Residual arteriovenous fistulae after "closed" in situ bypass grafting: an overrated problem.
OBJECTIVE
To prospectively evaluate the incidence and consequences of residual arteriovenous (AV)-fistulae after "closed" in situ bypass grafting.


METHODS
In 34 patients, 35 "closed" in situ bypasses were performed. Postoperative assessment of residual AV-fistulae and bypass patency was performed with duplex scanning.


RESULTS
Postoperative mortality was 3%. During 35 "closed" in situ bypass procedures 216 side 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-fistulae were treated for: decreased distal bypass flow in one; persistent leg oedema in one; pain and redness of the skin in two. One-year primary patency was 80% (SE 8.4%). Residual AV-fistulae were detected in none of six bypass occlusions during follow-up.


CONCLUSIONS
Residual AV-fistulae detected following "closed" in situ bypass grafting only need treatment if they are symptomatic, which is uncommon.
van Dijk
L C
LC
Department of Radiology, University Hospital Rotterdam Dijkzigt, The Netherlands.
van Urk
H
H
Laméris
J S
JS
Wittens
C H
CH
D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D004487:Edema / Q000209:etiology; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D004890:Erythema / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007383:Intermittent Claudication / Q000601:surgery / Q000628:therapy; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D007871:Leg Ulcer / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011446:Prospective Studies; D012039:Regional Blood Flow; D012075:Remission, Spontaneous; D015996:Survival Rate; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency