Axillary vein transfer in trabeculated postthrombotic veins

Slides:

Advertisements

Similar presentations

A review of 100 consecutive reconstructions of the distal vertebral artery for embolic and hemodynamic disease Ramon Berguer, MD, PhD, Mark D. Morasch,

Advertisements

Is long vein bypass from groin to ankle a durable procedure

Axillary-to-carotid artery bypass grafting for symptomatic severe common carotid artery occlusive disease Joseph P. Archie, PhD, MD Journal of Vascular.

Diagnosis and treatment of venous lymphedema

Lloyd M. Taylor, M.D., Edward S. Phinney, M.D., John M. Porter, M.D.

Iliac vein stenting in postmenopausal leg swelling

Richard T. Purdy, M. D. , Frederick C. Beyer, M. D. , William D

Effect of a femoral arteriovenous fistula on lower extremity venous hemodynamics after femorocaval reconstruction Sunil S. Menawat, MD, Peter Gloviczki,

Venous stenting across the inguinal ligament

Persistent sciatic artery and vein: An unusual case

Common femoral endovenectomy with iliocaval endoluminal recanalization improves symptoms and quality of life in patients with postthrombotic iliofemoral.

High prevalence of nonthrombotic iliac vein lesions in chronic venous disease: A permissive role in pathogenicity Seshadri Raju, MD, Peter Neglen, MD,

Creation and closure of temporary arteriovenous fistulas for venous reconstruction or thrombectomy: Description of technique Richard J. Sanders, M.D.,

Superficial femoral popliteal vein: An anatomic study

Exposure of the anterior tibial artery by medial popliteal extension

Unexpected major role for venous stenting in deep reflux disease

Superficial femoral—popliteal veins and reversed saphenous veins as primary femoropopliteal bypass grafts: A randomized comparative study Martin L. Schulman,

Surgical treatment of venous obstruction and insufficiency

Axial transformation of the profunda femoris vein

Seshadri Raju, MD, Peter Neglen, MD, PhD Journal of Vascular Surgery

Axillofemoral bypass: A tool with a limited role

Ambulatory venous pressure revisited

Percutaneous recanalization of total occlusions of the iliac vein

Malcolm O. Perry, MD, Richard Kempczinski, MD

Interposition grafting for reoperation on the common femoral artery

Axillopopliteal bypass for limb salvage

Walter J. McCarthy, MD, William H. Pearce, MD, William R

De novo renal artery aneurysm presenting 6 years after transplantation: A complication of recurrent arterial stenosis? Shelby H. Burkey, MD, Miguel A.

Vikram S. Kashyap, MD, Wesley S. Moore, MD, William J

Stenting of the venous outflow in chronic venous disease: Long-term stent-related outcome, clinical, and hemodynamic result Peter Neglén, MD, PhD, Kathryn.

Stenting of chronically obstructed inferior vena cava filters

Tibial bypass grafting for limb salvage with ringed polytetrafluoroethylene prostheses: Results of primary and secondary procedures Hans Schweiger, MD,

Presidential address: Vascular surgery—The third generation

Peter Neglén, MD, PhD, Kathryn C. Hollis, BA, Seshadri Raju, MD

Infrainguinal arterial reconstruction for claudication: Is it worth the risk? An analysis of 409 procedures John Byrne, MD, R.Clement Darling III, MD,

T. V. How, PhD, C. S. Rowe, PhD, G. L. Gilling-Smith, MS, FRCS, P. L

Peter Neglén, MD, PhD, Seshadri Raju, MD Journal of Vascular Surgery

Raul Garcia-Rinaldi, M. D. , Ph. D. , J. M. Revuelta, M. D. , Ph. D

Autogenous aortoiliac/femoral reconstruction from superficial femoral–popliteal veins: Feasibility and durability G.Patrick Clagett, MD, R.James Valentine,

Use of duplex scanning in the diagnosis of arteria profunda femoris stenosis Andreas L. Strauss, MD, Willi Schäberle, MD, Horst Rieger, MD, Franz-Josef.

Ramon Berguer, MD, PhD, Lisa M. Flynn, MD, Ronald A

Elna M. Masuda, MD, Robert L. Kistner, MD Journal of Vascular Surgery

Late hemodynamic sequelae of deep venous thrombosis

Anthony D. Whittemore, MD, Magruder C. Donaldson, MD, John A

Aortoiliac surgery in renal transplant patients

Gangrene of the immediate postoperative above-knee amputation stump: Role of emergency revascularization in preventing death T.J. Bunt, M.D. Journal.

Peter F. Lawrence, MD, Ke Li, MD, Steven W. Merrell, MD, Greg R

Composite sequential bypasses to the ankle and beyond for limb salvage

Popliteal artery aneurysms

Ambulatory venous pressure revisited

Regarding “Venous ulcers and the superficial venous system”

Venous obstruction: An analysis of one hundred thirty-seven cases with hemodynamic, venographic, and clinical correlations Seshadri Raju, MD, Ruth Fredericks,

James E. Edwards, MD, Lloyd M. Taylor, MD, John M. Porter, MD

Polytetrafluoroethylene versus human umbilical vein in above-knee femoropopliteal bypass: Six-year results of a randomized clinical trial Gijs J. Aalders,

Venous valve repair: Early results in fifty-two cases

Surgical management of severe acute lower extremity ischemia

Early experience with cryopreserved saphenous vein allografts as a conduit for complex limb-salvage procedures Philip J. Walker, FRACS, R.Scott Mitchell,

Hemodynamic and metabolic responses to graded microvascular occlusion

Should patient age be a consideration in carotid endarterectomy?

