George Andros, M. D. , Robert W. Harris, M. D. , Sergio X

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Presentation transcript:

Arm veins for arterial revascularization of the leg: Arteriographic and clinical observations George Andros, M.D., Robert W. Harris, M.D., Sergio X. Salles-Cunha, Ph.D., Leopoldo B. Dulawa, M.D., Robert W. Oblath, M.D., Roseanne L. Apyan, R.N Journal of Vascular Surgery Volume 4, Issue 5, Pages 416-427 (November 1986) DOI: 10.1016/0741-5214(86)90375-7 Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Deep femoral to infrageniculate popliteal artery cephalic vein graft, still patent 104 months after implantation; arteriogram taken at 80 months. Journal of Vascular Surgery 1986 4, 416-427DOI: (10.1016/0741-5214(86)90375-7) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2A Arteriogram shows extensive neointimal fibroplasia at proximal end of deep femoral-to-anterior tibial cephalic vein bypass graft (“redo”), 4 months after implantation with enlarged view of proximal anastomosis. Journal of Vascular Surgery 1986 4, 416-427DOI: (10.1016/0741-5214(86)90375-7) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2B Artist's rendering of arteriogram in Fig. 2A. (Neointimal stenosis at proximal anastomosis was detected in seven grafts.) Journal of Vascular Surgery 1986 4, 416-427DOI: (10.1016/0741-5214(86)90375-7) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Midgraft fibrotic stenosis; deep femoral-to-posterior tibial artery cephalic vein bypass graft (“redo”), 4 months after implantation (incidence of finding, two grafts). Journal of Vascular Surgery 1986 4, 416-427DOI: (10.1016/0741-5214(86)90375-7) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Valvular fibrosis; inflow jump graft from aortofemoral bypass to a femoropopliteal saphenous vein graft. Vein patch was performed 25 months after implantation of inflow jump graft (incidence of finding, one graft). Journal of Vascular Surgery 1986 4, 416-427DOI: (10.1016/0741-5214(86)90375-7) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Neointimal fibroplasia at distal anastomosis of deep femoral-to-posterior tibial artery cephalic vein bypass graft, detected 17 months after implantation and repaired 6 months later. Graft was otherwise free of disease (incidence of finding, three grafts). Journal of Vascular Surgery 1986 4, 416-427DOI: (10.1016/0741-5214(86)90375-7) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 Diffusely fibrotic vein; common femoral-to-distal anterior tibial artery composite arm vein graft. A, Cephalic vein at median antecubital region measured 13 mm in diameter 16 days after implantation. B, At 7 months after implantation the same area was reduced to 6 to 7 mm in diameter. Journal of Vascular Surgery 1986 4, 416-427DOI: (10.1016/0741-5214(86)90375-7) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 Focal aneurysm (perhaps vein valve sinus) of single-length forearm cephalic-upper arm basilic vein bypass graft from the superficial femoral artery to the infrageniculate popliteal artery, detected 50 months after implantation in an asymptomatic patient. A, Frontal view. B, Lateral view with hyperextension of the knee. Journal of Vascular Surgery 1986 4, 416-427DOI: (10.1016/0741-5214(86)90375-7) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 8A Contrast material streaming was noted in grafts with and without defects. This single length graft of forearm cephalic—upper arm basilic vein extended from the proximal superficial femoral to the posterior tibial artery. Journal of Vascular Surgery 1986 4, 416-427DOI: (10.1016/0741-5214(86)90375-7) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 8B At 104 months, two focal aneurysms (perhaps vein valve sinuses) and 30% diameter fibrotic stenosis were detected in asymptomatic patient. Journal of Vascular Surgery 1986 4, 416-427DOI: (10.1016/0741-5214(86)90375-7) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 9 Patency rates according to indication for operation. Numbers indicate patients at risk during the time interval. Journal of Vascular Surgery 1986 4, 416-427DOI: (10.1016/0741-5214(86)90375-7) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 10 Patency rates according to distal anastomosis. Numbers indicate patients at risk during the time interval. Journal of Vascular Surgery 1986 4, 416-427DOI: (10.1016/0741-5214(86)90375-7) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 11 Patency rates according to first leg revascularization or secondary “redo” operation. Numbers indicate patients at risk during the time interval. Journal of Vascular Surgery 1986 4, 416-427DOI: (10.1016/0741-5214(86)90375-7) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions