| Remote distal arteriovenous fistula to improve infrapopliteal bypass patency. | |
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MedLine Citation:
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PMID: 2296098 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The results of the use of prosthetic materials for femorocrural bypass surgery have been less than optimal. The creation of a distal anastomotic arteriovenous fistula to augment blood flow and velocity through the graft is well known. However, it may create turbulence at the anastomosis and steal blood flow away from the distal artery. A canine model was developed to evaluate the effect of fistula size on graft/arterial hemodynamics. In 16 patients we have constructed a distal arteriovenous fistula, which is remote from the distal anastomosis, and we studied the effect of such fistulas on bypass patency and distal arterial hemodynamics. Patients selected for this procedure had multiple previously failed reconstructions and limb-threatening ischemia and did not have usable autogenous vein. Femorotibial bypass graft reconstructions were performed with polytetrafluoroethylene followed by the creation of a side-to-side arteriovenous fistula 5 to 15 cm below the distal anastomosis in the same artery and accompanying veins. We have achieved a 1-year patency of 67% with a 75% limb salvage rate. We also serially measured blood flow and velocity within the bypass, the arteriovenous fistula, and the distal outflow vessel using duplex scanning after surgery. Mean estimated blood flow through the bypass during the immediate postoperative period was 264 ml/min, the arteriovenous fistula was 157 ml/min, and the distal artery was 19 ml/min. Unlike an arteriovenous fistula created at the distal anastomosis, a remote distal arteriovenous fistula not only increases graft blood flow but also augments native arterial blood flow between the distal anastomosis and fistula and thus may improve distal limb perfusion. |
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Authors:
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P S Paty; D M Shah; J Saifi; B B Chang; P J Feustel; J L Kaufman; R P Leather; K R Wengerter; E Ascer; S K Gupta |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter Volume: 11 ISSN: 0741-5214 ISO Abbreviation: J. Vasc. Surg. Publication Date: 1990 Jan |
Date Detail:
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Created Date: 1990-02-22 Completed Date: 1990-02-22 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 171-7; discussion 177-8 Citation Subset: IM |
Affiliation:
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Department of Surgery, Albany Medical College, NY 12208. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Animals Arteriovenous Shunt, Surgical* Dogs Humans Popliteal Artery / surgery* Vascular Patency* |
| Grant Support | |
ID/Acronym/Agency:
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GM15426/GM/NIGMS NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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