RESUMEN

This study aimed to examine the influence of diabetes on the left internal mammary artery (LIMA) and saphenous vein (SV) graft failure for 5-year follow-up. We enrolled 202 patients who underwent isolated off-pump coronary artery bypass grafting (CABG) surgery in 2014, angiographic follow-up occurred at 5 years after surgery. Angiographic outcomes in patients with or without diabetes were analyzed. Multivariate logistic regression analysis was used to identify independent predictors of graft dysfunction. A total of 66 (32.7%) patients had diabetes. Five-year rates of LIMA and SV graft failure were similar in patients with and without diabetes. In addition, in diabetics, the proportion of complete graft failure was significantly lower in the LIMA grafts (12/66, 18.2%) than in the SV grafts (57/133, 42.9%) (P = .001). In nondiabetic, the proportion of complete graft failure was also significantly lower in the LIMA grafts (28/136, 20.6%) than in the SV grafts (105/275, 38.2%) (P < .001). Multivariate logistic regression analysis showed that mean graft flow (MGF) was an independent predictor factor for LIMA (odds ratio = 1.186, 95% CI = 1.114-1.263, P < .001) and SV (odds ratio = 1.056, 95% CI = 1.035-1.077, P < .001) graft failure. Diabetes did not influence the patency of LIMA or SV grafts over a 5-year follow-up. LIMA grafts should be maximized in patients undergoing off-pump CABG surgery. Diabetes does not affect the patency of grafts CABG. Using angiography, our study proved that diabetes does not affect the patency of grafted vessels after CABG for 5 years.

Asunto(s)

Angiografía Coronaria , Puente de Arteria Coronaria Off-Pump , Arterias Mamarias , Grado de Desobstrucción Vascular , Humanos , Puente de Arteria Coronaria Off-Pump/métodos , Masculino , Femenino , Angiografía Coronaria/métodos , Persona de Mediana Edad , Anciano , Arterias Mamarias/trasplante , Arterias Mamarias/diagnóstico por imagen , Vena Safena/trasplante , Vena Safena/diagnóstico por imagen , Diabetes Mellitus/epidemiología , Oclusión de Injerto Vascular/epidemiología , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/etiología , Estudios Retrospectivos , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Estudios de Seguimiento

RESUMEN

OBJECTIVE: Reversed great saphenous vein (GSV) graft is widely used for revascularization in limb-sparing surgery for sarcoma invading great vessels. However, a mismatch in caliber between the reverse graft and cut end of the artery can threaten graft patency. Recently, we introduced the use of a venous valvulotome to allow nonreversed GSV graft. The purpose of this study was to evaluate the safety and versatility of this technique. DESIGN: We retrospectively compared long-term patency and limb salvage rates between nonreversed GSV and reversed GSV in patients undergoing limb-sparing surgery for sarcoma. METHODS: Thirty-seven patients were included, with 21 in the nonreversed GSV group and 16 in the reversed GSV group. Patient characteristics, surgical details, and complications were reviewed from the hospital records. The patency of the reconstructed vessels was assessed using contrast-enhanced CT or MRI. Statistical analyses, including Kaplan-Meier survival analysis, were employed for comparisons. RESULTS: The median follow-up was 38 months. Overall graft patency was 90.4% (19 of 21 patients) in the nonreversed GSV group and 81.2% (13 of 16) in the reverse GSV (RGSV) group. In the nonreversed GSV group, there was 1 case of graft occlusion each in the acute and chronic phases, but limb circulation remained intact and all limbs were spared. CONCLUSION: Nonreversed GSV grafting with valvulotome offers a safe and versatile alternative to reversed GSV grafts in limb-sparing sarcoma surgery. It eliminates the need for vein reversal and minimizes diameter mismatch, potentially expanding the indication for autologous revascularization to previously ineligible cases.

