Use of ViaBahn open revascularisation technique for above-knee femoro-popliteal anastomosis: a technical note.

We describe a ViaBahn Open Revascularization TEChnique (VORTEC) application in peripheral femoro-popliteal polytetrafluoroethylene (PTFE) graft bypass in 13 patients.

A new minimally invasive hybrid technique for femoro - above knee popliteal bypass.

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.

Does supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery?

AIM: An association has been proposed between perioperative administration of 80% oxygen and a lower incidence of wound infection after colorectal surgery. The present study was conducted to assess this hypothesis. METHODS: Thirty-eight patients (ASA classification 1 and 2) undergoing elective colorectal cancer surgery were allocated at random to 2 groups. Group 1 consisted of 19 patients who received an admixture of 80% oxygen and 20% nitrogen during anesthesia through an orotracheal tube and during the 2 first hours in the recovery room through a tight facemask with reservoir. Group 2 consisted of 19 patients who received an admixture of 70% nitrous oxide and 30% oxygen during anesthesia, followed by administration of 30% oxygen delivered by a blender through a tight facemask with reservoir in the same manner than group 1, during the first 2 hours in the recovery room. Wound infection was evaluated daily during hospital stay and after 7 days, 2 weeks, and 1 month. RESULTS: The incidence of wound infection was 12.5% in group 1 and 17.6% in group 2 (p=0.53). CONCLUSIONS: The results of this study showed no reduction in the incidence of wound infection following elective colorectal surgery in patients receiving 80% oxygen during the perioperative period.

Preserving the left arm vein in cases of hemodialysis access generating left internal mammary artery steal syndrome.

In patients undergoing chronic hemodialysis (HD) through an arm arteriovenous fistula (AVF), coronary insufficiency can occur if the patient undergoes a coronary artery bypass graft (CABG) using the ipsilateral internal mammary artery (1-4). Therefore, the creation of a new AVF after CABG should avoid using the arm ipsilateral to the side where the internal thoracic artery was used. In cases where coronary syndrome appears when this advice is not followed, treatment should be offered aimed at overcoming the hemodynamic interference between the diminished coronary supply through the left or right internal mammary artery by closure of the existing fistula, with or without temporary central venous line insertion until the maturation of a new fistula. We suggest a different approach by moving only the arterial inflow site of the AVF to the controlateral subclavian artery, but in addition, leaving the well functioning venous outflow tract intact. In cases of left internal mammary steal it is achieved by creating a conduit running from the right subclavian artery to the left cephalic vein; therefore, creating a new arterial inflow source, connected to the existing functioning old venous outflow tract to maintain an immediately functioning new fistula without a coronary steal.