Long-term graft occlusion in aortobifemoral position

Background/Aim. Aortobifemoral (AFF) bypass is still the most common surgical procedure used in treatment of aortoiliac occlusive disease. One of the most common complications of AFF bypass procedure is long-term graft occlusion. The aim of this study was to determine the cause of long-term graft occlusion in AFF position, as well as the results of early treatment of this complication. Methods. This retrospective study, performed at the Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia in Belgrade, involved 100 patients treated for long-term occlusion of bifurcated Dacron graft which was ensued at least one year after the primary surgical procedure. Results. The most common cause of the longterm graft occlusion was the process at the level of distal anastomosis or below it (Z = 3.8, p = 0.0001). End-to-end type of proximal anastomosis has been associated with a significantly increased rate of long-term graft occlusion (Z = 2.2, p = 0.0278). Five different procedures were used for the treatment of long-term graft occlusion: thrombectomy and distal anastomosis patch plasty (46% of the cases); thrombectomy and elongation (26% of the cases); thrombectomy and femoropopliteal bypass (24% of the cases); crossover bypass (2% of the cases) and a new AFF bypass (2% of the cases). The primary early graft patency was 87%. All 13 early occlusions occurred after the thrombectomy associated with patch plasty of distal anastomosis. Thrombectomy with distal anastomosis patch plasty showed a statistically highest percentage of failures in comparison to thrombectomy with graft elongation, or thrombectomy with femoro-popliteal bypass (Z = 2 984, p = 0.0028). Redo procedures were performed in all the cases of early occlusions. In a 30-day follow-up period after the secondary surgery, 90 (90%) patients had their limbs saved, and above knee amputation was made in 10 (10%) patients. Conclusion. Long-term AFF bypass patency can be obtained by proximal end-to-end anastomosis on the juxtarenal part of aorta and distal anastomosis on the bifurcation of the common femoral, or on the deep femoral artery.

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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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Abstract O.73: Long-term Results Of Percutaneous Transluminal Coronary Rotational Atherectomy For Localized Stenosis Caused By Kawasaki Disease

Circulation ◽

10.1161/circ.131.suppl_2.o73 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Etsuko Tsuda ◽

Shinsuke Hoshino ◽

Yasuhide Asaumi ◽

Yosuke Hayama ◽

Osamu Yamada

Keyword(s):

Kawasaki Disease ◽

Graft Patency ◽

Rotational Atherectomy ◽

Long Term Results ◽

Cardiac Events ◽

Main Trunk ◽

One Year ◽

Percutaneous Transluminal ◽

Localized Stenosis

We report the results of percutaneous transluminal coronary rotational atherectomy (PTCRA) for localized stenosis caused by Kawasaki disease (KD). Thirteen male and a female, aged 5 to 29 years (median 13 years), underwent PTCRA and the interval from the PTARA to the latest angiogram ranged from 3 months to 16 years (median 6 years). The target vessels were the left anterior descending artery (3 patients), the left circumflex (2), left main trunk (2) and the right coronary artery (7). The immediate results of PTCRA were successful in all patients, and the mean stenosis degree improved from 86 ± 11% to 36 ± 13%. Five cardiac events occurred within one year (acute myocardial infarction 2, transient complete atrioventricular block 1 and re-PTCRA 2). The survival rate and cardiac event free rate at 15 years after PTCRA were 93% and 71%, respectively. For the graft patency, 4 pts who underwent PTCRA within 10 yeas old, had asymptomatic occlusion within 1 year. The patency rate at 15 years after PTCRA was 69%, in 10 pts who underwent it more than 10 years old. Cardiac events and restenosis occurred within a year after PTCRA. The results in patients less than 10 years old was poor. If a graft is patent in one year after procedure, long-term patency may be expected in patients more than 10 years old.

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Aprotinin in Aortocoronary Bypass Surgery: Increased Risk of Vein-Graft Occlusion and Myocardial Infarction? Supportive Evidence from a Retrospective Study

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650311 ◽

1996 ◽

Vol 75 (01) ◽

pp. 001-003 ◽

Cited By ~ 24

Author(s):

