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. 2023 Mar 26;13(7):1246.
doi: 10.3390/diagnostics13071246.

Long-Term Results of Below-The-Knee Bypass Using a Prosthetic Graft with a Distal Arteriovenous Fistula Interposition

Francesco Spinelli  1 , Giuseppe Roscitano  2 , David Barillà  3 , Graziana Derone  4 , Antonio Nenna  5 , Nunzio Montelione  1 , Vincenzo Catanese  1 , Andrea Cutrupi  3 , Martina Maria Giambra  2 , Alessandra Varrà  2 , Pier Francesco Veroux  2 , Francesco Stilo  1
Affiliations

Long-Term Results of Below-The-Knee Bypass Using a Prosthetic Graft with a Distal Arteriovenous Fistula Interposition

Francesco Spinelli et al. Diagnostics (Basel). .

Abstract

Surgical bypass is the gold standard treatment in patients affected by chronic limb-threatening ischemia in advanced GLASS stages, according to the Global Vascular Guidelines. For patients in whom an autologous graft is not available, a prosthesis could be used with the adjunct of a distal arteriovenous fistula interposition. The aim of this study was to examine the long-term results of below-the-knee surgical revascularization using a prosthesis with the distal adjunct mentioned above. From 2010 to 2020, we performed 159 lower limb below-the-knee surgical revascularizations using a prosthesis with the creation of an arteriovenous fistula interposition on the distal anastomosis. The GLASS stage was 3 in 100% of patients. The primary patency rates were as follows: 86.7% at 1 year, 57.2% at 3 years, and 12.6% at 5 years. The graft thrombosis rates were 17.4% at 1 year, 42.1% at 3 years, and 64.5% at 5 years. The amputation-free survival rates were 79% at 1 year, 76% at 3 years, and 64% at 5 years. PTFE prosthetic bypass for below-the-knee arteries using an arteriovenous fistula interposition is a good solution in patients without an autologous conduit. This technique offers reasonable graft patency and limb salvage rates.

Keywords: arteriovenous fistula; chronic limb-threatening ischemia; distal adjunct; prosthetic graft; surgical revascularization.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Distal arteriovenous fistula and PTFE anastomosis to the comitans vein.
Figure 2
Figure 2
(A) Banding of the comitans vein with a silk suture. Green arrow: posterior tibial artery. Blue arrow: posterior tibial vein. Yellow arrow: PTFE graft. (B) Final result of AVF with a silk suture in the comitans vein.
Figure 3
Figure 3
CT angiography.
Figure 4
Figure 4
Angiography frame of the distal anastomosis on the peroneal artery.
Figure 5
Figure 5
(A) Primary patency rates, (B) assisted primary patency rates, (C) graft thrombosis rates, and (D) amputation rates.
Figure 6
Figure 6
(A) Amputation-free survival rates and (B) survival rates.
See this image and copyright information in PMC

References

    1. Conte M.S., Bradbury A.W., Kolh P. GVG Writing Group for the Joint Guidelines of the Society for Vascular Surgery (SVS), European Society for Vascular Surgery (ESVS), and World Federation of Vascular Societies (WFVS). Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur. J. Vasc. Endovasc. Surg. 2019;58:S1–S109.e33. doi: 10.1016/j.ejvs.2019.05.006. - DOI - PMC - PubMed
    1. Rutherford R.B., Baker J.D., Ernst C. Recommended standards for reports dealing with lower extremity ischemia: Revised version. J. Vasc. Surg. 1997;26:517–538. doi: 10.1016/S0741-5214(97)70045-4. - DOI - PubMed
    1. Mazzariol F., Ascher E., Hingorani A. Lower- extremity revascularisation without preoperative contrast arteriography in 185 cases: Lessons learned with duplex ultrasound arterial mapping. Eur. J. Vasc. Endovasc. Surg. 2000;19:509–515. doi: 10.1053/ejvs.1999.1019. - DOI - PubMed
    1. Spinelli F., Pipitò N., Martelli E. Endo first is not appropriate in some patients with critical limb ischemia because ‘bridges are burned’. Ann. Vasc. Surg. 2015;29:272–277. doi: 10.1016/j.avsg.2014.09.032. - DOI - PubMed
    1. Spinelli F., Stilo F., Benedetto F. Early and one-year results of infrainguinal bypass after failure of endovascular therapy. Int. Angiol. 2011;30:156–163. - PubMed

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