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Patrick G Clagett - One of the best experts on this subject based on the ideXlab platform.
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femoral Vein harvest for vascular reconstructions pitfalls and tips for success
Seminars in Vascular Surgery, 2008Co-Authors: Stephen T Smith, Patrick G ClagettAbstract:The femoral-Popliteal Vein has proved to be an excellent conduit for a variety of indications. These include in situ reconstruction of infected aortic grafts, and mesenteric, brachiocephalic, and lower-extremity bypasses. This article discusses the technical details of successful deep Vein harvest. Information regarding the preoperative evaluation, postoperative surveillance, reintervention, and venous morbidity is provided. The femoral-Popliteal Vein graft has proven to be a durable conduit with minimal late venous morbidity.
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aortic reconstruction with femoral Popliteal Vein graft stenosis incidence risk and reintervention
Journal of Vascular Surgery, 2008Co-Authors: Adam W Beck, Carlos H. Timaran, Frank R. Arko, Erin H Murphy, Jennie A Hocking, Patrick G ClagettAbstract:Background Management using femoral-Popliteal Vein (FPV) of aortic graft infections, failing aortofemoral bypass, and aortoiliac occlusive disease in young patients with a small aorta is now an accepted therapeutic method and is performed frequently at our institution. A high reintervention rate for FPV graft stenosis has recently been reported. The purpose of this study was to determine the incidence of FPV graft failure due to stenosis after neoaortoiliac system (NAIS) reconstruction, and to identify risk factors for this complication. Methods A review was performed of 240 patients who underwent NAIS reconstruction at our institution between January 1991 and December 2005. All patients were entered into a prospective database and were evaluated for the incidence of Vein graft stenosis requiring reintervention, risk factors for stenosis, and the rate and type of reintervention required to assist patency. Patients with occlusion are evaluated and reported, but excluded from detailed analysis. Risk factors assessed included gender, operative features, FPV size (diameter), smoking history, and medical comorbidities. Results Of the 240 NAIS procedures performed during this time period, 11 (4.6%) patients have required 12 graft revisions (one patient required a second intervention) for stenosis using open and endovascular techniques. Over the same time period, graft occlusion occurred in nine patients (3.8%). This provided a primary patency at 2 and 5 years of 87% and 82%, and an assisted primary patency rate of 96% and 94%. Mean time to revision was 23.5 months (range 5.5 to 83.5 months). Median FPV graft size in the nonrevised patients was 7.8 mm (range 4.0 to 11.4 mm), and 6.4 mm (range 4.7 to 8.7 mm) in the revised group ( P = .006). Survival analysis revealed small Vein graft size ( P = .002, .02, .01, respectively), with multivariable analysis confirming these results ( P = .002, .06, .012). Patients with CAD combined with small graft size were found to be at especially high risk for stenosis, with 8/36 (22.2%) requiring revision vs 3/184 (1.6%) of patients without both factors ( P Conclusions FPV graft stenosis requiring revision after NAIS reconstruction is uncommon. Risk factors for stenosis include small graft size, history of CAD, and smoking. All patients merit aggressive counseling for smoking cessation, and patients exhibiting multiple risk factors should undergo close postoperative surveillance for graft stenosis.
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arterial reconstruction of infected femoral artery pseudoaneurysms using superficial femoral Popliteal Vein
Journal of The American College of Surgeons, 2005Co-Authors: Christopher Bell, Ahsan T. Ali, Gregory J Modrall, James R Valentine, John G Brawley, Victor J Daddio, Patrick G ClagettAbstract:Background Infected femoral artery pseudoaneurysms (IFAPs) secondary to percutaneous arterial access, injection of illegal substances, and from infected synthetic grafts, appear to be increasing in incidence. Ligation of IFAPs without revascularization offers control of infection but may risk limb ischemia. Revascularization with extraanatomic synthetic grafts may risk reinfection and abrupt thrombosis. Excision of IFAPs with revascularization using superficial femoral Popliteal Vein (SFPV) provides both control of infection and excellent limb perfusion. Study design A retrospective review was conducted of patients diagnosed with IFAP who underwent resection and revascularization with SFPV at a single medical center. Outcomes measured included reinfection and amputation rate. These were compared with other series using various methods to treat IFAPs. Results Eleven patients with IFAP were encountered from 1992 to 2004. Mean age was 64 years (±10 SD). Five patients developed IFAP secondary to percutaneous arterial access procedures. Four patients developed infected femoral artery pseudoaneurysms secondary to synthetic graft infection. Two patients developed IFAP secondary to injection of illegal substances in the femoral region. All patients had positive wound cultures initially. Staphylococcus was the most common organism found in wound cultures. All patients underwent resection of IFAP with lower extremity revascularization using SFPV. There was no incidence of limb ischemia and no perioperative deaths in this series. Conclusions Excision of IFAP with revascularization can be successfully achieved using SFPV. This method may prove to be superior to other methods with apparent higher patency rates and resistance to reinfection.
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superficial femoral Popliteal Vein as a conduit for brachiocephalic arterial reconstructions
Annals of Vascular Surgery, 2002Co-Authors: Gregory J Modrall, Mark R Jackson, Donald R Joiner, Scott A Seidel, James R Valentine, Patrick G ClagettAbstract:Revascularization of brachiocephalic arteries with prosthetic graft offers excellent patency for most reconstructions. For complex brachiocephalic reconstructions, such as redo operations or reconstructions for infection, autogenous conduit may be preferable. Occasionally saphenous Vein is inadequate or absent. The purpose of this study was to evaluate the indications and intermediate-term outcomes of superficial femoral-Popliteal Vein (SFPV) as an alternative conduit for brachiocephalic reconstructions. Over a 6-year period, 71 patients underwent carotid, subclavian, or axillary artery bypass. In 18 (25%) of these reconstruction SFPV was used as the conduit. Ten bypasses (55%) were redo operations. Three bypasses (17%) were performed after failed prosthetic grafts. Three grafts (17%) were required in infected patients. Indications for the use of SFPV included inadequate saphenous Vein (n = 13), infection (n = 3), and failed prosthetic bypass (n = 3). Thirty-day mortality was 5.5%. The neurologic event rate was 5.5%. During a mean follow-up of 26 ± 5 months, there were no graft thromboses or graft infections. Revision-free primary patency was 92% at 48 months. Assisted primary patency was 100%. These data suggest that SFPV is a safe, durable conduit for brachiocephalic reconstructions. SFPV yielded excellent results for a disadvantaged patient population.
Mark R Jackson - One of the best experts on this subject based on the ideXlab platform.
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superficial femoral Popliteal Vein as a conduit for brachiocephalic arterial reconstructions
Annals of Vascular Surgery, 2002Co-Authors: Gregory J Modrall, Mark R Jackson, Donald R Joiner, Scott A Seidel, James R Valentine, Patrick G ClagettAbstract:Revascularization of brachiocephalic arteries with prosthetic graft offers excellent patency for most reconstructions. For complex brachiocephalic reconstructions, such as redo operations or reconstructions for infection, autogenous conduit may be preferable. Occasionally saphenous Vein is inadequate or absent. The purpose of this study was to evaluate the indications and intermediate-term outcomes of superficial femoral-Popliteal Vein (SFPV) as an alternative conduit for brachiocephalic reconstructions. Over a 6-year period, 71 patients underwent carotid, subclavian, or axillary artery bypass. In 18 (25%) of these reconstruction SFPV was used as the conduit. Ten bypasses (55%) were redo operations. Three bypasses (17%) were performed after failed prosthetic grafts. Three grafts (17%) were required in infected patients. Indications for the use of SFPV included inadequate saphenous Vein (n = 13), infection (n = 3), and failed prosthetic bypass (n = 3). Thirty-day mortality was 5.5%. The neurologic event rate was 5.5%. During a mean follow-up of 26 ± 5 months, there were no graft thromboses or graft infections. Revision-free primary patency was 92% at 48 months. Assisted primary patency was 100%. These data suggest that SFPV is a safe, durable conduit for brachiocephalic reconstructions. SFPV yielded excellent results for a disadvantaged patient population.
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repair of a saccular aortic aneurysm with superficial femoral Popliteal Vein in the presence of a pancreatic abscess
Journal of Vascular Surgery, 2000Co-Authors: Scott F Rosen, Dwayne F Ledesma, Jorge A Lopez, Mark R JacksonAbstract:When one is faced with impending rupture, repair of an aortic aneurysm cannot be delayed. In the presence of coexisting intra-abdominal sepsis, traditional therapy would call for aneurysm exclusion and axillofemoral bypass grafting. Consequences of this choice of treatment include limited long-term graft patency and recurrent prosthetic infection. Autogenous deep Veins from the lower extremities have demonstrated exceptional patency and resilience to infection when used to replace infected aortic grafts. We now report a case of concomitant open drainage of a pancreatic abscess and repair of a saccular abdominal aortic aneurysm using the superficial femoral-Popliteal Vein as a conduit.
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the superficial femoral Popliteal Vein transposition fistula description of a new vascular access procedure
Journal of The American College of Surgeons, 2000Co-Authors: Mark R JacksonAbstract:With advances in the medical care of patients with end-stage renal disease, an increasing number of patients continue to need reliable AV access after failure of multiple upper-extremity vascular access sites. In many cases, these failures are related to central venous outflow obstruction caused by previous subclavian Vein catheters. Although it is technically possible to restore central venous patency in some patients with the use of percutaneous transluminal angioplasty and stent placement, 1-year patency rates as low as 17% have been reported with this approach. Given the success of using the superficial femoral–Popliteal Vein (SFPV) for arterial and venous reconstructions, I decided to use this conduit to construct a transposition AV fistula in the thigh of patients presenting for AV access surgery in the face of multiple failed upper-extremity access attempts and central venous occlusion. To my knowledge, this is the first study using this technique.
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venous morbidity after superficial femoral Popliteal Vein harvest
Journal of Vascular Surgery, 1999Co-Authors: J K Wells, Ryan T Hagino, R J Valentine, G P Clagett, K M Bargmann, Mark R Jackson, Humam B Kakish, H R Schanzer, M I Schulman, D Jr E StrandnessAbstract:Abstract Purpose: The superficial femoral-Popliteal Vein (SFPV) is a reliable conduit for aortoiliac, infrainguinal, and venous reconstructions. In this prospective study, we characterized the anatomic and physiologic changes in SFPV harvest limbs and their relationship to the development of late venous complications. Methods: Since 1990, we have studied 61 patients after harvest of 86 SFPVs at 6-month intervals with clinical examinations, lower-extremity venous duplex, and venous function tests. The CEAP system was used as a means of categorizing clinical changes. Results: Mean (± SEM) follow-up was 37 ± 3 months. Less than one third of harvest limbs had edema without skin changes (C 3 ). No patient had major chronic venous changes (C 4 to C 6 ) or venous claudication. There were no significant differences in limb measurements between harvest and non-harvest limbs, except in a subgroup of patients with unilateral harvest in which there was a small but significant ( P = .046) increase in harvest limb thigh and calf circumference, compared with the opposite non-harvest limb. These clinical results were not affected by the presence or absence of an intact greater saphenous Vein (GSV). Large, direct collaterals (4 to 6 mm in diameter) between the Popliteal Vein stump and profunda femoris Vein (PFV) were seen by means of duplex ultrasonography in 29 harvest limbs (34%). The remainder appeared to have smaller, less direct collaterals to the PFV. Mild venous reflux with rapid cuff deflation was present at the Popliteal or posterior tibial Vein in nine of 79 harvest limbs (11%). Six of these nine limbs (67%) with reflux were clinical class C 3 , compared with only 19 of the 70 limbs without reflux (27%; P = .02). Ambulatory venous pressure (AVP) with exercise was significantly increased in harvest limbs (60 ± 4.7 mm Hg), compared with non-harvest limbs (47.8 ± 5.2 mm Hg; P = .049). The AVP recovery time of harvest limbs (14.0 ± 1.0 seconds) was reduced, compared with non-harvest limbs (23.5 ± 4.5 seconds; P = .02). AVPs (exercise) remained stable or decreased in six of 10 harvest limbs measured serially. Venous refill time in harvest limbs (15.1 ± 1.1 seconds) was shortened, compared with non-harvest limbs (22.3 ± 2.1 seconds)( P = .002). Venous outflow obstruction measured by means of plethysmography was present in 93% of harvest limbs, compared with 36% of non-harvest limbs ( P = .001). Conclusion: SFPV harvest results in minimal mid-term to late-term lower-extremity venous morbidity despite outflow obstruction. The most likely mechanisms preserving clinical status include the low incidence of mild reflux, the presence of collateral venous channels, and the lack of progression in abnormal harvest limb physiology. The absence of the ipsilateral GSV does not adversely affect clinical outcome. (J Vasc Surg 1999;29:282-91.)
Thomas W Wakefield - One of the best experts on this subject based on the ideXlab platform.
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closed plication is a safe and effective method for treating Popliteal Vein aneurysm
Journal of vascular surgery. Venous and lymphatic disorders, 2021Co-Authors: Robert J Beaulieu, Anna M Boniakowski, Dawn M Coleman, Chandu Vemuri, Andrea T Obi, Thomas W WakefieldAbstract:Abstract Background Popliteal Vein aneurysms are a rare vascular anomaly first reported in the 1980s. Degeneration of elastic fibers and smooth muscle cell reduction, possibly secondary to inflammation, are implicated as integral steps in the development of these aneurysms. Given the rarity of this clinical entity, significant controversy exists regarding ideal treatment strategies, including the role of observation, medical management with anticoagulation, and surgical intervention. Retrospective reviews have demonstrated a failure rate of >40% with anticoagulation alone, with patients often presenting with pulmonary embolism. This has prompted our institutional preference for surgical management once the aneurysm is identified. Surgical management involves tangential repair with lateral venorrhaphy most commonly, followed in prevalence by aneurysm resection and end-to-end anastomosis either primarily or with Vein interposition. Herein, we report our results with venous plications, through both closed and open techniques. Methods We performed a retrospective review of prospectively collected data for 10 patients undergoing Popliteal Vein plication for treatment of Popliteal Vein aneurysms. Patient-level characteristics and operative details were examined from periprocedural and follow-up records. Results We identified 10 patients undergoing Popliteal Vein plication, including 9 closed plications and 1 open plication. The average aneurysm size at presentation was 2.35 ± 0.69 cm for closed plication and 4.74 cm for the one open plication. After treatment, the average Popliteal Vein size was significantly reduced to 1.12 ± 0.45 cm for the closed plications (P Conclusions Closed plication demonstrated favorable primary patency rates and low recurrence rates, avoiding technical issues or need for early institution of systemic anticoagulation associated with tangential repair and venorrhaphy or resection methods. Closed plication represents an attractive option in patients without luminal thrombus to limit the risk of these postoperative complications and obviates the need for bypass conduit and postoperative anticoagulation.
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Popliteal Vein entrapment presenting as deep venous thrombosis and chronic venous insufficiency
Journal of Vascular Surgery, 1993Co-Authors: Todd M Gerkin, Hugh G Beebe, David M Williams, Jess R Bloom, Thomas W WakefieldAbstract:Abstract Purpose: This report describes Popliteal Vein entrapment in three patients and demonstrates that it may present with manifestations of typical venous disease. Methods: This report was compiled from a review of inpatient and outpatient records. Results: In the first case, a 28-year-old woman was seen with left leg Popliteal and calf deep Vein thrombosis without obvious cause. She described long-standing calf discomfort, and passive dorsiflexion of the left foot caused disappearance of arterial pulsations at the pedal level. She was given the anticoagulants heparin and sodium warfarin (Coumadin) followed by surgical exploration. The Popliteal Vein and artery were entrapped by a fibrous extension of the medial head of the gastrocnemius muscle attaching to the lateral femoral condyle. After band lysis, the patient has been symptom free for 6 years. The second patient, a 37-year-old man, was seen with bilateral chronic venous insufficiency (CVI). Passive dorsiflexion and active plantar flexion of the feet did not diminish the pedal pulses; impedance plethysmography suggested mild outflow obstruction. Ascending venography demonstrated entrapment at the midportion of duplicated Popliteal Veins with no postthrombotic changes. He was treated with compression stockings and has done well during an 18-month follow-up. The third patient, a 17-year-old male, was seen with severe symptoms of right leg CVI and venous obstruction since 3 years of age. Air plethysmography revealed ambulatory venous hypertension, whereas venography demonstrated reflux down to the knee with an extrinsic narrowing at the midPopliteal Vein. During operation, an abnormal origin of the lesser saphenous Vein (LSV) from the Popliteal Vein was found; the LSV took a medial route, compressed the tibial nerve, and caused severe distortion and narrowing of the Popliteal Vein. Division of the LSV resulted in release of Popliteal venous compression and immediate relief of symptoms. Conclusions: The three cases presented demonstrate that Popliteal venous entrapment may begin with symptoms of deep Vein thrombosis and CVI. Popliteal venous entrapment must be considered in the differential diagnosis of venous disease in younger patients in whom common predisposing factors are absent. (J VASC SURG 1993;18:760-6.)