J van der Meer ◽

H L Hillege ◽

C A P L Ascoop ◽

P H J M Dunselman ◽

B J M Mulder ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Loss ◽

Vein Graft ◽

Bypass Surgery ◽

Graft Patency ◽

Graft Occlusion ◽

Aortocoronary Bypass ◽

Aortocoronary Bypass Surgery ◽

Increased Risk ◽

One Year

SummaryTo assess the thrombotic risk of aprotinin in aortocoronary bypass surgery, we retrospectively analyzed the results of a trial, originally designed to compare the effects of one-year treatment with various antithrombotic drugs in the prevention of vein-graft occlusion. Graft patency at one year was assessed by angiography. Myocardial infarction, thromboembolism, major bleeding, and death were clinical endpoints. Of 948 randomized patients, 42 received aprotinin, all enrolled by one of the participating centres. Occlusion rates of distal anastomoses were 20.5% in the aprotinin group and 12.7% in the non-aprotinin group (p = 0.091). The proportions of patients with occluded grafts were 44.1% versus 26.3% (p = 0.029). Perioperative myocardial infarction occurred in 14.3% and 7.0%, respectively (p = 0.12). Mean postoperative blood loss was 451 ml in the aprotinin group compared with 1039 ml in the non-aprotinin group (p <0.0001). Mean transfusion requirements were 1.1 U versus 2.1 U of red blood cells (p = 0.004).Aprotinin decreases blood loss and transfusion requirement. Our data suggest that this benefit may be associated with a reduction of graft patency and an increased risk of myocardial infarction.

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Hemodynamics of End-to-End Femoral Bypass Graft

Computational Technologies for Fluid/Thermal/Structural/Chemical Systems With Industrial Applications, Volume 2 ◽

10.1115/pvp2004-3125 ◽

2004 ◽

Author(s):

Aike Qiao ◽

Teruo Matsuzawa

Keyword(s):

Blood Flow ◽

Shear Stress ◽

Wall Shear Stress ◽

Femoral Artery ◽

Bypass Graft ◽

Distal Anastomosis ◽

Geometry Configuration ◽

Temporal And Spatial ◽

End To End

In the conventional femoral bypassing operation, side-to-end (STE) configuration at the proximal anastomosis and end-to-side (ETS) configuration at the distal anastomosis are usually employed. With these configurations, blood flow from the bypass graft at the distal anastomosis strongly strikes on the floor of the host artery opposite the anastomosis. This will result in the violent variations of hemodynamics in the vicinity of distal anastomosis, and further bring about anastomotic intimal hyperplasia (IH) and restenosis. Consequently, the effectiveness of bypassing surgery is compromised in the medium and long term by the development of these pathological changes. It is widely accepted that hemodynamics is close correlated to the geometry configuration of femoral bypass graft. It is verified that flow field at the distal junction has more influences on the pathogenesis and its aftereffects are more critical because the development of IH and restenosis is prone to occur in that region and endangers the patency of subsequent arteries. Nonuniform hemodynamics, characterized by nonuniform Wall Shear Stress (WSS) and large sustained Wall Shear Stress Gradients (WSSG), is also commonly considered as one of the most important causes among the numerous complex physiological and biomechanical factors. Purpose of the present study is to investigate an alternative geometry configuration to improve the hemodynamics at the vicinity of distal anastomosis and increase the medium and long term patency rate of bypass graft surgery. According to the clinical observation, the stenosed host artery may become fully stenosed after bypassing surgery and the bypass graft is the only way to restore normal blood flow to ischemic limbs. The authors presented a modified bypassing configuration with an end-to-end (ETE) conjunction at the distal anastomosis. In this new model, the proximal graft is arc-shaped with STE junction and the distal graft is sinusoid-shaped with ETE junction. The bypass graft is of the same diameter of d = 8mm as the host femoral artery, so the graft can be connected with the femoral artery smoothly at the distal junction. The polytetrafluoroethylene (PTFE) is employed as the graft material. The blood is assumed to be an isotropic, homogeneous, incompressible, Newtonian continuum having a constant density and viscosity. The vessel walls are assumed to be rigid and impermeable. The blood flow is assumed to be physiologically pulsatile laminar flow. The mean Reynolds number is Rem = 204.7, Womersley number is α = 6.14. The boundary conditions include: the physiologically pulsatile entrance velocities at the inlet section, the no-slip boundary condition on the wall, the symmetric condition in the centerline plane of femoral and graft, and the outlet pressure condition with a reference pressure P = 0 at the exit section. Three-dimensional idealized femoral bypass graft model is developed and discretized. The blood flow in the proposed model is simulated with computational fluid dynamics (CFD) method using the finite element analysis. The temporal and spatial distributions of hemodynamics such as flow patterns and WSS in the vicinity of distal anastomosis during the cardiac cycle were analyzed. Especially, the emphasis here was on the analysis of WSS, the temporal and spatial WSSG and the Oscillating Shear Index (OSI). The simulation results indicated that: (1) the ETE model is featured with small secondary flow; (2) WSS at the distal anastomosis is uniform, WSSG is small, and OSI of the ETE model has not much changes compared with ETS graft. The present study showed that the femoral bypassing configuration with ETE bypass graft was of more favorable hemodynamics, and it could consequently improve the flow conditions and decrease the probability of IH and restenosis. With the consideration of that numerical simulation was proved to be of great help and guidance meaning for the biofluidmechanics research and the biomedical engineering, the results of the present study can be applied to medical device design and clinical treatment planning in addition to the application of computational methods to cardiovascular disease research.

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Predicting coronary graft occlusion in males with type 2 diabetes: an annual prospective study

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2020-27-4-189-200 ◽

2020 ◽

Vol 27 (4) ◽

pp. 189-200

Author(s):

N. S. Lisytenko ◽

N. A. Morova ◽

V. N. Tsekhanovich

Keyword(s):

Type 2 Diabetes ◽

Left Ventricle ◽

Artery Bypass ◽

Bypass Graft ◽

Coronary Bypass ◽

Bypass Grafting ◽

Graft Occlusion ◽

Bypass Patency ◽

One Year

Aim. Identiﬁcation of factors affecting coronary bypass graft patency in patients with type 2 diabetes (T2D) during one year after coronary bypass grafting.Materials and methods. Coronary artery bypass grafting for stable effort angina was ordered in 23 men with T2D. The patients had transthoracic echocardiogram before surgery. All patients were veriﬁed for lupus anticoagulant (LA) in blood on the 14th day after surgery. A year later, the patients underwent coronary shuntography to assess bypass patency.Results. LA was detected in 15 of 23 patients (65%). One year after surgery, occlusions of coronary shunts were revealed in 10 of 23 patients. In patients with coronary shunt occlusions, end-diastolic and end-systolic dimensions, end-diastolic and end-systolic volumes, end-systolic and end-diastolic indices (EDD, ESD, EDV, ESV, ESI, EDI, respectively), as well as the LA ratio signiﬁcantly exceeded those in patients without occlusions (Mann—Whitney p values 0.004, 0.012, 0.012, 0.006, 0.006, 0.004, 0.017, respectively). A method is proposed for predicting coronary shunt occlusions based on assessment of end-diastolic volume of left ventricle and the LA ratio.Conclusion. Echocardiographic values for left ventricle (EDD, ESD, EDV, ESV, ESI, EDI) and the LA ratio are predictors of coronary graft occlusions in patients with type 2 diabetes.

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Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years

VASA ◽

10.1024/0301-1526/a000151 ◽

2011 ◽

Vol 40 (6) ◽

pp. 474-481 ◽

Cited By ~ 1

Author(s):

Radak ◽

Babic ◽

Ilijevski ◽

Jocic ◽

Aleksic ◽

...

Keyword(s):

Diabetes Mellitus ◽

Limb Salvage ◽

Iliac Artery ◽

Graft Patency ◽

Long Term Results ◽

Surgical Reconstruction ◽

Safe Procedure ◽

Term Survival

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

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Surgical management of extracranial carotid artery aneurysms

VASA ◽

10.1024/0301-1526/a000528 ◽

2016 ◽

Vol 45 (3) ◽

pp. 223-228 ◽

Cited By ~ 2

Author(s):

Jan Paweł Skóra ◽

Jacek Kurcz ◽

Krzysztof Korta ◽

Przemysław Szyber ◽

Tadeusz Andrzej Dorobisz ◽

...

Keyword(s):

Carotid Artery ◽

Surgical Management ◽

Minor Stroke ◽

Stroke Rate ◽

Extracranial Carotid Artery ◽

Long Term Follow Up ◽

End To End ◽

Dacron Patch ◽

Major Stroke

Abstract. Background: We present the methods and results of the surgical management of extracranial carotid artery aneurysms (ECCA). Postoperative complications including early and late neurological events were analysed. Correlation between reconstruction techniques and morphology of ECCA was assessed in this retrospective study. Patients and methods: In total, 32 reconstructions of ECCA were performed in 31 symptomatic patients with a mean age of 59.2 (range 33 - 84) years. The causes of ECCA were divided among atherosclerosis (n = 25; 78.1 %), previous carotid endarterectomy with Dacron patch (n = 4; 12.5 %), iatrogenic injury (n = 2; 6.3 %) and infection (n = 1; 3.1 %). In 23 cases, intervention consisted of carotid bypass. Aneurysmectomy with end-to-end suture was performed in 4 cases. Aneurysmal resection with patching was done in 2 cases and aneurysmorrhaphy without patching in another 2 cases. In 1 case, ligature of the internal carotid artery (ICA) was required. Results: Technical success defined as the preservation of ICA patency was achieved in 31 cases (96.9 %). There was one perioperative death due to major stroke (3.1 %). Two cases of minor stroke occurred in the 30-day observation period (6.3 %). Three patients had a transient hypoglossal nerve palsy that subsided spontaneously (9.4 %). At a mean long-term follow-up of 68 months, there were no major or minor ipsilateral strokes or surgery-related deaths reported. In all 30 surviving patients (96.9 %), long-term clinical outcomes were free from ipsilateral neurological symptoms. Conclusions: Open surgery is a relatively safe method in the therapy of ECCA. Surgical repair of ECCAs can be associated with an acceptable major stroke rate and moderate minor stroke rate. Complication-free long-term outcomes can be achieved in as many as 96.9 % of patients. Aneurysmectomy with end-to-end anastomosis or bypass surgery can be implemented during open repair of ECCA.

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