The effects of endothelial injury on smooth muscle cell proliferation

Ronald L. Dalman, MD, Lloyd M. Taylor, MD, Gregory L

Relationship of venous reflux to the site of venous valvular incompetence: Implications for venous reconstructive surgery Natalia A. Gooley, M.D., David.

Axillary-to-carotid artery bypass grafting for symptomatic severe common carotid artery occlusive disease Joseph P. Archie, PhD, MD Journal of Vascular.

Innominate artery trauma: A thirty-year experience

Benjamin B. Chang, MD, R. Clement Darling, MD, Devon E. M

Technique in direct venous valvuloplasty

Thigh claudication due to profunda femoris artery occlusion

Twelve-year experience with intraluminal sutureless ringed graft replacement of the descending thoracic and thoracoabdominal aorta Mehmet C. Oz, MD *,

Elna M. Masuda, MD, Robert L. Kistner, MD, Eugene B. Ferris, MD

Superficial femoral artery eversion endarterectomy: A useful adjunct for infrainguinal bypass in the presence of limited autogenous vein Spence M. Taylor,

Presentation transcript:

Axillary vein transfer in trabeculated postthrombotic veins Seshadri Raju, MD, Peter Neglén, MD, Jeffery Doolittle, BS, Edward F. Meydrech, PhD Journal of Vascular Surgery Volume 29, Issue 6, Pages 1050-1064 (June 1999) DOI: 10.1016/S0741-5214(99)70246-6 Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

Fig 1 Axillary vein transfer. Exposure of the femoral vein confluence in the groin area. Sharp dissection through postthrombotic fibrous encasement is necessary so that the artery may be carefully separated from the vein. Dense encasement was present in 40% of the cases in this series. A 3- to 4-cm segment of vein should be cleared of small branches and collaterals, carefully preserving the profunda femoris vein. Journal of Vascular Surgery 1999 29, 1050-1064DOI: (10.1016/S0741-5214(99)70246-6) Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

Fig 2 Intraluminal synechiae are excised to create a single lumen for the anastomoses. Thin-walled collaterals developing from vasa vasorum in the wall of the vein may be present. Excision of intramural vasa vasorum collaterals to direct their flow into the lumen is not recommended to avoid dangerous weakening of the wall resulting in suture line tears. These flimsy collaterals should be incorporated into the suture line. Journal of Vascular Surgery 1999 29, 1050-1064DOI: (10.1016/S0741-5214(99)70246-6) Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

Fig 3 Exposure of the axillary vein and bench repair. Bench repair by means of the transcommissural technique is shown. Because the valve station needs to be distended during bench repair, it is easier to perform the procedure in situ or after transfer. In situ repair in the axilla avoids unnecessary harvest in the occasional instances in which the repair is unsuccessful. Journal of Vascular Surgery 1999 29, 1050-1064DOI: (10.1016/S0741-5214(99)70246-6) Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

Fig 4 Axillary vein transfer. The proximal anastomosis has been completed. Interrupted sutures should be used for at least half the circumference of the anastomosis. Note the absence of valve leak with the proximal clamp off. Standard vascular clamps provide effective vascular control, even in heavily trabeculated veins. Clamp injury has not been noticed. Journal of Vascular Surgery 1999 29, 1050-1064DOI: (10.1016/S0741-5214(99)70246-6) Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

Fig 5 Axillary vein transfer. A ringed polytetrafluoroethylene sleeve is being applied around the transferred valve to prevent late dilatation. Journal of Vascular Surgery 1999 29, 1050-1064DOI: (10.1016/S0741-5214(99)70246-6) Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

Fig 6 Axillary vein transfer, technical variations. A, A branched axillary vein has been used to construct a valved “double barrel” conduit. This technique may be used to address size disparities. B, A branched axillary vein can also be used to reconstruct the femoral confluence, restoring competency to both the superficial femoral and profunda femoris veins. Journal of Vascular Surgery 1999 29, 1050-1064DOI: (10.1016/S0741-5214(99)70246-6) Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

Fig 7 Cumulative patency rate of transferred axillary valves in the trabeculated group. Journal of Vascular Surgery 1999 29, 1050-1064DOI: (10.1016/S0741-5214(99)70246-6) Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

Fig 8 Valve closure times of transferred axillary valves; survival probability (actuarial) for valve closure times of 1 second or less, 2 seconds or less, and 3 seconds or less are shown. Number of valves at risk at selected intervals are shown above each curve. Journal of Vascular Surgery 1999 29, 1050-1064DOI: (10.1016/S0741-5214(99)70246-6) Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

Fig 9 Actuarial recurrence-free ulcer healing in the subset of patients with stasis ulceration after axillary vein transfer to nontrabeculated (group 1, n = 51) and trabeculated veins (group 2, n = 59). Limbs at risk at selected intervals are shown above each curve. Journal of Vascular Surgery 1999 29, 1050-1064DOI: (10.1016/S0741-5214(99)70246-6) Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

Fig 10 Venographic appearance of trabeculated deep veins in a patient with severe postthrombotic syndrome. Despite venographic appearance, functional obstruction is typically well compensated in these patients. Journal of Vascular Surgery 1999 29, 1050-1064DOI: (10.1016/S0741-5214(99)70246-6) Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

Fig 11 Venographic appearance in case of advanced postthrombotic syndrome. Note extensive network of superficial collaterals. Saphenous vein appears to function as main outflow tract, and proximal femoral veins are not visualized (A). “Blind” exploration of groin (see Technique section) revealed enlarged trabeculated profunda femoris vein to which an axillary vein transfer was performed (B). A poorly recanalized superficial femoral vein was divided, and the dilated saphenous vein was stripped, which was tolerated without any ill effects. Nonvisualization of profunda femoris on this venogram, therefore, proved to be a venographic artifact. Journal of Vascular Surgery 1999 29, 1050-1064DOI: (10.1016/S0741-5214(99)70246-6) Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions