[Evaluation of arteriovenous shunts following venous by-pass with the saphenous vein in situ. A suggested approach (author's transl)].
An isotopic method employing microspheres of serum-albumin of a mean diameter of 15 microns was used to study the problem raised by the development of arteriovenous fistulae following saphenous by-pass in situ, enabling measurement of shunt flow and qualitative evaluation of the distal bed. Shunt blood flow varies greatly from practically negligible quantities to a maximum of 90%. Comparing data from angiography during operation with these data showed a parallel between the worst angiographic appearances, the poorest scintigraphy images, and the most marked shunts. Sustained clinical manifestations of the fistulae were apparent in shunts of over 60% only. Signs of ischaemia were absent, even in shunts taking 90% of by-pass blood flow. Arteriovenous fistulae induced by by-pass operations employing the saphenous vein in situ appear, therefore, to be relatively well-tolerated. Ligature of the most important, preferably proximal, collaterals is nevertheless recommended, to reduce disturbing side-effects as far as possible, and loss of flow to the distal arterial bed in cases with very large fistulae.
D000792:Angiography; D001164:Arteriovenous Fistula / Q000150:complications* / Q000000981:diagnostic imaging; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008863:Microspheres; D011150:Popliteal Artery / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D012501:Saphenous Vein / Q000637:transplantation*
Evaluation des shunts artério-veineux dans les pontages veineux par saphène in situ élaboration d'une attitude.