Asunto(s)

Recuperación del Miembro , Extremidad Inferior , Vena Safena , Sarcoma , Grado de Desobstrucción Vascular , Humanos , Vena Safena/trasplante , Masculino , Femenino , Estudios Retrospectivos , Sarcoma/cirugía , Persona de Mediana Edad , Adulto , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/cirugía , Anciano , Recuperación del Miembro/métodos , Procedimientos de Cirugía Plástica/métodos , Adolescente , Adulto Joven , Resultado del Tratamiento , Neoplasias de los Tejidos Blandos/cirugía

RESUMEN

The saphenous vein graft (SVG) remains the most used conduit as a second graft in Coronary Artery Bypass Grafting (CABG).1 Traditionally, surgeons harvest SVG with an open approach, making a long incision along the medial part of the leg or thigh. This procedure can potentially result in important complications, such as delayed wound healing, postoperative pain and infection.2 Thus, less invasive techniques for vessel harvesting have grown in popularity. Endoscopic vein harvesting (EVH) is a minimally invasive harvesting procedure, which only requires a short incision, leading to less wound complications and a faster return to normal daily activities. This article intends to describe how we do EVH technique in our centre, from the preparation of the patient to the postoperative period and share some tips and tricks from our experience.

Asunto(s)

Puente de Arteria Coronaria , Endoscopía , Vena Safena , Recolección de Tejidos y Órganos , Humanos , Recolección de Tejidos y Órganos/métodos , Vena Safena/trasplante , Puente de Arteria Coronaria/métodos , Endoscopía/métodos

RESUMEN

BACKGROUND: The descending genicular artery (DGA) and medial thigh region have been underused as donor sites for perforator flaps. This study evaluated the anatomical relationship between the perforators of the DGA and the saphenous vein (SV) to review the clinical applications of the free descending genicular artery perforator (DGAP) flap for locoregional reconstruction. METHODS: Fifteen cadavers were arterially perfused with red latex and dissected. Thirty-one patients with extremity tissue defects were treated with a free DGAP flap, including six patients who received a chimeric flap. The minimum distance between the DGAP and the SV was measured during surgery. RESULTS: In all patients, the skin branch of the descending genicular artery was found in the medial femoral condyle plane in front of the SV. The average distance between the descending genicular artery perforator and the SV was 3.71 ± 0.38 cm (range: 2.9-4.3 cm). Thirty flaps survived completely, and one flap developed partial necrosis; however, this flap healed two weeks after skin grafting. The average follow-up time was 11.23 months. CONCLUSIONS: We conclude that the SV can be preserved when harvesting the descending genicular artery perforator flap, causing less damage to the donor site and having no effect on flap survival. The free descending genicular artery perforator flap without the SV is a better therapy for complicated tissue defects.

Asunto(s)

Cadáver , Colgajo Perforante , Procedimientos de Cirugía Plástica , Vena Safena , Humanos , Colgajo Perforante/irrigación sanguínea , Masculino , Femenino , Vena Safena/trasplante , Persona de Mediana Edad , Anciano , Adulto , Procedimientos de Cirugía Plástica/métodos

RESUMEN

OBJECTIVES: Endoscopic vein harvesting (EVH) is an alternative technique to obtain the saphenous vein for coronary artery bypass grafting (CABG) surgery. We aimed to evaluate the early and mid-term outcomes of patients with EVH in CABG. METHODS: This cohort study included consecutive isolated CABG patients in Nanjing First Hospital from July 2020 to December 2022 using propensity score matching methods. Patients were classified to EVH group and open vein harvesting (OVH) group according to the vein harvesting methods. The primary outcome was the all-cause death, and the secondary outcomes were major adverse cardiovascular events (MACEs) including cardiovascular death, heart failure, myocardial infarction and revascularization and asymptomatic survival in the follow-up. RESULTS: Totally 1247 patients were included in the study with 849 in OVH group and 398 in EVH group. Patients with EVH were more female, diabetes, higher body mass index, more multi-vessel and left main diseases. 308 pairs were formed after the matching. There was no significant difference in the rates of in-hospital death (EVH vs. OVH, 2.3% vs. 1.3%, P = 0.543). During the 3 years follow-up, EVH grafts were considered not inferior to OVH grafts, no differences were found in all-cause death [8.5% vs. 5.0%, hazard ratio (HR) 1.565, 95% confidence interval (CI): 0.77-3.17, P = 0.21], MACEs (8.1% vs. 7.1%, HR 1.165, 95CI: 0.51-2.69, P = 0.71) and asymptomatic survival (66.7% vs. 72.5%, HR 1.117, 95%CI: 0.65-1.92, P = 0.68). CONCLUSIONS: EVH grafts were considered comparable to OVH grafts in patients following CABG in the 3 years follow-up.

