PLCL vascular external sheath carrying prednisone for improving patency rate of the vein graft

Background: In patients with chronic renal failure, a major concern is to provide safe and reliable long-term vascular access for haemodialysis. The radiocephalic arteriovenous (AV) fistula remains the first choice vascular access procedure, however the grafts are used in order to obtain vascular access in patients with failed native distal and proximal AV fistulas. The aim of this study was to compare the patency rate of different grafts such as standard wall polytetrafluoroethylene (sPTFE), bovine vein graft, Diastat graft, in these patients. Patients and methods: Four hundred and forty-six AV fistulas were surgically created in 361 patients. Eighty-four out of 361 patients undergoing different graft replacements were retrospectively reviewed. We evaluated the primary patency rates, days between the fistula placement and the last dialysis treatment before thrombosis had occurred, and the secondary patency rate, days between the fistula placement and the last dialysis treatment before the graft was considered completely lost. The graft survival was calculated according to the Kaplan-Meier method. Results: There were 58 (69%) women and 26 (31%) men with a mean age of 54,5 years. The sPTFE (Gore- Tex) graft was used in 41 (41.8%), bovine vein graft (ProCol) in 38 (38.7%) and Diastat vascular grafts in 19 (19.5%) patients. Primary and secondary patency rates for sPTFE graft were 37% and 60%, 68% and 85% for bovine graft and 26% and 42% for Diastat vascular grafts, respectively. Conclusions: This study demonstrates that the bovine vein graft provides the longest patency rate compared to the other grafts even in patients with multiple failed accesses.

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“No-Touch” versus “Endo” Vein Harvest: Early Patency on Symptom-Directed Catheterization and Harvest Site Complications

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000084 ◽

2014 ◽

Vol 9 (4) ◽

pp. 306-311 ◽

Cited By ~ 10

Author(s):

John D. Mannion ◽

Daniel Marelli ◽

Todd Brandt ◽

Megan Stallings ◽

Jeffery Cirks ◽

...

Keyword(s):

Vein Graft ◽

Patency Rate ◽

Platelet Rich Plasma ◽

Wound Complication ◽

Graft Patency ◽

Vasa Vasorum ◽

Complication Rates ◽

Significant Difference ◽

Harvest Site ◽

Vein Harvesting

Objective “No-touch” (NT) saphenous vein harvesting preserves the adventitial vasa vasorum, prevents medial ischemia, and is associated with an improved short-term and long-term vein graft patency. It may also be associated with a higher rate of harvest site complications. Endovascular vein harvesting (endo-vein) has a low rate of harvest site complications but also a tendency toward a lower patency rate. Methods During a 2-year period (2011–2012), we compared the vein graft patency at symptom-directed cardiac catheterization as well as wound complication rates in 210 patients who received either NT (87 patients) or endo-vein (123 patients). Results The recatheterization rate for the two groups was similar: 9 (10.3%) of 87 of the NT patients versus 11 (9.0%) of 123 of the endo-vein patients. There was a significant difference in vein graft patency between the groups: 15 (94%) of 16 NT vein grafts were patent versus 6 (27%) of 22 of endo-veins ( P < 0.02). The endo-vein graft patency during this 2-year period was similar to the total endo-vein patency (37%) during a 4-year period. A comparison between a more experienced and a less experienced harvester revealed no difference in patency rate. Harvest site complications were significantly higher with the NT harvest: 18% of the NT patients requiring vacuum-assisted wound closure or intravenous antibiotics versus 2% of the endo-vein patients ( P < 0.0001). The application of platelet-rich plasma did not significantly lower wound complication rates ( P = 0.27). Conclusions These results suggest that NT vein harvesting may be associated with improved graft patency, but methods should be developed to lower wound complication rates.

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Patency rate of the internal thoracic artery to the left anterior descending artery bypass is reduced by competitive flow from the concomitant saphenous vein graft in the left coronary artery

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2008.07.011 ◽

2008 ◽

Vol 34 (4) ◽

pp. 833-838 ◽

Cited By ~ 18

Author(s):

Masashi Kawamura ◽

Hiroyuki Nakajima ◽

Junjiro Kobayashi ◽

Toshihiro Funatsu ◽

Yoritaka Otsuka ◽

...

