Improved method to create the common ostium variant of the distal arteriovenous fistula for enhancing crural prosthetic graft patency

Abstract

Configuration of the adjunctive dAVF may impact on prosthetic graft patency in the crural position. In addition, the type of graft material used for bypass may be instrumental in preventing or precipitating the steal phenomenon. These issues require further study to better understand flow dynamics, patterns of intimal hyperplasia, and blood distribution as a function of conduit material and impedance of the arterial and venous runoff.

Update on the Role of the Distal Arteriovenous Fistula as an Adjunct for Improving Graft Patency and Limb Salvage Rates after Crural Revascularization

“…Earlier publications have documented these flow phenomena which have also been confirmed by use of flow meters, angiography, and Doppler sonography. 2,4,11 Most important, however, is the clear improvement in patient symptomatology and limb salvage outcomes. In addition, we have noted a major drop in the number of early postoperative graft failures and need to return to the operating room for thrombectomy and possible graft revision.…”

“…1e3 In addition, 2 variations of the umbilical vein grafts were used during the specific times of their manufacture (Meadox Medicals, 1979e89 and Synovis [BioVascular], 1989e2007) and therefore contribute to the difficulty in creating exact and comparable periods. The current unreported cases (n ¼ 215) added to those cases from prior reports, provide a unique personal experience from which a number of conclusions can be reached 2,4 The number of cases in each period is depicted in Table III and the types of graft materials used and the distribution of the target arteries.…”

Distal vein patch with an arteriovenous fistula: A viable option for the patient without autogenous conduit and severe distal occlusive disease

“…Other authors have reported success for difficult tibial artery bypass with the use of a distal arteriovenous fistula (AVF). [5][6][7][8][9] We extrapolated from this experience to optimize bypass patency in those patients lacking autogenous conduit and disadvantaged arterial runoff by combining the DVP technique with a common ostium AVF.…”

Regarding “A comparative evaluation of polytetrafluoroethylene, umbilical vein, and saphenous vein bypass grafts for femoral-popliteal above-knee revascularization: a prospective randomized Department of Veterans Affairs cooperative study”

“…The currently available UV graft is manufactured by BioVascular Inc, Minn. There are available data 7,8 showing absence of aneurysmal degradation with the latter product as well as a significant reduction in the early thrombotic events as documented by Johnson et al 1 with the Meadox product. This is based on improved quality control during manufacture, reduction of residual aldehyde moities in graft and storage media, and appreciation of the surgical skills required for implantation.…”

“…Additional experience and even better results with the improved UV graft were reported in 1995 7 and 1996. 8 …”