C P Gibbons - One of the best experts on this subject based on the ideXlab platform.
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a 10 year experience of using femoro Popliteal Vein for re vascularisation in graft and arterial infections
European Journal of Vascular and Endovascular Surgery, 2009Co-Authors: O Ehsan, C P GibbonsAbstract:Abstract Background Infected prosthetic grafts and mycotic aneurysms carry a high mortality and morbidity rate, with a substantial risk of persistent graft infection, but there is evidence that this can be minimised by using femoro-Popliteal Vein for arterial reconstruction after debridement and graft excision. We present our 10-year experience of this technique. Methods Forty-six patients underwent 48 arterial reconstructions with femoro-Popliteal Vein (24 aortic). Six had mycotic aneurysms (three aortic) and 40 had graft infections (16 aortic). Results There were two early postoperative deaths (4.3%) and two patients with pre-existing ischaemia underwent major amputation despite a patent graft. Median follow-up was 4.1 years (range: 2 months to 10 years). Patient survival was 70% and limb salvage 96% at 5 years. Primary graft patency was 75% and 62% and secondary patency 93% and 91% at 2 and 5 years, respectively. Two patients required further surgery for recurrent infection. Anastomotic or graft stenosis occurred in 11 patients (24%). There were three major wound infections. Donor-limb swelling was transient. Conclusion For arterial and prosthetic graft infections, femoro-Popliteal Vein is an excellent conduit for vascular reconstruction after drainage and debridement of infected tissue and graft material under antibiotic cover, providing good long-term survival and limb salvage.
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experience with femoro Popliteal Vein as a conduit for vascular reconstruction in infected fields
European Journal of Vascular and Endovascular Surgery, 2003Co-Authors: C P Gibbons, C J Ferguson, L J Fligelstone, K EdwardsAbstract:Abstract Objective: to review the outcome of femoro-Popliteal Vein grafts for arterial reconstruction in the presence of sepsis. Patients and Methods: twenty-six patients underwent 27 arterial reconstructions with femoro-Popliteal Vein in the presence of infection. Five had mycotic aneurysms (3 aortic, 1 iliac and 1 femoral), 21 had prosthetic graft infections (9 aortic, 8 femoro-femoral, 2 axillo-femoral, 1 ilio-femoral and 1 femoral dacron patch) and one underwent superior mesenteric artery reconstruction following ischaemic small bowel perforation. Arterial reconstruction followed debridement of infected tissue, removing any infected graft, povidone iodine washout and appropriate antibiotic cover. Where possible, new grafts were placed in a clean field or wrapped in omentum. Four femoral anastomoses were covered by rectus femoris flaps. Results: there was one early postoperative death (4%) and no limb loss. All others remained free from infection with patent grafts at 1 month to 5 years (median 22 months). Three major wound infections healed without exposing the graft. One infarcted rectus femoris flap required removal. Donor limb swelling was transient. Five required percutaneous angioplasty and one underwent open profundaplasty within 3 months. Conclusion: femoro-Popliteal Vein reconstruction with debridement and appropriate antibiotic therapy is recommended for the treatment of arterial or graft infections. Eur J Vasc Endovasc Surg 25 , 424-431 (2003)
Carlos H. Timaran - One of the best experts on this subject based on the ideXlab platform.
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aortic reconstruction with femoral Popliteal Vein graft stenosis incidence risk and reintervention
Journal of Vascular Surgery, 2008Co-Authors: Adam W Beck, Carlos H. Timaran, Frank R. Arko, Erin H Murphy, Jennie A Hocking, Patrick G ClagettAbstract:Background Management using femoral-Popliteal Vein (FPV) of aortic graft infections, failing aortofemoral bypass, and aortoiliac occlusive disease in young patients with a small aorta is now an accepted therapeutic method and is performed frequently at our institution. A high reintervention rate for FPV graft stenosis has recently been reported. The purpose of this study was to determine the incidence of FPV graft failure due to stenosis after neoaortoiliac system (NAIS) reconstruction, and to identify risk factors for this complication. Methods A review was performed of 240 patients who underwent NAIS reconstruction at our institution between January 1991 and December 2005. All patients were entered into a prospective database and were evaluated for the incidence of Vein graft stenosis requiring reintervention, risk factors for stenosis, and the rate and type of reintervention required to assist patency. Patients with occlusion are evaluated and reported, but excluded from detailed analysis. Risk factors assessed included gender, operative features, FPV size (diameter), smoking history, and medical comorbidities. Results Of the 240 NAIS procedures performed during this time period, 11 (4.6%) patients have required 12 graft revisions (one patient required a second intervention) for stenosis using open and endovascular techniques. Over the same time period, graft occlusion occurred in nine patients (3.8%). This provided a primary patency at 2 and 5 years of 87% and 82%, and an assisted primary patency rate of 96% and 94%. Mean time to revision was 23.5 months (range 5.5 to 83.5 months). Median FPV graft size in the nonrevised patients was 7.8 mm (range 4.0 to 11.4 mm), and 6.4 mm (range 4.7 to 8.7 mm) in the revised group ( P = .006). Survival analysis revealed small Vein graft size ( P = .002, .02, .01, respectively), with multivariable analysis confirming these results ( P = .002, .06, .012). Patients with CAD combined with small graft size were found to be at especially high risk for stenosis, with 8/36 (22.2%) requiring revision vs 3/184 (1.6%) of patients without both factors ( P Conclusions FPV graft stenosis requiring revision after NAIS reconstruction is uncommon. Risk factors for stenosis include small graft size, history of CAD, and smoking. All patients merit aggressive counseling for smoking cessation, and patients exhibiting multiple risk factors should undergo close postoperative surveillance for graft stenosis.
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Femorofemoral bypass with femoral Popliteal Vein.
Journal of Vascular Surgery, 2005Co-Authors: Victor J. D’addio, Ahsan T. Ali, Carlos H. Timaran, Tif Siragusa, James Valentine, Frank R. Arko, J. Gregory Modrall, G. Patrick ClagettAbstract:Background The femoroPopliteal Vein (FPV) has been used successfully for vascular reconstructions at multiple sites. To date, there have been no studies documenting patency of the FPV graft in the femorofemoral position. Our goal was to assess long-term patency of the FPV graft used for femorofemoral bypass (FFBP). Methods Patients undergoing FFBP over a 10-year period were studied. Those in whom the FPV was used as a conduit were analyzed for runoff resistance score to assess how patients with poor runoff fared. Poor runoff was defined as a runoff resistance score of ≥7 (1 = normal runoff, 10=total occlusion of all runoff vessels). Results Fifty-four patients underwent FPV FFBP as a sole procedure (n = 16, 30%) or as a portion of an aortofemoral reconstruction with a FFBP component (n = 38, 70%). Mean (± SD) follow-up was 47 ± 33 months. The 1-, 3-, and 5-year primary patencies were 97%, 93%, and 76%. The 5-year assisted primary and secondary patency rates were 85% and 90%. Among 27 patients with poor runoff (runoff resistance score of ≥7), the cumulative 40 month patency rate was 90%. Among patients in whom FPV FFBP was performed as a primary procedure (no aortofemoral component), there were no graft failures. Conclusions FFBP performed with FPV has excellent 1-, 3, and 5-year patency rates. FPV has sustained patency for FFBP in patients with poor runoff.