14 (70%) males and six (30%) females. Mean age±SD was 71±13.5 years. Overall, 85% were diabetic, 75% hypertensive, 30% coronary heart disease, and 80% were smokers. CLTI clinical presentation was ischemic rest pain (20%) and tissue loss and gangrene (80%). Technical success was 85%. There were no procedural mortalities or complications except one case of limited leg hematoma (5%). The 6-month mortality was 5.8%, and major amputation was 5.8%. The 6-month primary and secondary patency rates were 62.5 and 87.5%, respectively, whereas the 6-month limb salvage rate was 93.75%. Conclusions Retrograde pedal access angioplasty to treat below-knee CLTI is a safe and feasible alternative to antegrade tibial angioplasty when it fails, with similar limb salvage and acceptable complications, but with possible higher reintervention rate, which needs to be studied further on a larger scale.

Popliteal venous aneurysms: Retrospective monocentric series of 26 cases. Diagnosis, treatment and immediate and 4-year results

Popliteal venous aneurisms (PVA) are rare. Sometimes revealed by a thromboembolic complication, a deep venous thrombosis (DVT) and/or a pulmonary embolism (PE), they can be life-threatening. They are frequently diagnosed fortuitously during a systematic ultrasound examination for the assessment of chronic superficial venous insufficiency (CSVI). The aim of this study was to report the modes of discovery, the anatomical criteria, the methods of management, and the immediate and mid-term postoperative results in terms of patency or thromboembolic recurrence.

A Novel Hybrid Silk Fibroin/Polyurethane Arteriovenous Graft for Hemodialysis: Proof-of-Concept Animal Study in an Ovine Model.

To solve the problem of vascular access failure, a novel semi-degradable hybrid vascular graft, manufactured by electrospinning using silk fibroin and polyurethane (Silkothane), has been previously developed and characterized in vitro. This proof-of-concept animal study aims at evaluating the performances of Silkothane grafts in a sheep model of arteriovenous shunt, in terms of patency and short-term remodeling. Nine Silkothane grafts are implanted between the common carotid artery and the external jugular vein of nine sheep, examined by palpation three times per week, by echo-color Doppler every two weeks, and euthanized at 30, 60, and 90 days (N = 3 per group). At sacrifice, grafts are harvested and submitted for histopathology and/or scanning electron microcopy (SEM). No cases of graft-related complications are recorded. Eight of nine sheep (89%) show 100% primary unassisted patency at the respective time of sacrifice (flow rate 1.76±0.61L min-1 , one case of surgery-related thrombosis excluded). Histopathology and SEM analysis evidence signs of inflammation and pseudointima inside the graft lumen, especially at the venous anastomosis; however, endoluminal stenosis never impairs the functionality of the shunt and coverage by endothelial cells is observed. In this model, Silkothane grafts grant safety and 100% patency up to 90 days.

Endarterectomy with "systematized" resection anastomosis of carotid bulb, about 240 cases.

Carotid endarterectomy has traditionally been the strategy for the surgical management of carotid stenosis. Alongside the usual techniques, this study presents another technique: endarterectomy with systematized resection-anastomosis. A retrospective study from January 2006 to December 2018, included all patients managed for carotid stenosis at Meaux hospital with the "endarterectomy with systematized resection-anastomosis" technique. The perioperative death and stroke rate were evaluated according to the judgment criterion "homolateral ischemic stroke and any stroke or perioperative death". Statistical analysis of the data was performed using SPSS software. For 415 carotids operated, we identified 240 managed with this technique. The average age was 71.7±9.6 years, 70% men and 30% women. The main cardiovascular risk factor was hypertension (76.7%), 24.2% of patients had an ischemic heart disease history, 43.7% homolateral ischemic stroke and 29% transient ischemic attack. Bilateral lesions were diagnosed in 6.2% of patients and 7.5% had contralateral occlusion. Carotid stenosis was symptomatic in 52.9% of patients. The average stenosis rate observed was 82.9±8.1% on computed tomography angiogram and 83.7±7.7% on magnetic resonance angiogram. The shunt was used in 45.4% of procedures. The average length of stay was 5.9±2.3 days. All patients had satisfactory results in terms of patency and anatomical appearance on the 1st check. In the post-operative period during the first month, complications occurred in 12.5% of patients (1.6% acute coronary syndrome, 0.8% neurological event, 0.8% death, 0.4% infection, 12.1% hematoma, 1.6% recovery for bleeding). The overall perioperative death and stroke rate was 2.6%. Myocardial infarction and sepsis were the causes of death for the 2 patients in the peri operative period. The mean duration of follow-up was 21.2 months, without any restenosis or occurrence of neurological complications. One patient died beyond the 1st month of follow-up without established cause, and the overall mortality rate was 1.3%. Thromboendarterectomy with "systematized" anastomosis resection represents an angioplasty method for carotid stenosis surgical management under visual control.

