Harvest of brachio-basilic vein complex for arterial bypass.

Brachial vein has been overlooked as a conduit for arterial bypass. It can be harvested with very little morbidity. A deep incision placed on the medial aspect of the upper arm allows exposure of the brachial and basilic veins, giving access to vein of adequate length and diameter for many applications. The medical deep veins of the upper arm are usually our first alternative to ipsilateral saphenous vein for autogenous reconstruction. Because of inconsistent anatomy and nomenclature in this area, we refer to these veins as the "deep brachial vein complex".

Color flow duplex screening of infrainguinal grafts combining low- and high-velocity criteria.

The aim of this prospective study was to evaluate the ability of duplex ultrasonography to identify infrainguinal grafts at high risk for failure. The criteria used identified low flow by low peak systolic velocity (less than 45 cm/s) and stenosis by high velocity (greater than 300 cm/s) or by velocity at the stenosis three times the velocity in the adjacent normal graft. A total of 114 patent grafts were scanned and compared with concurrent angiograms. Duplex scanning correctly identified 18 high-risk grafts by low-flow criteria and an additional 21 by stenosis criteria. There was one false-negative finding (sensitivity 98 percent). The velocity ratio of the stenosis to the adjacent graft was useful in estimating the degree of stenosis. Color flow duplex imaging reduced examination time through visual feedback by highlighting the graft and areas of high velocity. These results indicate that color flow duplex scanning, combining low- and high-peak systolic criteria, is a very sensitive screening test in the early detection of failing grafts.