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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2001 December;8(4):285-96

language: English, Italian

Distal revascularisation of lower limbs using prosthetic bypass and venous interposition fistula following the Ascer procedure

Spinelli F., D’Alfonso M., Mandolfino T., Acri I., La Spada M., Mirenda F.

From the Institute of Thoracic and Cardiovascular Surgery University of Messina, Messina, Italy


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Background. The ­study ­aimed to eval­u­ate ­long-­term paten­cy and ­limb sal­vage ­rates in dis­tal pros­thet­ic revas­cu­lar­isa­tion of low­er ­limbs ­using com­ple­men­tary arter­i­ov­e­nous fis­tu­la and ­deep ­vein inter­po­si­tion (AVF/VI).
Methods. From 1992 to 2000, AVF/VI was per­formed as an adjunc­tive tech­nique for pros­thet­ic ­bypass on infra­pop­li­teal arter­ies in 32 ­patients ­with 1 or ­more ­failed ipsi­lat­er­al infra­in­gui­nal bypass­es, in ­whom a total­ly autog­e­nous ­vein ­bypass was not fea­sible. Critical ische­mia was the ­sole indi­ca­tion for sur­gery ­with ­rest ­pain, non-heal­ing ischem­ic ­ulcers and ­foot gan­grene.
Results. Perioperative mor­tal­ity (with­in 30 ­days of sur­gery) was ­zero. Five bypass­es ­failed at post­op­er­a­tive day 30, 3 bypass­es ­were pro­longed dis­tal­ly, 3 ampu­ta­tions ­were per­formed. During the fol­low-up (1-96 ­months), 15 bypass­es occlud­ed. Cumulative paten­cy was 62% at 1 ­year, 47% at 2 ­years, 21% at 5 ­years and 21% at 8 ­years. Limb sal­vage was 66% at 1 ­year, 57% at 2 ­years, 53% at 5 ­years and 53% at 8 ­years.
Conclusions. Adjunctive AVF/VI ­proved use­ful in main­tain­ing paten­cy of infra­pop­li­teal pros­thet­ic bypass­es and achiev­ing ­limb sal­vage.

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