Keyword(s):

Coronary Artery ◽

Saphenous Vein ◽

Vein Graft ◽

Patency Rate ◽

Left Coronary Artery ◽

Internal Thoracic Artery ◽

Saphenous Vein Graft ◽

Artery Bypass ◽

Left Anterior Descending Artery

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2223Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on vein-graft patency 1 year after coronary artery bypass grafting with or without diabetes: a post-hoc analysis of the DACAB tria

European Heart Journal ◽

10.1093/eurheartj/ehz748.0119 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y P Zhu ◽

H Liu ◽

M L Zhang ◽

J Mei ◽

Q Zhao

Keyword(s):

Coronary Artery ◽

Vein Graft ◽

Patency Rate ◽

Artery Bypass ◽

Graft Patency ◽

Bypass Grafting ◽

Once Daily ◽

Vein Grafts ◽

Significant Difference ◽

Graft Patency Rate

Abstract Introduction The association of diabetes and vein graft patency after coronary artery bypass grafting (CABG) remains controversial. In patients with diabetes, impaired endothelial function in vein grafts and high platelet turnover might result in early vein graft failure. The DACAB trial showed ticagrelor plus aspirin significantly increased 1-year vein graft patency vs. aspirin alone, while no significant difference between ticagrelor alone and aspirin alone. However, whether the results is different between the patients with or without diabetes is unknown. Purpose To assess the effects of ticagrelor with or without aspirin vs. aspirin alone on 1-year vein grafts patency after CABG in patients with or without diabetes. Methods We examined the subgroups of patients with and without diabetes from DACAB trial (NCT02201771), in which 500 patients were randomized to 1 of 3 antiplatelet regimens (ticagrelor 90mg twice daily plus aspirin 100mg once daily, T+A group; ticagrelor 90mg twice daily, T group; or aspirin 100mg once daily, A group) within 24 hours post-CABG. The primary outcome was 1-year vein graft patency (FitzGibbon grade A) assessed by multi-slice computed tomographic angiography or coronary angiography. Results According to the baseline medical history and/or glycated hemoglobin (HbA1c) ≥6.5%, 283 patients with 818 vein grafts were allocated to the non-diabetes subgroup, remaining 217 patients with 642 vein grafts to the diabetes subgroup. By per-graft analysis, no significant difference on 1-year vein graft patency rate was observed between non-diabetes and diabetes subgroup (84.6% [692/881] for non-diabetes vs. 80.2% [515/642] for diabetes, adjusted odds ratio (OR) =1.39, 95% CI: 0.92–2.09, P=0.116). In T+A group, 1-year vein graft patency rates were 91.0% (244/268) for non-diabetes vs. 85.8% (188/219) for diabetes; In T group, 85.0% (221/260) for non-diabetes vs. 80.3% (183/228) for diabetes; In A group, 78.3% (227/290) for non-diabetes vs. 73.9% (144/195) for diabetes. Ticagrelor plus aspirin showed higher vein graft patency rate than aspirin alone in both non-diabetes and diabetes subgroup (non-diabetes: adjusted OR = 0.34, 95% CI: 0.17–0.69, and diabetes: adjusted OR = 0.42, 95% CI: 0.19–0.91, P for interaction = 0.524), whereas ticagrelor alone did not show improvement on vein graft patency compared with aspirin alone in both subgroups (non-diabetes: adjusted OR=0.62, 95% CI: 0.32–1.20, and diabetes: adjusted OR = 0.65, 95% CI: 0.33–1.31, P for interaction = 0.795). Similar results were showed by per-patient analysis. A total 16 major adverse cardiovascular events occurred, 8 (2.8%) for non-diabetes and 8 (3.7%) for diabetes. Conclusion In the DACAB trial, diabetes was not found to be associated with decreased vein graft patency at 1 year after CABG. The effect of ticagrelor plus aspirin on improvement of 1-year vein graft patency, when compared with aspirin alone, is consistent in patients with or without diabetes. Acknowledgement/Funding AstraZeneca

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Very distal vein bypass in patients with thromboangiitis obliterans

VASA ◽

10.1024/0301-1526/a000624 ◽

2017 ◽

Vol 46 (4) ◽

pp. 304-309 ◽

Cited By ~ 4

Author(s):

Achim Neufang ◽

Carolina Vargas-Gomez ◽

Patrick Ewald ◽

Nicolaos Vitolianos ◽

Tolga Coskun ◽

...

Keyword(s):

Conservative Treatment ◽

Vein Graft ◽

Duplex Ultrasound ◽

Critical Limb Ischaemia ◽

Thromboangiitis Obliterans ◽

Surgical Revascularization ◽

Autologous Vein ◽

Therapeutic Concept ◽

Autologous Vein Graft ◽

Vein Bypass

Abstract. Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex findings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin configuration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superficial femoral artery was used for inflow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identified graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after definitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.

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Oral Anticoagulation in the Prevention of One-Year Vein Graft Occlusion after Aortocoronary Bypass Surgery: Optimal Therapeutic Range and Practical Limitations

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648941 ◽

1994 ◽

Vol 72 (05) ◽

pp. 676-681 ◽

Cited By ~ 2

Author(s):

J van der Meer ◽

H L Hillege ◽

P H J M Dunselman ◽

B J M Mulder ◽

H R Michels ◽

...

Keyword(s):

Myocardial Infarction ◽

Major Bleeding ◽

Oral Anticoagulation ◽

Vein Graft ◽

Oral Anticoagulant Therapy ◽

Coronary Bypass ◽

Graft Patency ◽

Graft Occlusion ◽

Coronary Bypass Grafts ◽

One Year

SummaryTo assess the optimal level of oral anticoagulation to prevent occlusion of vein coronary bypass grafts, 318 patients from a graft patency trial were analysed retrospectively. Oral anticoagulant therapy was started one day before surgery and continued for one year, after which graft occlusion was assessed by angiography. The aimed level of anticoagulation was 2.8-1.8 International Normalized Ratio (INR). Clinical outcome was assessed by the incidence of myocardial infarction, thrombosis and major bleeding.The observed anticoagulation level was 2.8-4.8 INR for 54%, and 1.8-3.8 INR for 75% of time per patient. Occlusion rates in patients who spent <35, 35-70, and ≥70% of time within INR range 2.8-1.8 were 10.5%, 10.8% and 11.8%, respectively (differences not statistically significant). Patients who spent ≥70% of time within INR range 1.8-3.8 versus 2.8-4.8 showed comparable occlusion rates. The risk of graft occlusion was not related to quality of anticoagulation early (0-3 months) or late (3-12 months) after surgery. Myocardial infarction, thrombosis and major bleeding occurred in 1.3%, 2.0% and 2.9% of patients.To maintain vein graft patency in the first postoperative year by oral anticoagulation, a level within INR range 1.8-3.8 for ≥70% of time seems to be sufficient.

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Reliability of the Mangled Extremity Severity Score in the Management of Peripheral Vascular Injuries in Children: A Retrospective Review

International Journal of Angiology ◽

10.1055/s-0040-1720970 ◽

2020 ◽

Author(s):

Ahmed Mousa ◽

Ossama M. Zakaria ◽

Mai A. Elkalla ◽

Lotfy A. Abdelsattar ◽

Hamad Al-Game'a

Keyword(s):

Severity Score ◽

Vein Graft ◽

Bypass Surgery ◽

Age Groups ◽

Vascular Injuries ◽

Peripheral Vascular ◽

Group Iii ◽

Mangled Extremity ◽

Group I ◽

End To End

AbstractThis study was aimed to evaluate different management modalities for peripheral vascular trauma in children, with the aid of the Mangled Extremity Severity Score (MESS). A single-center retrospective analysis took place between 2010 and 2017 at University Hospitals, having emergencies and critical care centers. Different types of vascular repair were adopted by skillful vascular experts and highly trained pediatric surgeons. Patients were divided into three different age groups. Group I included those children between 5 and 10 years; group II involved pediatrics between 11 and 15 years; while children between 16 and 21 years participated in group III. We recruited 183 children with peripheral vascular injuries. They were 87% males and 13% females, with the mean age of 14.72 ± 04. Arteriorrhaphy was performed in 32%; end-to-end anastomosis and natural vein graft were adopted in 40.5 and 49%, respectively. On the other hand, 10.5% underwent bypass surgery. The age groups I and II are highly susceptible to penetrating trauma (p = 0.001), while patients with an extreme age (i.e., group III) are more susceptible to blunt injury (p = 0.001). The MESS has a significant correlation to both age groups I and II (p = 0.001). Vein patch angioplasty and end-to-end primary repair should be adopted as the main treatment options for the repair of extremity vascular injuries in children. Moreover, other treatment modalities, such as repair with autologous vein graft/bypass surgery, may be adopted whenever possible. They are cost-effective, reliable, and simple techniques with fewer postoperative complication, especially in poor/limited resources.

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