Increased mortality with paclitaxel-eluting stents is driven by lesion length

BackgroundEndovascular stenting has become the first-line treatment of symptomatic peripheral artery disease of the femoropopliteal axis (FPA). Several randomized clinical trials have reported that paclitaxel-eluting stents (PESs) significantly reduce the rates of restenosis. However, a meta-analysis investigating paclitaxel-coated devices in the FPA showed a significant increase in all-cause mortality after the use of PES. The aim of this study was to compare the long-term, real-world outcomes of bare-metal stents (BMSs) and PESs for treating FPA occlusive disease. MethodsA retrospective review of the medical records of 296 patients who underwent FPA stenting between January 2011 and December 2017 was performed. Patients were grouped into BMS and PES groups. The primary end point was all-cause mortality. Secondary end points included limb salvage, primary patency, primary assisted patency, and secondary patency. A comparison between the two groups within TransAtlantic Inter-Society Consensus (TASC) II subgroups was also performed. ResultsOf the study cohort, 101 patients (34%) received PES, whereas 195 patients (66%) underwent BMS placement. Median follow-up time was 23 months (interquartile range, 7-40 months). The 2-year all-cause mortality estimates were 12% for the PES group compared with 11.4% for the BMS group (P = .26). There were no differences in the 2-year limb salvage (90.7% vs 92%; P = .4), primary patency (78.8% vs 81.1%; P = .62), primary assisted patency (100% vs 96.5%; P = .4), and secondary patency (100% vs 98.6%; P = .26) between the PES and the BMS groups, respectively (all P > .05). These findings persisted when patients were stratified by TASC II lesions. Among patients with TASC C and D lesions, the use of PES was associated with significantly higher 2-year all-cause mortality (23.9% vs 5.1%; P = .05). After adjustment for age and other potential confounders, PES use was associated with significant increase in all-cause mortality (adjusted hazard ratio, 2.3; 95% confidence interval, 1.31-27 P = .02) in TASC C and D patients. ConclusionsConsistent with the meta-analysis of several randomized clinical trials, the use of PES in a real-world setting was associated with a twofold increase in the risk of death. However, these findings were seen only among patients with TASC C and D lesions, who required multiple longer stents and potentially larger paclitaxel dose. There was no advantage in terms of patency in PES vs BMS in this population with extensive disease. Further studies of larger populations are required.

Brachiobasilic Arteriovenous Fistulas do Better than Brachioaxillary Access Grafts in Terms of Patency and Complications: A Single Centre Study

Brachiobasilic Arteriovenous Fistulas do Better than Brachioaxillary Access Grafts in Terms of Patency and Complications: A Single Centre Study

Comparison of Upper Limb Translocated Femoral Vein and Prosthetic Arteriovenous Bridge Grafts.

IntroductionNative veins are an ideal option for dialysis in a patient with chronic kidney disease (CKD) as compared to a prosthetic graft. Femoral vein (FV) translocation to the upper arm is also an alternative to a prosthetic graft as reported in the literature when all options of using the native veins of the arms are exhausted. Thus, we aimed to compare the patency of the upper limb translocated FV arteriovenous fistula (AVF) with a prosthetic arteriovenous bridge graft (AVBG).MethodsIt is a retrospective cohort study that was conducted in the Department of Vascular Surgery, Aga Khan University Hospital. It included adult patients who underwent either upper arm translocation of FV or prosthetic AVBG using the consecutive purposive sampling technique. There were a total of 10 patients who underwent FV translocation AVF and 20 patients who had AVBG in the upper arms.ResultsA total of 30 patients were included in the study. Of these 30 patients, 10 underwent FV translocation AVF and the remaining 20 had AVBG. There was a significant difference in the mean operating time of the two surgeries. The mean operating time in FV translocation was 223 (± 41.5) minutes and in those with AVBG, the mean operating time was 100 (±26.5) (p= <0.001). There was no significant difference in the total length of hospital stay in both procedures performed. The primary patency rate for FV translocation was 90% and 95% in AVBG (p=1.00). Ten percent of FV translocation had a primary failure rate compared with that of AVBG, which was 5% (p=1.00). The mean follow-up period was 61 weeks in the FV translocation group and 64 weeks in the AVG group.ConclusionThere was no significant difference in both groups in terms of patency, length of hospital stay, and fewer complications were observed in the FV translocation group as compared with the AVBG group.

Safety and effectiveness of a new valvulotome: insights from the LIMBSAVE registry.

In the endovascular era peripheral bypass surgery still plays a key role. In situ saphenous vein bypass is a standardized technique. The main limitation of this procedure is the vein diameter. A new hydrophylic valvulotome (HYDRO LeMaitre® Valvulotome; LeMaitre Vascular, Burlington, MA, USA) allows even to disrupt the valves in smaller veins. The aim of this study was to analyze the intraprocedural and technical successes of this new valvulotome. In January 2018 in Italy a national, multicenter, observational, prospective registry based on the examination of treatment of critical limb ischemia with infragenicular bypass adopting in situ saphenous vein technique (LIMBSAVE registry) started the enrollment. Until December 2018 216 patients have been enrolled in the registry. All data concerning the procedures were prospectively collected in a dedicated database. The information included demographics, preoperative risk factors, clinical and diagnostic preoperative assessments, intraoperative features, and discharge outcomes, including the safety and effectiveness of the valvulotome during the surgical procedure. Patients were predominantly male (160, 74.1%) with a mean age of 74.1 years (range 49-95). The mean diameter of the great saphenous vein was 3.7 mm (range 1.7-10) in the proximal part of the thigh, 3.4 mm (range 1.6-7) in the distal part of the thigh, and 3.1 mm in the proximal part of the leg (range 1.6-5). The technical success was obtained in all cases (the bypass pulsed after the utilization of the valvulotome). The valvulotome was able to reach the proximal anastomosis in all cases. The mean number of utilizations was 2.6 (range 1-5). No vein perforation has been detected. In 6 cases (2.8%) a vein adventitial damage occurred. In one case with uncontrolled bleeding (0.5%) the substitution of the deleted vein segment was necessary. Preliminary intraprocedural outcomes of LIMBSAVE registry showed that HYDRO LeMaitre® Valvulotome was safe and effective in disrupting the valves and obtaining the pulsatility of the saphenous vein. The rate of complications related to the utilization of the valvulotome was low. Further examinations are needed to evaluate the long-term outcomes of the bypass in terms of patency, reinterventions, and limb salvage.

SS13. Bypass Configuration Outcomes for Acute Mesenteric Ischemia

Acute mesenteric ischemia is associated with extremely high morbidity and mortality rates. Open revascularization has been considered the “gold standard” treatment; however, there have been concerns about supraceliac clamping in potentially unstable patients as well as patency rates for iliac-based bypasses. The purpose of this study was to compare outcomes for antegrade and retrograde mesenteric bypass configurations in acute mesenteric ischemia. The registry of a single vascular group was queried for bypasses performed for acute mesenteric ischemia. Demographics, operative details, and perioperative and long-term outcomes were recorded and compared using χ2 analysis, Fisher exact test, t-test, and log-rank analysis. There were 53 patients identified who underwent open reconstruction for acute mesenteric ischemia from 2007 to 2017. There were 34 patients who underwent aorta to superior mesenteric artery/common hepatic bypass (antegrade) and 19 who underwent iliac to superior mesenteric artery bypass (retrograde) and were followed up for a mean of 15 months (range, 1-99 months). Demographics and comorbidities, such as hypertension, hypercholesterolemia, coronary disease, tobacco use, diabetes, and renal failure, were similar among the patients. The study included a sex split of 20 male and 23 female patients; 46 bypasses were performed with polytetrafluoroethylene, and 7 bypasses used excised vein as conduit. Operative blood loss was similar between groups (antegrade range, 100-2000 mL; retrograde range, 50-800 mL; P = .664). Perioperative complications were similar between groups and included pulmonary failure, sepsis, abdominal compartment syndrome, bowel ischemia, and myocardial infarction. Five (26.3%) retrograde patients had an attempt at supraceliac clamping; however, technical difficulties secondary to calcific disease led to use of the iliac artery as inflow. Bowel resection rates were similar between groups (antegrade, 20.58%; retrograde, 12.63%; P = 1.0). Perioperative mortality rates were similar (11.32% antegrade vs 9.47% retrograde; P = .378). The 1-year survival rates were similar for antegrade and retrograde (59% vs 42%; P = .247). All bypasses were patent in survivors at 1 year (P = 1.0). Acute mesenteric ischemia is associated with very high mortality rates, and open bypass remains the treatment standard. Bypasses using supraceliac aorta as inflow appear to offer perioperative mortality rates equivalent to those of their iliac-based counterparts. In terms of patency, iliac-based bypasses offered similar outcomes to aorta-based bypasses.

