The Results of The Interposition Graft-Technique in Treatment of High Flow Vascular Access.

OBJECTIVE: High-flow (HF) vascular access (VA) is a fearsome condition potentially responsible for cardiac or pulmonary complications, steal syndrome and hand ischemia. The present study was conducted to report the results achieved in a group of patients undergoing interposition-graft technique to treat HF. MATERIALS AND METHODS: An analysis of clinical, ultrasound and echocardiography data collected from the review of medical charts was performed. Flow reduction, complications and need for secondary interventions were investigated. RESULTS: Among a total 498 hemodialysis access interventions performed during a 6-years period, 30 patients (n 15, 50% male, median age 63.5, range 42-91 years) presented with high-flow (median flow 1.9 L/min, range 1.5-4 L/min). 18 patients were asymptomatic (60%); 6 (20%) suffered from a severe distal hand ischemia; 5 (16.6%) developed signs of congestive heart failure and 1 patient (3.3%) presented with pulmonary hypertension. In twenty patients (66.7%) the access was preserved by the interposition of a 6 mm polytetrafluroethylene (PTFE) prosthesis. This approach was used as a primary flow reduction technique in 16 patients (80%) or the failure of a previously attempted procedure in 4 cases. No intraoperative complications were observed. Post-operative median VA flow was 1.1 L/min (range 0.900-2 L/min), with a median flow reduction of 0.770 L/min (range 0.100-2.8 L/min). At a median follow-up of 9 months (range 1-42), 95% (n 19) of patients were free from recurrences. CONCLUSION: In treatment of HF-VA graft interposition demonstrated satisfactory results at the mid-term follow-up. More data are needed to affirm this technique as the preferential one.

An external open ring for isolated aortic valve repair.

Experience with repair of isolated aortic insufficiency (AI) is increasing, encouraged by the results of valve-sparing procedures. Current techniques associate the treatment of cusp prolapse with the reduction of the almost constantly dilated aortic annular base diameter. Although few series provided satisfying mid-term results in selected patients, the lack of standardization limits their widespread use. We developed a standardized aortic valve repair procedure for isolated AI (sinuses of Valsalva ≪40 mm), combining cusp repair with a subvalvular external aortic ring annuloplasty. Alignment of cusp free edges and resuspension of the cusp effective height are performed prior to implantation of the external subvalvular ring. The prosthetic ring is of an open configuration to allow its placement externally to the aorta and below the coronary arteries without detaching them from the aortic wall. Ring size is undersized by one size relative to annular base inner diameter measured intraoperatively. The aim of the ring is to reduce the dilated aortic annular base diameter while increasing coaptation height.

Total videoscopic iliac artery aneurysm repair.

We report a case of totally videoscopic iliofemoral bypass to treat an isolated iliac artery aneurysm. Both iliac and femoral approaches and anastomoses were performed under videoscopic control. This intervention allowed us to obtain the well-known long term results of conventional iliac artery aneurysm repair while reducing operative trauma.