Asunto(s)

Puente de Arteria Coronaria , Endoscopía , Vena Safena , Recolección de Tejidos y Órganos , Humanos , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/mortalidad , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Vena Safena/trasplante , Endoscopía/métodos , Recolección de Tejidos y Órganos/métodos , Anciano , Enfermedad de la Arteria Coronaria/cirugía , Resultado del Tratamiento , Puntaje de Propensión

Asunto(s)

Aneurisma Coronario , Embolización Terapéutica , Humanos , Resultado del Tratamiento , Aneurisma Coronario/diagnóstico por imagen , Aneurisma Coronario/cirugía , Aneurisma Coronario/etiología , Aneurisma Coronario/terapia , Masculino , Embolización Terapéutica/instrumentación , Puente de Arteria Coronaria/efectos adversos , Angiografía Coronaria , Anciano , Vena Safena/trasplante , Vena Safena/diagnóstico por imagen

Asunto(s)

Arteria Poplítea , Vena Safena , Humanos , Vena Safena/trasplante , Arteria Poplítea/cirugía , Arteria Poplítea/diagnóstico por imagen , Masculino , Resultado del Tratamiento , Anciano , Grado de Desobstrucción Vascular

RESUMEN

INTRODUCTION: Surgical site infection after saphenous vein harvest is common, with reported leg wound infection rates ranging from 2 to 24%. There have been few investigations into sex-related differences in complication rates. Moreover, varied effects of smoking have been reported. The aim of this study was to investigate risk factors such as gender and smoking, associated with surgical site infection after vein graft harvesting in coronary artery bypass grafting surgery. METHODS: We included 2,188 consecutive patients who underwent coronary artery bypass grafting surgery with at least one vein graft at our centre from 2009 to 2018. All patients were followed up postoperatively. Risk factors for leg wound infection requiring antibiotic treatment and surgical revision were analysed using logistic regression analysis. RESULTS: In total, 374 patients (17.1%) received antibiotic treatment and 154 (7.0%) underwent surgical revision for leg wound infection at the harvest site. Female sex, high body mass index, diabetes mellitus, longer operation time, peripheral vascular disease and direct oral anticoagulants were independently associated with any leg wound infection at the harvest site. Among surgically revised patients, female sex and insulin or oral treatment for diabetes mellitus as well as longer operation time were independent risk factors. Smoking was not associated with leg wound infection. CONCLUSION: Female sex is associated with increased risk of leg wound infection. The underlying mechanism is unknown. In the current population, previous or current smoking was not associated with an increased risk of leg wound infection.

Asunto(s)

Puente de Arteria Coronaria , Vena Safena , Infección de la Herida Quirúrgica , Recolección de Tejidos y Órganos , Humanos , Puente de Arteria Coronaria/efectos adversos , Femenino , Masculino , Vena Safena/trasplante , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Estudios Retrospectivos , Factores de Riesgo , Anciano , Persona de Mediana Edad , Recolección de Tejidos y Órganos/efectos adversos , Recolección de Tejidos y Órganos/métodos , Factores Sexuales

RESUMEN

OBJECTIVE: The aim of this study was to evaluate the outcomes of cold stored saphenous vein allografts (CSVAs) for haemodialysis vascular access. METHODS: A retrospective, two centre study was conducted between January 2016 and December 2020 of all patients who had CSVA placement for haemodialysis vascular access. Primary, primary assisted, and secondary patency were analysed, as well as procedural complications and re-interventions. RESULTS: One hundred and nine patients (n = 55 women) with a mean age of 67.2 ± 13.6 years, with no options for creating an autogenous arteriovenous fistula, were included in the study. At one year, primary, primary assisted, and secondary patency were 37.6%, 59.0%, and 73.3%, respectively; and at two years 19.9%, 42.5%, and 54.9%, respectively. During a mean follow up period of 26 ± 18 months, five patients (4.6%) had an access infection, with no related death. During the follow up period, 32 patients (29.4%) died and 13 patients (11.9%) underwent a kidney transplant. None of these patients showed immunoconversion before transplantation. The cumulative incidence of adverse events by the Fine-Gray method was calculated. Considering competing risks (death and renal transplantation), 9.2% of patients lost their vascular access at one year and 18% at two years. Moreover, 57.8% patients had stenosis, mainly on the outflow (45.9%), and 49.5% had thrombosis. CONCLUSION: With a comparable patency rate associated with a low infection rate, CSVA offers a potential alternative to expanded polytetrafluoroethylene grafts. This creates haemodialysis vascular access when the venous capital is exhausted in patients with reported risk factors for vascular access infection, i.e., insertion in the thigh, advanced age, diabetes mellitus, immunocompromised state, obesity, or revision of an infected prosthetic graft.

