EARLY RESULTS OF ENDOVASCULAR-ASSISTED IN-SITU SAPHENOUS-VEIN BYPASS-GRAFTING

Purpose: This study evaluated an endovascular technique for occlusion of arteriovenous fistula when performing saphenous vein in situ bypass grafting. Methods: In 31 limbs femoropopliteal (17) or femorotibial ( 14) in situ bypass grafting was performed for claudication/aneurysm (4 ), rest pain (6), or tissue loss (21). A valvulotome was used for valv e lysis. Saphenous vein branches were identified with angioscopy in 16 limbs or with fluoroscopy in the remainder. An electronically steerab le endovascular catheter was used to deliver platinum coils into the v enous tributaries to occlude them. Results: The maximal number of coil s placed in any limb was nine. Most operations were performed with onl y a groin incision (length = 9.8 +/- 1.6 cm) and a distal incision (le ngth = 16.8 +/- 6.5 cm). Wound complications occurred in four limbs, w hereas four limbs developed localized superficial thrombophlebitis. Th e postoperative ankle-brachial index increased to a mean of 0.91 +/- 0 .12. Postoperative duplex imaging revealed a missed arteriovenous fist ula in 12 limbs. Two were surgically ligated, whereas the remainder we re embolized in the radiology suite. Postoperative length of hospitali zation was 4 +/- 2 days in uncomplicated cases. Follow-up revealed fiv e graft occlusions. Occlusion occurred at 12 hours, 2 weeks, and 6, 14 , and 15 months after operation. Although there were no perioperative deaths, two patients have died of unrelated causes. Conclusion: This e ndovascular technique of arteriovenous fistula embolization decreased the length of the surgical wounds, and patients were discharged 4 +/- 2 days in uncomplicated cases. The ultimate test of its efficacy, howe ver, will be long-term functional results.