title: Adjuvant arteriovenous fistula as means of rescue for infrapopliteal venous bypass with poor runoff.
abstract: OBJECTIVE
  The aim of this study was to assess the outcome of infrapopliteal bypass when an adjuvant arteriovenous (AV) fistula was reconstructed as means of rescue as a result of poor runoff. The design was a retrospective multicenter case-control study.
  
  
  METHODS
  Seventy-seven infrapopliteal vein bypasses required an adjuvant AV fistula among 1813 patients operated on for critical leg ischemia in 3 vascular centers between 1996 and 2003. The mean age was 74 years (range, 39-90 years). A total of 70% of the patients had diabetes, and 24% had undergone previous vascular surgery. In 25% of the bypasses, the distal anastomosis was in a crural artery, in 55% it was in the dorsal pedal artery, and in 20% it was in a plantar artery. An adjuvant AV fistula was reconstructed in all cases because of poor intraoperative arterial status, intraoperative angiography, or low intraoperative flow. A control group was retrieved that matched the study group according to the recipient artery and runoff score.
  
  
  RESULTS
  The primary and secondary patency were 61% and 75%, respectively, at 1 year in the AV fistula group and 57% and 71% in the control group. The 3-year patency rates were 49% and 62% for the AV fistula group and 46% and 71% for the control group, respectively. There was a 76% leg-salvage rate at 3 years in the study group, compared with 87% in the control group. There were no major complications related to the AV fistula. Intraoperative flow was increased from a median of 20 mL/min to 115 mL/min by the AV fistula (P = .003). The graft flow was significantly higher in the AV fistula group than in the control group (P = .001).
  
  
  CONCLUSIONS
  The adjuvant AV fistula increased graft flow significantly in a poor-outflow venous bypass. In this extreme patient group, acceptable patency and leg salvage was achieved without adverse effects. Despite this, the AV fistula did not improve the outcome.
authors.affiliation: Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland. katariina.laurila@ekshp.fi
authors.forename: Katariina
authors.initials: K
authors.lastname: Laurila
authors.forename: Michael
authors.initials: M
authors.lastname: Luther
authors.forename: Wolf-Dieter
authors.initials: WD
authors.lastname: Roth
authors.forename: Pekka
authors.initials: P
authors.lastname: Vilkko
authors.forename: Ilkka
authors.initials: I
authors.lastname: Kantonen
authors.forename: Kari
authors.initials: K
authors.lastname: Teittinen
authors.forename: Eero I
authors.initials: EI
authors.lastname: Sihvo
authors.forename: Leo
authors.initials: L
authors.lastname: Ihlberg
authors.forename: Anders
authors.initials: A
authors.lastname: Albäck
authors.forename: Mauri
authors.initials: M
authors.lastname: Lepäntalo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D011152:Popliteal Vein / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome