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  • Title: A new "closed" in situ vein bypass technique.
    Author: Wittens CH, van Dijk LC, du Bois NA, van Urk H.
    Journal: Eur J Vasc Surg; 1994 Mar; 8(2):166-70. PubMed ID: 8181609.
    Abstract:
    AIM: We have developed a new closed technique using a co-axial catheter embolisation system for intraoperative coil embolisation of the side branches of in situ vein bypass grafts in order to avoid long skin incisions. TECHNIQUE: After completion of the proximal anastomosis, disruption of the valves and completion of the distal anastomosis, the catheter is introduced via a proximal side branch of the greater saphenous vein. Under fluoroscopic control the side branches are identified, selectively catheterised and an embolisation coil is positioned in each side branch. PATIENTS: In 14 patients (eight men, six women), 16 in situ bypasses were performed (12 below knee femoro-popliteal, four femoro-crural). RESULTS: Once mastered the embolisation procedure took less than 1 hour. In four cases persistent arteriovenous fistulae had to be treated in the postoperative period. Two major wound complications occurred and there were three early failures. One late failure occurred due to a rupture of the venous bypass 6 weeks postoperatively. The remaining 12 bypasses are patent, with a median follow-up of 16 (3-26) months. CONCLUSION: These preliminary results suggest that the "closed" technique is feasible and that long term occlusion of AV-fistulae can be achieved without ligation via incisions.
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