Asunto(s)

Derivación Arteriovenosa Quirúrgica , Diálisis Renal , Vena Safena , Grado de Desobstrucción Vascular , Humanos , Femenino , Masculino , Estudios Retrospectivos , Anciano , Vena Safena/trasplante , Persona de Mediana Edad , Derivación Arteriovenosa Quirúrgica/efectos adversos , Derivación Arteriovenosa Quirúrgica/métodos , Resultado del Tratamiento , Aloinjertos , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/epidemiología , Oclusión de Injerto Vascular/fisiopatología , Anciano de 80 o más Años , Factores de Riesgo , Factores de Tiempo , Criopreservación , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación

RESUMEN

Deep venous arterialization (DVA) is a final option for limb salvage in patients with end stage arterial anatomy. We report a 66-year-old dialysis dependent male with forefoot gangrene, Rutherford class 6 chronic limb ischemia, who required a redo endovascular DVA. On initial presentation an angiogram was demonstrated a desert foot with absent tibial runoff to his bilateral lower extremities. After discussion, patient elected to trial DVA in hope of avoiding a major amputation. A hybrid DVA was performed using a Pioneer Plus and .018″ Viabahn stents from the peroneal artery into the peroneal venous system; following this, the peroneal vein was anastomosed to the lesser saphenous vein via an open posterior approach at the ankle. 3 months later, a second DVA was performed by exposing the above knee popliteal artery and vein and creating an end-to-side anastomosis. Of note, the great saphenous vein was less than 2 mm in diameter and no arm vein was available due to history of prior fistulas in bilateral arms. Via the popliteal vein, the posterior tibial vein was selected and additional .018″ Viabahn stents were deployed from the malleolus to the P2 segment of the popliteal vein. Three months after the second hybrid DVA, the patient's forefoot had healed after split thickness skin grafting. Continued patency is noted of the re-do hybrid DVA with minimal calf edema. Newer creative strategies are required for "No Option Chronic Limb Ischemia" which is becoming more relevant in diabetic and dialysis dependent patients. This case illustrates the potential to convert a deep venous arterialization to a superficial venous arterialization for improved venous outflow and wound healing.

Asunto(s)

Procedimientos Endovasculares , Isquemia , Recuperación del Miembro , Vena Poplítea , Vena Safena , Stents , Grado de Desobstrucción Vascular , Humanos , Masculino , Anciano , Resultado del Tratamiento , Isquemia/fisiopatología , Isquemia/diagnóstico por imagen , Isquemia/cirugía , Isquemia/etiología , Procedimientos Endovasculares/instrumentación , Vena Poplítea/fisiopatología , Vena Poplítea/diagnóstico por imagen , Vena Poplítea/cirugía , Vena Safena/trasplante , Vena Safena/diagnóstico por imagen , Vena Safena/fisiopatología , Diálisis Renal , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/cirugía , Reoperación , Enfermedad Crónica , Gangrena

RESUMEN

A 72-year-old male with a history of a triple-vessel coronary artery bypass graft years ago presented with a DeBakey type 2 aortic dissection and an aorto-left atrial fistula with patent bypass grafts (left internal mammary artery and saphenous vein grafts). He developed pulmonary oedema and required intubation. The right axillary artery was cannulated. After the ascending aorta and left internal mammary artery were clamped, the aorta was transected, leaving aortic tissue around two saphenous vein grafts as two separate patches. An entry tear was found adjacent to the proximal anastomosis of the saphenous vein graft to the posterior descending artery. A fistula, which was located between a false lumen in the non-coronary sinus and the dome of the left atrium, was primarily closed. Because the adventitia was thinned out in the non-coronary sinus due to aortic dissection, partial aortic root remodelling was performed with resuspension of the commissures. Hemiarch repair was performed under moderate hypothermia and unilateral antegrade cerebral perfusion. After systemic perfusion was resumed, the locations of the saphenous vein graft buttons were determined. The ascending graft was cross-clamped again; the saphenous vein graft to the obtuse marginal branch graft was reimplanted using the Carrel patch technique while a saphenous vein graft to the posterior descending artery required interposition of a 10-mm Dacron graft to accommodate the length.

Asunto(s)

Disección Aórtica , Puente de Arteria Coronaria , Atrios Cardíacos , Humanos , Masculino , Anciano , Atrios Cardíacos/cirugía , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/efectos adversos , Fístula Vascular/cirugía , Fístula Vascular/etiología , Fístula Vascular/diagnóstico , Fístula/cirugía , Fístula/etiología , Fístula/diagnóstico , Reoperación/métodos , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico , Vena Safena/trasplante

RESUMEN

BACKGROUND: Octogenarians are regarded as one of the frailest patient groups among the chronic limb-threatening ischaemia population with high perioperative morbidity and mortality rates. As a result, alternative vein bypass surgery in the absence of sufficient great saphenous vein is often not considered as a potential treatment option. The aim of this study was to compare the results of octogenarians undergoing alternative vein bypass surgery due to chronic limb-threatening ischaemia to younger patients. METHODS: A single-centre retrospective analysis of patients undergoing bypass surgery for chronic limb-threatening ischaemia with alternative autologous vein grafts between 1997 and 2018 was performed. Patients aged over 80 years were compared with those under 80 years. Graft patency rates were assessed and a risk factor analysis for limb loss was performed. RESULTS: In total, 592 patients underwent bypass surgery during the study interval. Twenty-one per cent (n = 126) of patients were 80 years or older. At 4 years, primary, primary-assisted and secondary patency as well as limb salvage rates were not significantly different between the two groups (46% versus 50%, 60% versus 66%, 69% versus 72%, 72% versus 77%, for octogenarians versus non-octogenarians respectively). Major amputations were performed in 27 (21%) octogenarians and 91 (20%) non-octogenarians (P = 0.190). No higher 30-day and long-term mortality rates nor morbidity rates were detected in the octogenarian group with a median follow-up time of 27 (interquartile range 12-56) months. Minor amputation, the reason for alternative vein grafts, as well as the profunda femoris artery as proximal origin of the bypass were risk factors for limb loss in the postoperative course. CONCLUSION: Alternative vein bypass surgery in octogenarians with chronic limb-threatening ischaemia is safe and effective in terms of patency rates, limb salvage and survival compared with younger patients in the absence of sufficient great saphenous vein. Age alone should not be a deterrent from performing bypass surgery.

Asunto(s)

Amputación Quirúrgica , Recuperación del Miembro , Grado de Desobstrucción Vascular , Humanos , Estudios Retrospectivos , Masculino , Anciano de 80 o más Años , Femenino , Recuperación del Miembro/métodos , Anciano , Amputación Quirúrgica/estadística & datos numéricos , Isquemia Crónica que Amenaza las Extremidades/cirugía , Vena Safena/trasplante , Injerto Vascular/métodos , Injerto Vascular/efectos adversos , Injerto Vascular/mortalidad , Factores de Riesgo , Factores de Edad , Persona de Mediana Edad , Isquemia/cirugía , Resultado del Tratamiento , Enfermedad Crónica

RESUMEN

BACKGROUND: Common carotid artery occlusion (CCAO) is rare, where a revascularization procedure might be needed in symptomatic or recurrent ischemic events. In this study, we describe the carotid-carotid artery crossover bypass technique for Riles type 1 A CCAO. METHODS: The procedure was conducted via bilateral neck incisions utilizing the saphenous vein graft. The graft was patent after surgery, along with substantial improvement in cerebral perfusion, resulting in a stroke-free postoperative period. CONCLUSION: The carotid-carotid crossover bypass is effective for CCAO patients requiring revascularization. However, individual bypass options and vascular grafts should be carefully considered.

