A novel method of vein cuff creation for below-knee femoropopliteal bypass with a prosthetic graft

Abstract

Vein cuff anastomosis is beneficial in cases in which a prosthetic graft is anastomosed to a small and thickened peripheral artery. Various types of vein cuff are currently in use, although their design is insufficient when a size discrepancy exists between the two vessels and the angle of anastomosis requires adjustment. We report a case of a patient who underwent below-knee femoropopliteal bypass using a new design of vein cuff (boat-form vein cuff) that increases the ease of cuff creation and enables surgeons to adjust the anastomotic size and angle.

Keywords: Femoropopliteal bypass; Miller's cuff; Vein cuff.

Fig 1

Illustration of the boat-form vein cuff anastomosis. a, Side-to-side anastomosis between the vein and popliteal artery. b, Vein distention and selected incision line (dotted line). The arrow indicates the infusion of heparinized saline solution. c, Anastomosis between the graft and vein cuff. d, Completed boat-form vein cuff anastomosis.

Fig 2

Three-dimensional computed tomography reconstruction from images acquired at the 5-year follow-up. Computed tomography data obtained at the 5-year follow-up revealed patency of the polytetrafluoroethylene graft, vein cuff anastomosis, and every branch of the left lower limb.

Fig 3

A comparison of the types of vein cuff anastomosis. a1, a2, a3, Length of arteriotomy, α, β, Anastomosis angle. Length of arteriotomy differs in relation to the type of vein cuff creation in the anastomosis of same size and angle of prosthetic graft (a1 > a2 > a3). Boat-form vein cuff requires shorter arteriotomy, and trimming of proximal cuff is adjustable to the change of size and angle of prosthetic graft (α > β).