Kalsifiye Stenotik Süperfisyal Femoral Arter Lezyonlarının Tedavisinde Direksiyonel Aterektomi ile Kombine Edilmiş Paklitaksel Salınımlı Balon Anjioplasti ve Kendiliğinden Açılan Nitinol Stent Uygulamasının Karşılaştırılması

Aim: The frequency and variety of endovascular interventions have increased with the rise in peripheral arterial occlusive disease incidence and to lessen undesirable outcomes after peripheral vascular surgery. Extensive calcific stenotic lesions affect patency rates of endovascular interventions and enhance complication rates. In this study we aimed to compare paclitaxel eluting balloon angioplasty (PEBA) combined with directional atherectomy (DA) with self expandable nitinol stent (SENS) implantation in terms of patency rates.Material and Methods: Fifty-six patients (28 patients in each group) underwent endovascular interventions for calcific stenotic superficial femoral artery lesions between March 2013 and May 2014 at Cardiovascular Surgery clinic in Namık Kemal University Hospital were included in the study. Mean age was 65.4±7.6 and male to female ratio was 46/10. Patients were followed up with ankle brachial index (ABI), Rutherford score (RS) and Doppler ultrasonography (DUSG) from the pre-intervention period to sixth month after intervention.Results: Mean lesion length in DA and PEBA group was 66.4±24.8 mm and 65.0±20.6 mm in SENS group. Primary and secondary patency rates were 85.7% and 92.9% in DA and PEBA group, and 57.1% and 71.4% in SENS group in six months follow up. There was a statistically significant difference between groups. Significant improvement was detected in terms of ABI and RS in both groups.Conclusion: We conclude from this study results that PEBA combined with DA is better than SENS implantation, because of its successful early-term results, no intravascular foreign bodies, and continues the chance of surgery without affecting the anastomosis field.

Comparative study between no touch technique and conventional method in the distal radio cephalic arterio venous fistula for hemodialysis

Background The distal radiocephalic arteriovenous fistula (RC-AVF) is the gold standard for hemodialysis but has significant failure rates owing to occlusions and failure to mature. The size and quality of the veins play an important role in the patency of the fistula. Objective The aim of this study was to evaluate the no-touch technique compared with the conventional method in the distal radiocephalic fistula for hemodialysis in terms of patency and complications. Patients and methods A prospective randomized study including 80 patients with ESRD in need for hemodialysis access was done between March 2016 and March 2017 and followed up to October 2017 at Menoufia university hospital. The patients were randomly categorized into two groups (no-touch group that included 40 patients where the vein and artery were dissected with the surrounding tissue cushion and conventional group that included 40 patients). Primary failure, primary and secondary patency rates, and complications of each group were collected and analyzed. Patients with vein caliber less than 2.5 mm, previous arteriovenous fistula, without venous continuity in the arm, or with severely atherosclerotic radial artery were excluded from the study. Results In the no-touch group, primary fistula failure was 7.5%, whereas three (7.5%) fistulas failed later one owing to thrombosis (one case), anastomotic pseudoaneurysm (one case), and anastomotic stenosis (one case). Primary and secondary patency rates at 6 months were 85 and 90%, respectively, whereas in the conventional group, primary fistula failure was 17.5%, whereas eight (20%) fistulas failed later owing to thrombosis (two cases), anastomotic pseudoaneurysm (two cases), anastomotic stenosis (three case), and venous hypertension (one case). Primary and secondary patency rates at 6 months were 62.5 and 67.5%, respectively Conclusion The results of this study indicate that no-touch technique can be used for primary radiocephalic fistula surgery with better patency rate and less complications compared with conventional method. This method offers the potential to create a RC-AVF in patients with distal cephalic veins 2.5 mm or more in caliber with encouraging results.

Brachial vein transposition: an alternative to hemodialysis arteriovenous graft.

BackgroundThere is currently a worldwide effort to increase the options for autogenous hemodialysis access.ObjectivesTo evaluate patency and complications of brachial vein transposition compared to other autogenous hemodialysis accesses.MethodsA retrospective evaluation of 43 patients and 45 procedures. Patients who did not have adequate superficial veins according to duplex scanning were allocated to brachial vein transposition. The sample was thus divided in two groups, as follows: A: brachial vein transposition n=10 and B: other autogenous accesses n=35.ResultsThere were no statistical differences between the two groups in terms of age diabetes, systemic arterial hypertension, dyslipidemias, arteriopathies, neoplasms, kidney disease stage, donor artery diameter, recipient vein diameter, systolic blood pressure in the operated limb, postoperative ischemia, hematoma, or infection. There were no statistical differences in terms of patency on day 7: A 80% vs. B 90% p=0.6, on day 30: A 80% vs. B 86% p=0.6, or on day 60: A 60% vs. B 80% p=0.22. There were statistical differences between the groups for number of previous fistulae A 1.0 ± 0.44 vs. B 0.6 ± 0.3 p = 0.04 and upper limb edema A: 20% x B 0% p = 0.04. A vein with diameter of less than 3 mm was associated with an increased risk of early occlusion (RR = 8 p = 0.0125). During the study period there were no procedures using grafts.ConclusionsTransposition of brachial vein is an alternative to arteriovenous graft.