1. 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 (June 1999)
DOI: /S (99)
Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

2. 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  , DOI: ( /S (99) )
Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

3. 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  , DOI: ( /S (99) )
Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

4. 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  , DOI: ( /S (99) )
Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

5. 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  , DOI: ( /S (99) )
Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

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

7. 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  , DOI: ( /S (99) )
Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

8. Fig 7
Cumulative patency rate of transferred axillary valves in the trabeculated group.
Journal of Vascular Surgery  , DOI: ( /S (99) )
Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

9. 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  , DOI: ( /S (99) )
Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

10. 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  , DOI: ( /S (99) )
Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

11. 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  , DOI: ( /S (99) )
Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions

12. 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  , DOI: ( /S (99) )
Copyright © 1999 Society for Vascular Society Surgery and International Society for Cardiovascular Society, North American Chapter Terms and Conditions