Intragraft drug infusion as an adjunct to balloon catheter thrombectomy for salvage of thrombosed infragenicular vein grafts: A preliminary report

Walsh, Daniel B.; Zwolak, Robert M.; McDaniel, Martha D.; Schneider, Joseph R.; Cronenwett, Jack L.

doi:10.1016/0741-5214(90)90070-q

Cited by 17 publications

(1 citation statement)

References 25 publications

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“…This occurred several months after I attended the New England Society for Vascular Surgery meeting at Mount Washington in 1989, where Dr Daniel Walsh from Dartmouth-Hitchcock Medical Center had presented an abstract on improving secondary patency of thrombosed vein grafts with direct infusion of an anticoagulant and a vasodilator through a vein side branch. 6 Although my patient had not yet thrombosed the graft, Dr Walsh's presentation led me to think out of the box. I inserted a fine catheter through a side branch of the proximal vein graft to infuse nitroglycerin and heparin for the next 2 days.…”

Section: Vascular Sage: Sprezzaturamentioning

confidence: 97%

The science and art of the vascular whisperers

LaMuraglia

2020

Journal of Vascular Surgery

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Section: Vascular Sage: Sprezzaturamentioning

confidence: 97%

The science and art of the vascular whisperers

LaMuraglia

2020

Journal of Vascular Surgery

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A blinded comparison of angiography, angioscopy, and duplex scanning in the intraoperative evaluation of in situ saphenous vein bypass grafts

Gilbertson¹,

Walsh²,

Zwolak³

et al. 1992

Journal of Vascular Surgery

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Angiography, angioscopy, and duplex scanning have each been advocated for intraoperative assessment of in situ saphenous vein grafts. We compared these three modalities during operation in a prospective, blinded study during the construction of 20 femoral-infragenicular in situ saphenous vein grafts. Bach modality was used and interpreted by a surgeon blinded to the results of the other studies. Abnormalities requiring intervention were defined as (1) patent vein side branches, (2) residual valve cusps, and (3) anastomotic stenoses > 30%. Criteria, specific to the modality, corresponding to each category were prospectively defined. Fourteen residual valve cusps, 49 patent vein branches, and 6 anastomotic stenoses were suggested by at least one modality. Nine residual valve cusps, 32 patent vein branches, and no anastomotic stenoses were actually found (and corrected) by direct inspection. Sensitivityofdetecting patent side branches for angiography, duplex scanning, and angioscopy was 44%, 12%, and 66%, respectively. Both angiography and angioscopy were significandy more sensitive than duplex scanning for detection ofunligated side branches (p < 0.01). Sensitivity ofdetecting residual valve cusps was 22% (angiography), 11% (duplex scanning), and 100% (angioscopy). Angioscopy was significandy more sensitive than either duplex scanning or angiography in detection of residual valve cusps Cl < 0.01). Since no anastomotic stenoses were confirmed, the false-positive rates for stenosis detection were 20% for angiography, 10% for duplex scanning, and 0% for angioscopy. Time requirement was 17 to 20 minutes and did not differ among the three modalities. No stenosis or arteriovenous fistula has been detected in any graft by postoperative duplex surveillance (mean, 10-month follow-up). Angiography and angioscopy were superior to duplex scanning for detecting patent vein branches. Angiography or duplex scanning alone would have missed > 75% of residual valve cusps. These results suggest that angioscopy is the preferred method for intraoper-. ative in situ vein graft evaluation.

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