title: Questionable value of adjuvant arteriovenous fistula in pedal bypass at high risk for early failure.
abstract: Results of an adjuvant arteriovenous fistula (AVF) in pedal bypass surgery in the presence of poor status of the recipient artery, severely impaired intraoperative runoff, or revision for early failure and flow restitution were analyzed in a retrospective study. From January 1998 to December 2006, 24 adjuvant AVFs were constructed in autologous vein or composite pedal bypasses with low intraoperative bypass flow, poor status of the pedal artery, or during successful early bypass revision to prevent graft failure. All infrainguinal bypass operations were registered in a computerized database and prospectively followed. Pedal bypasses with adjunctive AVF were reviewed for fistula function, graft patency, limb salvage, and patient survival. Primary and secondary bypass patency rates at 1 year were 59% and 77%, respectively, with an AVF patency of 36%. Four legs were amputated despite a patent bypass with patent AVF on three occasions. The corresponding limb salvage rate was 65% at 1 year. Patient survival was 50% at 3 years. Adjuvant AVF constructed in grafts considered at high risk for early failure in pedal vein graft or composite bypass does not seem to prevent future graft failure. In patent bypasses the fistula has a significant tendency for spontaneous occlusion. It may be considered in the use of prosthetic composite pedal grafts in selected cases.
authors: Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University School of Medicine, Mainz, Germany. neufang@mail.uni-mainz.de
authors: Achim
authors: A
authors: Neufang
authors: Christine
authors: C
authors: Espinola-Klein
authors: Bernhard
authors: B
authors: Dorweiler
authors: Michael
authors: M
authors: Pitton
authors: Savvas
authors: S
authors: Savvidis
authors: Walther
authors: W
authors: Schmiedt
authors: Christian
authors: C
authors: Vahl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D017211:Treatment Failure; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*