RESIDUAL ARTERIOVENOUS-FISTULAS AFTER CLOSED IN-SITU BYPASS-GRAFTING - AN OVERRATED PROBLEM

Objectives: To prospectively evaluate the incidence and consequences o f residual arteriovenous (AV)-fistulae after ''closed'' in situ bypass grafting. Methods: In 34 patients, 35 ''closed'' in situ bypasses wer e performed. Postoperative assessment of residual AV-fistulae and bypa ss patency was performed with duplex scanning. Results: Postoperative mortality was 3%. During 35 ''closed'' in situ bypass procedures 216 s ide branches were coil embolised. Postoperatively 39 AV-fistulae were detected (15% of the total number of 216 + 39 = 255 side branches). Of these, 13 (5%) closed spontaneously. Fifteen (6%) remained unchanged and 11 (4%) were treated. In three patients four asymptomatic residual AV-fistulae were treated. In four patients seven symptomatic AV-fistu lae were treated for: decreased distal bypass flow in one; persistent leg oedema in one; pain and redness of the skin in two. One-year prima ry patency was 80% (SE 8.4%). Residual AV-fistulae were detected in no ne of six bypass occlusions during follow-up. Conclusion: Residual AV- fistulae detected following ''closed'' in situ bypass grafting only ne ed treatment if they are symptomatic, which is uncommon.