Asunto(s)

Arteria Carótida Común , Estenosis Carotídea , Revascularización Cerebral , Vena Safena , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Carótida Común/cirugía , Estenosis Carotídea/cirugía , Revascularización Cerebral/métodos , Vena Safena/trasplante , Resultado del Tratamiento

RESUMEN

BACKGROUND: This study investigated the impact of complete revascularization (CR) and incomplete revascularization (IR) on long-term survival in patients undergoing isolated coronary artery bypass grafting (CABG) using multiple arterial graft (MAGs) or a single artery with saphenous vein grafts (SAGs). METHODS: Between January 2006 and December 2020, 12,625 patients underwent CABG and were divided into 4 groups: MAG CR (n = 1066), MAG IR (n = 286), SAG CR (n = 8360), and SAG IR (n = 2913). Inverse probability of treatment weighting based on the generalized propensity score was used to minimize imbalance between the groups. RESULTS: In the weighted cohort, median follow-up time was 8.35 years (interquartile range, 5.01-11.6 years). MAG CR was associated with similar long-term survival compared with MAG IR (hazard ratio [HR], 0.79; 95% CI, 0.60-1.03; P = .084). SAG CR was associated with improved long-term survival compared with SAG IR (HR, 0.67; 95% CI, 0.52-0.84; P = .01). MAG CR was associated with better long-term survival compared with SAG CR (HR, 0.45; 95% CI, 0.35-0.57; P < .001). Moreover, MAG IR was protective compared with SAG IR (HR, 0.62; 95% CI, 0.45-0.85; P = .033). Additional analysis was performed comparing perfect CR vs imperfect CR vs IR in MAG and SAG patients, separately. In the weighted sample of MAG, there were no differences in the long-term survival between perfect CR, imperfect CR, and IR. However, in the weighted sample of the SAG cohort, SAG perfect CR was associated with improved survival compared with SAG imperfect CR (HR, 0.81; 95% CI, 0.0.72-0.92; P = .001). Whereas, SAG perfect and imperfect CR were both associated with improved survival compared with SAG IR (HR, 0.51; 95% CI, 0.0.35-0.87; P = .006 and HR, 0.72; 95% CI, 0.64-0.82; P < .001), respectively. CONCLUSIONS: MAG CR is associated with better survival compared with SAG CR. If IR is inevitable, patients with MAG IR had better long-term survival compared with patients receiving SAG IR. Moreover, similar long-term survival is observed whether perfect CR, imperfect CR, or IR is achieved in the MAG population but not in SAG patients.

Asunto(s)

Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria , Humanos , Masculino , Femenino , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/mortalidad , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/mortalidad , Tasa de Supervivencia/tendencias , Vena Safena/trasplante , Estudios de Seguimiento , Factores de Tiempo , Puntaje de Propensión

RESUMEN

BACKGROUND: Previous studies suggested only the radial artery and the No-touch (NT) technique were effective in reducing graft occlusion after coronary artery bypass grafting (CABG) surgery. However, there is no randomized trial comparing these 2 graft conduits. The optimum second conduit for CABG remains undetermined. MATERIALS AND METHODS: This study is a prospective, single-center randomized clinical trial, aiming to compare the graft patency between the radial artery and the NT vein graft. All patients undergoing isolated CABG with left internal mammary artery (LIMA) plus at least 2 additional grafts will be considered eligible. About 774 cases (516 in the radial artery group and 258 in the NT vein group) will be enrolled in over 1 to 2 years. Participants will be randomized and allocated to two bypass strategies: the LIMA plus 1 radial artery and 1 conventional vein graft, or the LIMA plus 2 NT vein grafts. The primary outcome is graft occlusion at 1 year after CABG evaluated by CT angiography. The secondary outcomes include graft occlusion at 3 and 5 years and major adverse cardiac or cerebrovascular events at 1, 3, and 5 years follow-ups. DISCUSSION: This study will define whether or not the NT vein has a lower graft occlusion rate than the radial artery in short and mid-term follow-ups, and provide new evidence for the second conduit choice in CABG surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT06014047. Registered on October 15th, 2023.

Asunto(s)

Puente de Arteria Coronaria , Oclusión de Injerto Vascular , Arteria Radial , Vena Safena , Grado de Desobstrucción Vascular , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/cirugía , Oclusión de Injerto Vascular/prevención & control , Oclusión de Injerto Vascular/etiología , Arterias Mamarias/trasplante , Estudios Prospectivos , Arteria Radial/trasplante , Ensayos Clínicos Controlados Aleatorios como Asunto , Vena Safena/trasplante

RESUMEN

The study purpose is to review the surgical approach and evaluate the results in cases of head and neck malignancies with internal carotid artery invasion. The anatomical site of the primary tumor varied including a fixed massive metastatic neck disease of an occult intraoral carcinoma of the right tonsil, a recurrent metastatic neck tumor after laryngectomy for glottic primary carcinoma and a metastatic malignant melanoma of an unknown primary origin. In all cases carotid artery was invaded and therefore resected. An extended Javid shunt was performed between common carotid artery (CCA) and internal carotid artery (ICA) followed by CCA grafting with an interposition saphenous vein graft. In one case the vagus nerve was also grafted with an interposition sural graft. The total patient number was three. By clinical examination, follow-up and duplex scanning, the patency of the carotid grafts, vascular and non-vascular complications, disease recurrence and survival were analysed. Additionally, there was a double metachronous reconstruction for recurrence, giving the opportunity to study the graft adoption and response to disease. Internal carotid artery invasion portends a poor prognosis. The results show that carotid artery resection followed by the appropriate reconstruction yields a chance for cure or can provide reasonable palliation.

Asunto(s)

Arteria Carótida Interna , Invasividad Neoplásica , Procedimientos de Cirugía Plástica , Humanos , Estudios Retrospectivos , Masculino , Persona de Mediana Edad , Arteria Carótida Interna/cirugía , Procedimientos de Cirugía Plástica/métodos , Anciano , Femenino , Melanoma/cirugía , Recurrencia Local de Neoplasia , Arteria Carótida Común/cirugía , Vena Safena/trasplante , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias Tonsilares/cirugía , Neoplasias Tonsilares/patología , Estudios de Seguimiento , Adulto , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/patología , Injerto Vascular/métodos , Laringectomía/métodos

RESUMEN

The Best Endovascular Versus Best Surgical Therapy in Patients With Chronic Limb-Threatening Ischemia trial was a landmark trial which provides high-quality data for the decision-making regarding the treatment of chronic-limb threatening ischemia. Overall, the trial suggests that in patients with adequate greater saphenous vein conduit, bypass surgery should be offered as a first line treatment given superior outcomes. In this article, we outline the common critiques of the trial, followed by responses to provide a deeper understanding of the strengths and limitations of this important trial.

Asunto(s)

Procedimientos Endovasculares , Enfermedad Arterial Periférica , Vena Safena , Humanos , Resultado del Tratamiento , Procedimientos Endovasculares/efectos adversos , Vena Safena/cirugía , Vena Safena/trasplante , Enfermedad Arterial Periférica/cirugía , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Ensayos Clínicos Controlados Aleatorios como Asunto , Isquemia Crónica que Amenaza las Extremidades/cirugía , Factores de Riesgo , Isquemia/cirugía , Isquemia/fisiopatología , Isquemia/diagnóstico por imagen , Proyectos de Investigación , Recuperación del Miembro , Injerto Vascular/efectos adversos , Selección de Paciente , Enfermedad Crónica , Extremidad Inferior/irrigación sanguínea , Amputación Quirúrgica , Factores de Tiempo

RESUMEN

While single-segment great saphenous vein (GSV) remains the gold-standard conduit for infrainguinal bypass, several alternative options are available for use when GSV is absent in patients with chronic limb threatening ischemia requiring infrainguinal revascularization including alternative autologous vein, prosthetic conduits, and cryopreserved vein grafts.

Asunto(s)

Implantación de Prótesis Vascular , Isquemia Crónica que Amenaza las Extremidades , Extremidad Inferior , Humanos , Prótesis Vascular , Isquemia Crónica que Amenaza las Extremidades/diagnóstico por imagen , Isquemia Crónica que Amenaza las Extremidades/fisiopatología , Isquemia Crónica que Amenaza las Extremidades/cirugía , Criopreservación , Isquemia/cirugía , Isquemia/fisiopatología , Isquemia/diagnóstico por imagen , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/cirugía , Factores de Riesgo , Vena Safena/trasplante , Trasplante Autólogo/métodos , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Venas/trasplante , Venas/cirugía , Venas/diagnóstico por imagen

