Dolores F. Cikrit, MD, Michael C. Dalsing, MD, Stephen G

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Presentation transcript:

Early results of endovascular-assisted in situ saphenous vein bypass grafting Dolores F. Cikrit, MD, Michael C. Dalsing, MD, Stephen G. Lalka, MD, Nicholas F. Fiore, MD, Alan P. Sawchuk, MD, Alan P. Ladd, BS, Betty Solooki, MSN Journal of Vascular Surgery Volume 19, Issue 5, Pages 778-787 (May 1994) DOI: 10.1016/S0741-5214(94)70002-8 Copyright © 1994 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Angioscope (larger arrow) inserted from distal end of saphenous vein allowed visualization of orifice of side branches. Under angioscopic guidance SEC coil delivery system (small arrow) is articulated and advanced into branch orifice. Platinum occlusion coil, 3 mm × 6 cm, has just been injected (arrow head). Small dot proximal to coil is catheter Cynosar (Catheter Research, Inc., Indianapolis, Ind.) through which coil is delivered. Journal of Vascular Surgery 1994 19, 778-787DOI: (10.1016/S0741-5214(94)70002-8) Copyright © 1994 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 This intraoperative angiogram reveals two coils, 3 mm × 6 cm and 4 mm × 6 cm coil (arrows), occluding both branches of saphenous vein tributary, whereas main saphenous vein is widely patent (arrowhead). Journal of Vascular Surgery 1994 19, 778-787DOI: (10.1016/S0741-5214(94)70002-8) Copyright © 1994 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Bruit was noted in this limb after operation. Duplex evaluation confirmed presence of arteriovenous fistula with diameter measuring 2 mm. Residual fistula failed to spontaneously thrombose. This angiogram obtained 1 month after operation revealed bypass graft to be widely patent, with good flow distally through widely patent distal anastomosis. This was clearly evident on second film (not shown) of this five-film angiogram series. Residual fistula (arrow) is visible on this film. Proximal vein branch is evident but is thrombosed with coil located distally in branch (arrowhead). Journal of Vascular Surgery 1994 19, 778-787DOI: (10.1016/S0741-5214(94)70002-8) Copyright © 1994 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Selective cannulation of arterialized vein illustrated in Fig. 3 allows better fistula visualization in preparation for embolization. Although this residual fistula (arrow) was small, its direct communication with deep venous system (arrowhead) made it necessary to embolize fistula. Journal of Vascular Surgery 1994 19, 778-787DOI: (10.1016/S0741-5214(94)70002-8) Copyright © 1994 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Ten limbs with residual arteriovenous fistula were successfully embolized in radiology suite. In this angiogram fistula visualized in Fig. 4 has just been embolized (arrow) with three coils placed in tandem in fistula. Flow is no longer visualized through this perforating vein. Journal of Vascular Surgery 1994 19, 778-787DOI: (10.1016/S0741-5214(94)70002-8) Copyright © 1994 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions