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Adjuvant arteriovenous fistula as means of rescue for infrapopliteal venous bypass with poor runoff.

Abstract：

OBJECTIVE:The aim of this study was to assess the outcome of infrapopliteal bypass when an adjuvant arteriovenous (AV) fistula was reconstructed as means of rescue as a result of poor runoff. The design was a retrospective multicenter case-control study. METHODS:Seventy-seven infrapopliteal vein bypasses required an adjuvant AV fistula among 1813 patients operated on for critical leg ischemia in 3 vascular centers between 1996 and 2003. The mean age was 74 years (range, 39-90 years). A total of 70% of the patients had diabetes, and 24% had undergone previous vascular surgery. In 25% of the bypasses, the distal anastomosis was in a crural artery, in 55% it was in the dorsal pedal artery, and in 20% it was in a plantar artery. An adjuvant AV fistula was reconstructed in all cases because of poor intraoperative arterial status, intraoperative angiography, or low intraoperative flow. A control group was retrieved that matched the study group according to the recipient artery and runoff score. RESULTS:The primary and secondary patency were 61% and 75%, respectively, at 1 year in the AV fistula group and 57% and 71% in the control group. The 3-year patency rates were 49% and 62% for the AV fistula group and 46% and 71% for the control group, respectively. There was a 76% leg-salvage rate at 3 years in the study group, compared with 87% in the control group. There were no major complications related to the AV fistula. Intraoperative flow was increased from a median of 20 mL/min to 115 mL/min by the AV fistula (P = .003). The graft flow was significantly higher in the AV fistula group than in the control group (P = .001). CONCLUSIONS:The adjuvant AV fistula increased graft flow significantly in a poor-outflow venous bypass. In this extreme patient group, acceptable patency and leg salvage was achieved without adverse effects. Despite this, the AV fistula did not improve the outcome.

journal_name

J Vasc Surg

journal_title

Journal of vascular surgery

authors

Laurila K,Luther M,Roth WD,Vilkko P,Kantonen I,Teittinen K,Sihvo EI,Ihlberg L,Albäck A,Lepäntalo M

doi

10.1016/j.jvs.2006.06.037

subject

Has Abstract

pub_date

2006-11-01 00:00:00

pages

985-91; discussion 992

issue

eissn

0741-5214

issn

1097-6809

pii

S0741-5214(06)01209-2

journal_volume

pub_type

杂志文章,多中心研究

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Adjuvant arteriovenous fistula as means of rescue for infrapopliteal venous bypass with poor runoff.