Improved method to create the common ostium variant of the distal arteriovenous fistula for enhancing crural prosthetic graft patency Herbert Dardik,

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Presentation transcript:

Improved method to create the common ostium variant of the distal arteriovenous fistula for enhancing crural prosthetic graft patency Herbert Dardik, MD, Fred Silvestri, MD, Teresa Alasio, MA, Silvia Berry, MS, RVT, Mark Kahn, MD, Ibrahim M. Ibrahim, MD, Barry Sussman, MD, Fred Wolodiger, MD Journal of Vascular Surgery Volume 24, Issue 2, Pages 240-248 (August 1996) DOI: 10.1016/S0741-5214(96)70099-X Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Configurations of various dAVFs: A, common ostium (n = 280); B, proximal vein piggyback (n = 3); C, distal vein piggyback (n = 1); D, Vein interposition (VI) (n = 2); E, Remote side-to-side (n = 4); F, Proximal side-to-side (not used in this series). Journal of Vascular Surgery 1996 24, 240-248DOI: (10.1016/S0741-5214(96)70099-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Current method for performing common ostium dAVF. Arteriotomy and venotomy are established at 10 and 2 o'clock (A and C). Side-to-side anastomosis is begun at midpoint of “posterior” wall (B). Journal of Vascular Surgery 1996 24, 240-248DOI: (10.1016/S0741-5214(96)70099-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 dAVF suture line terminates at cephalad and caudad ends of parallel “otomies.” Journal of Vascular Surgery 1996 24, 240-248DOI: (10.1016/S0741-5214(96)70099-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Small incisions (nicks) in each quadrant convert common ostium into rectangular shape, helping to avoid twisting of subsequent graft anastomosis. Interrupted sutures (2 or 3) in each quadrant avoid stenosing anastomosis and fistula. Journal of Vascular Surgery 1996 24, 240-248DOI: (10.1016/S0741-5214(96)70099-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Life-table patency rates for femoral crural prosthetic grafts (predominantly umbilical vein) with dAVF. Steady improvement is noted over the three time periods, with statistical significance established for the 1990 to 1995 experience compared with the previous two series (p < 0.0001 for 1979-83 vs 1990-95; p = 0.0007 for 1984-89 vs 1990-95). Journal of Vascular Surgery 1996 24, 240-248DOI: (10.1016/S0741-5214(96)70099-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Life-table limb salvage rates for femoral crural prosthetic grafts (predominantly UV) with dAVF. Steady improvement is noted over the three time periods, with statistical significance established for the 1990-95 experience compared with the two previous series (p = 0.0016 for 1979-83 vs 1990-95; p = 0.0082 for 1984-89 vs 1990-95). Journal of Vascular Surgery 1996 24, 240-248DOI: (10.1016/S0741-5214(96)70099-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Life-table of fistula patency depicts annual attrition rates. Journal of Vascular Surgery 1996 24, 240-248DOI: (10.1016/S0741-5214(96)70099-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Duplex sonograms of femoral peroneal bypass with umbilical vein graft. dAVF was performed by common ostium method. Lower panel depicts antegrade flow in distal artery, confirming absence of steal. Journal of Vascular Surgery 1996 24, 240-248DOI: (10.1016/S0741-5214(96)70099-X) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions