Results of prosthetic-vein composite graft with remote popliteal arteriovenous fistula in infragenicular bypass

Palerme, L.P.; Reid, John D.; Chan, Arthur M.T.; Lokanathan, Ramesh; MacDonald, Shaun; Sladen, Joseph G.

doi:10.1067/mva.2002.126089

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…Since high shear stresses with a significant net direction can result in a reduction in neointimal hyperplasia, several strategies have been designed to modify shear stress to increase vascular patency following surgical interventions such as bypass graft and stenting. Thus a distal arteriovenous fistula has been used to increase blood flow and shear stress above a critical threshold to prevent thrombosis and neointimal hyperplasia of the graft, with the goal of improving the patency of bypass graft that had poor outflow (120, 121, 442, 472). Seeding of prosthetic bypass grafts with an EC monolayer reduces thrombosis and improve patency; application of a physiological level of laminar shear stress to such grafts increases the adhesion of seeded ECs and enhances their retention after implantation in vivo, thereby improvng graft patency (418, 429).…”

Section: Clinical Applications and Perspectivesmentioning

confidence: 99%

Effects of Disturbed Flow on Vascular Endothelium: Pathophysiological Basis and Clinical Perspectives

Chiu

Chien

2011

Physiological Reviews

1,757

1,694

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Vascular endothelial cells (ECs) are exposed to hemodynamic forces, which modulate EC functions and vascular biology/pathobiology in health and disease. The flow patterns and hemodynamic forces are not uniform in the vascular system. In straight parts of the arterial tree, blood flow is generally laminar and wall shear stress is high and directed; in branches and curvatures, blood flow is disturbed with nonuniform and irregular distribution of low wall shear stress. Sustained laminar flow with high shear stress upregulates expressions of EC genes and proteins that are protective against atherosclerosis, whereas disturbed flow with associated reciprocating, low shear stress generally upregulates the EC genes and proteins that promote atherogenesis. These findings have led to the concept that the disturbed flow pattern in branch points and curvatures causes the preferential localization of atherosclerotic lesions. Disturbed flow also results in postsurgical neointimal hyperplasia and contributes to pathophysiology of clinical conditions such as in-stent restenosis, vein bypass graft failure, and transplant vasculopathy, as well as aortic valve calcification. In the venous system, disturbed flow resulting from reflux, outflow obstruction, and/or stasis leads to venous inflammation and thrombosis, and hence the development of chronic venous diseases. Understanding of the effects of disturbed flow on ECs can provide mechanistic insights into the role of complex flow patterns in pathogenesis of vascular diseases and can help to elucidate the phenotypic and functional differences between quiescent (nonatherogenic/nonthrombogenic) and activated (atherogenic/thrombogenic) ECs. This review summarizes the current knowledge on the role of disturbed flow in EC physiology and pathophysiology, as well as its clinical implications. Such information can contribute to our understanding of the etiology of lesion development in vascular niches with disturbed flow and help to generate new approaches for therapeutic interventions.

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Section: Clinical Applications and Perspectivesmentioning

confidence: 99%

Effects of Disturbed Flow on Vascular Endothelium: Pathophysiological Basis and Clinical Perspectives

Chiu

Chien

2011

Physiological Reviews

1,757

1,694

View full text Add to dashboard Cite

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“…[43][44][45][46][47][48][49][50][51][52][53] However, the life expectancy of the patients in this long-term follow-up seems quite limited in these selected patients. Nonetheless, the use of prosthetic graft with the adjunctive AVF/VI seems to offer reasonable patency and limb salvage rates in patients who are not candidates for autogenous bypass grafts.…”

Section: Discussionmentioning

confidence: 99%

“…Patency rates have ranged from 48% to 71% at 2-3 years. 7,10, [43][44][45][46][47][48][49][50][51][52][53] In addition, improvement of hemodynamics in patients who have had this type of fistula placed has been suggested by one group of investigators. 54 However, owing to the limitations of these retrospective case series, controversy regarding whether any of these techniques is beneficial at all still remains.…”

Section: Discussionmentioning

confidence: 99%

A 10-Year Experience with Complementary Distal Arteriovenous Fistula and Deep Vein Interposition for Infrapopliteal Prosthetic Bypasses

Hingorani

Ascher²,

Marks³

et al. 2005

Vasc Endovascular Surg

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Since up to 20% of patients undergoing lower extremity revascularization do not have an adequate venous conduit, some authors have explored the use of prosthetic grafts with adjunctive techniques for lower extremity revascularization. However, the long-term graft patency of those procedures has not been well documented. The purpose of this study was to examine the long-term patency of polytetrafluoroethylene (PTFE) bypass with adjunctive arteriovenous fistula and venous interposition (AVF/VI) for infrapopliteal revascularization. Over a 10-year period, 246 lower extremity reconstructions were performed in 176 (71.5% men) patients with critical ischemia in whom a totally autogenous vein bypass was not feasible. Seventy-six limbs had undergone 1 or more failed ipsilateral infrainguinal bypasses. Indications for surgery were chronic critical limb-threatening ischemia (86%) (rest pain, ischemic ulcer, or gangrene) or acute ischemia (14%). Ages ranged from 46 to 91 years (mean 74 +/-0.6 [SD] years). Risk factors such as diabetes, hypertension, coronary artery disease, end-stage renal disease, and use of tobacco were present in 49%, 49%, 52%, 8%, and 67% of the patients, respectively. During the follow-up, 112 cases (45%) required reinterventions. Twenty-seven patients (15%) required bypass revision twice. During the follow up, 56 limbs (23%) were amputated (above-the-knee amputation 25 (10%); below-the-knee amputation 31 (13%). To date, 150 (85%) patients of a total of 176 are deceased. The primary graft patency rates were as follows: at 1 year, 51%; at 2 years, 41%; 3 years, 35%; and 5 years, 24%. Limb salvage rates were as follows: 1 year, 79%; 2 years, 76%; 3 years 76%; and 5 years, 74%. Patient survival rates were as follows: 1 year, 69%; 2 years, 60%; 3 years, 54%; and 5 years, 40%. Amputation-free patient survival rates were as follows: 1 year, 66%; 2 years, 57%, 3 years, 51%, and 5 years, 30%. This technique appears to offer reasonable patency and limb salvage rates in patients in whom autogenous bypass grafts are not feasible.

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Adjuvant Surgical Techniques for Limb Salvage

Macsata

Sidawy

2012

Haimovici's Vascular Surgery

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Results of prosthetic-vein composite graft with remote popliteal arteriovenous fistula in infragenicular bypass

Abstract: The technique of composite grafting with remote popliteal arteriovenous fistula may be a useful alternative in infragenicular bypass when a satisfactory autogenous vein is not available.

Cited by 4 publications

References 19 publications

Effects of Disturbed Flow on Vascular Endothelium: Pathophysiological Basis and Clinical Perspectives

Effects of Disturbed Flow on Vascular Endothelium: Pathophysiological Basis and Clinical Perspectives

A 10-Year Experience with Complementary Distal Arteriovenous Fistula and Deep Vein Interposition for Infrapopliteal Prosthetic Bypasses

Adjuvant Surgical Techniques for Limb Salvage

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