A new "closed" in situ vein bypass technique.

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.