RESUMEN

BACKGROUND: The use of cryopreserved saphenous veins (CSVs) for the treatment of lower extremity peripheral arterial disease is an attractive option when there is no available autogenous vein. Prior studies found CSVs are at risk for aneurysmal degeneration requiring reoperation. As the management of these complications and patient outcomes is not well described, the objective of this case series is to describe the open and endovascular management of degenerative CSVs at a tertiary community center. METHODS: All CSVs implanted for lower extremity bypass at our institution between 2001 and 2021 were retrospectively reviewed. All CSVs with evidence of aneurysmal change were included in this study. CSVs with evidence of active infection were excluded. The decision to intervene was left to the discretion of the operating surgeon. Demographic data, indications for the index operation, and details about subsequent interventions for degenerative CSVs were recorded. Study end points included limb salvage and continued patency. Demographic data, indications for the index operation, and details about subsequent interventions for degenerative CSVs were recorded. RESULTS: Seventeen bypasses were identified to have aneurysmal degeneration in 13 patients in the absence of infection between 2001 and 2021. Nine of the 13 patients were male, and the average age and body mass index during the index procedure were 72 and 28, respectively. Indications for the index bypass included acute limb ischemia (9), popliteal aneurysm (2), and chronic limb threatening ischemia with Rutherford's class IV (5) and V (1). The mean time between the index procedure and first graft revision due to aneurysmal changes was 4 years. Most of the aneurysms did not occur at the site of anastomosis with 13 occurring in the body of the graft. Thirteen grafts were managed with open surgery and 3 were managed with endovascular techniques. All endovascular repairs were managed via covered stenting. Patients were followed for an average duration of 7 years from the initial bypass and 2 years from their last aneurysmal repair. Limb salvage in this cohort was 87% with 2 limbs requiring amputation, all of whom underwent open reconstruction. The mortality rate in this series was 54% and no patients died due to complications from their graft. Continued patency on Kaplan Meier survival curve analysis was 79% at 6 months, 65% at 1 year, 54% at 3 years, and 27% at 5 years. CONCLUSIONS: In our experience, aneurysmal degeneration of CSV grafts was mostly managed with standard open surgical techniques, although endovascular therapy also proved acceptable. Limb salvage rates and continued patency of repair at 1 year in this cohort were acceptable. This case series highlights the importance of diligent surveillance for patients with CSVs.

Asunto(s)

Aneurisma , Criopreservación , Procedimientos Endovasculares , Recuperación del Miembro , Extremidad Inferior , Enfermedad Arterial Periférica , Reoperación , Vena Safena , Grado de Desobstrucción Vascular , Humanos , Vena Safena/trasplante , Estudios Retrospectivos , Masculino , Femenino , Anciano , Resultado del Tratamiento , Aneurisma/cirugía , Aneurisma/diagnóstico por imagen , Aneurisma/fisiopatología , Aneurisma/etiología , Factores de Tiempo , Extremidad Inferior/irrigación sanguínea , Factores de Riesgo , Enfermedad Arterial Periférica/cirugía , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Persona de Mediana Edad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Anciano de 80 o más Años , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación

RESUMEN

INTRODUCTION: Cystic adventitial disease (CAD) is an uncommon condition that affects arteries and veins. It can cause a rare type of non-atherosclerotic peripheral vessel disease. The most common vessel affected is the popliteal artery. The number of case reports on CAD of the femoral artery is growing. We present a case of a 62-year-old female presented with claudication of the left leg diagnosed with CAD of the left common femoral artery. The patient was treated surgically with cyst excision and vessel reconstruction with saphenous vein autograft patch plasty. After 8-months the cyste relapsed and she had new claudication complains. We decided to perform new surgery. Surgical treatment consisted of cyst resection by excision of the femoral bifurcation and saphenous vein autograft interposition reconstruction of the bifurcation. We also provide an update on the latest literature of surgical treatment of CAD of the ilio-femoral artery region. METHODS: Medline and EMBASE were used to collect articles on CAD of ilio-femoral artery. We included English written or translated case reports or series between 1987 and 2023. RESULTS: Twenty-nine patients out of 28 case reports were included. Most patients were male (59%). Claudication is the most common symptom (76%). Treatment consisted of cyst resection, cyst decompression, Endarterectomy, patch angioplasty and interposition graft using PTFE, Dacron, Great saphenous vein (GSV) or femoral vein autograft. Recurrence appeared in 4 cases (14%). CONCLUSION: In accordance to the literature and our experience we recommend complete vessel excision and saphenous vein (or PTFE) interposition bypass as treatment.

Asunto(s)

Adventicia , Quistes , Arteria Femoral , Vena Safena , Humanos , Femenino , Arteria Femoral/cirugía , Persona de Mediana Edad , Quistes/cirugía , Adventicia/cirugía , Vena Safena/trasplante , Claudicación Intermitente/etiología , Claudicación Intermitente/cirugía