Improved Results With Femoropopliteal Vein Grafts for Limb Salvage

Treatment of Arterial Occlusive Disease of the Lower Extremities

“…The operative mortality attendant upon axillofemoral re construction tends in most series to be slightly higher (3-4%) because of associated systemic disease (27). Although five-year limb salvage rates have been reported as high as 90%, patency rates for axillobifemoral grafts are clearly lower (40-70%) at five years than those for conventional aortobi femoral grafting (1,10,21,24,27). The patency rates associated with axillounifemoral.…”

“…The patency rates associated with axillounifemoral. bypass were no higher than 40% at five years and this technique was therefore abandoned in favor of bilateral reconstruction in all but the most unusual circumstances (21). Because of these obviously lower patency rates, extra-anatomic reconstruction should be reserved for patients with clearly threatened limbs, as opposed to those in whom reconstruction is indicated for claudication.…”

The Below-Knee Amputation: To Amputate or Palliate?

“…8 This finding is in contrast to multiple studies that have found the opposite to be true, that previous lower extremity bypass attempts lead to poorer outcomes following subsequent BKA. [11][12][13][14][15][16][17][18][19] Keagy et al reported an 83% BKA healing rate among patients without an ipsilateral vascular bypass and a 73% BKA healing rate among patients with an ipsilateral vascular bypass ( p < 0.001). 20 It is not surprising that these data are conflicting given the confounding variables that are difficult to account for.…”

Therapeutic strategies to combat neointimal hyperplasia in vascular grafts

“…Ischemia time and mechanical instrumentation of the vein during harvest, especially during dilation, to check for leaks and unligated side branches results in endothelial disruption, thereby exposing the media to proinflammatory and procoagulant blood components [19]. Both warm saline and hydrostatic dilatation may be harmful to the vein, and this injury is manifested by the platelet coating of the endothelium for several days after graft preparation [20]. In addition, vein harvesting results in disruption of the adventitial blood supply and affects its nervous innervations by removal of the vein from its bed.…”