(A) This is an ex vivo angiogram of a harvested left greater saphenous vein. We have begun using an ex vivo angiogram of the harvested vein graft for examination.

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Presentation transcript:

(A) This is an ex vivo angiogram of a harvested left greater saphenous vein. We have begun using an ex vivo angiogram of the harvested vein graft for examination of the integrity of the vein graft before implanting it into the patient. In this particular patient, an elderly lady, who had multiple bypasses in the past, and which failed and resulted in severe ischemic change in the right foot, with poor distal runoff. She also developed a gangrenous left foot with ischemic rest pain. Because of the previous surgeries on the right lower extremity several times, she does not have an autogenous vein in the right lower extremity. Therefore, the entirely of the left greater saphenous vein was harvested for simultaneous distal bypass in both limbs. (B) Artistic drawing showing bypass distally after dorsalis pedis artery (B) with the creation of distal AV fistula (C), between distal DPA and DPV, in order to increase distal flow. (C) Completion angiogram showing proximal anastomosis at the right popliteal artery (arrow) with a patent vein graft (double arrow). (D) Completion angiogram showing patent vein graft (arrow), DPA (double arrows), DPV (open triangle), reverse filling into vein system from distal AVF. (E) Completion angiogram of the same patient, at the same sitting, showing proximal anastomosis between the left popliteal artery (double arrow), and the remaining vein graft (arrow), which is patent. (F) Completion angiogram of the same patient showing patent left popliteal-left DPA bypass graft (arrow), with a patent distal anastomosis at the DPA (double arrows). Source: Lower Extremity Revascularization for Atherosclerotic Occlusive Disease, Peripheral Arterial Disease Citation: Dieter RS, Dieter RA, Jr., Dieter RA, III. Peripheral Arterial Disease; 2016 Available at: http://accesscardiology.mhmedical.com/DownloadImage.aspx?image=/data/books/1789/dieperi_ch37_f017a.png&sec=123049641&BookID=1789&ChapterSecID=123049469&imagename= Accessed: October 24, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved