ABSTRACT
We describe a ViaBahn Open Revascularization TEChnique (VORTEC) application in peripheral femoro-popliteal polytetrafluoroethylene (PTFE) graft bypass in 13 patients.
Subject(s)
Blood Vessel Prosthesis Implantation/methods , Endovascular Procedures/methods , Femoral Artery/surgery , Peripheral Arterial Disease/surgery , Popliteal Artery/surgery , Alloys , Anastomosis, Surgical , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/economics , Blood Vessel Prosthesis Implantation/instrumentation , Coated Materials, Biocompatible , Endovascular Procedures/economics , Endovascular Procedures/instrumentation , Femoral Artery/diagnostic imaging , Hospital Costs , Humans , Israel , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/economics , Polytetrafluoroethylene , Popliteal Artery/diagnostic imaging , Prosthesis Design , Severity of Illness Index , Stents , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Femoro above knee popliteal bypass using synthetic graft is a well recognized revascularization procedure in patients with severe lower limb ischemia with either critical limb ischemia (CLI), limiting claudication (IC) or with acute limb ischemia (ALI).Occasionally the patient's general condition would mandate a short and minimally invasive procedure. When endovascular revascularization is not possible or fails then the peripheral VORTEC technique is used. A telescopic sutureless anastomosis is created between an ePTFE graft to the above knee popliteal artery with a bridging piece of VIABHAN. The technique was described in detail and has been published in the August 2011 issue of the EJVES. Between April 2010 and October 2011 seventeen procedures were accomplished successfully in 16 patients. The median follow up was 13 months (range 3-17). Two patients died during follow up from unrelated caused, both from acute cardiac events and both with patent bypasses, one and 5 months after the index operation. There were 2 occasions of limb loss but only one graft loss related amputation. There were 4 thrombectomies for graft occlusions. All four did not have a distal anastomotic stenosis that could predict graft failure on pre occlusion follow up duplex scans. Primary patency for the whole cohort was 65%, the primary assisted patency was 70% and the secondary patency was 85%. In conclusion we believe that this technique could be advantageous in morbid patients and we therefore recommend using it in high risk patients if no endovascular option or saphenous vein are available.