Limb salvage by inverted "Y" grafts to below knee arteries.

(1) An inverted Y graft to the proximal tibial arteries is described, and the limited clinical experience with this type of graft is presented. (2) The inverted Y graft provides a low-resistance high-low situation, which theoretically favors graft patency. (3) This clinical series confirms the value of bypass procedures to small, below-knee arteries in limb salvage situations. An excellent rate of success can be accomplished if meticulous surgical technique is used to implement the principles of small vessel surgery.

Brachial artery to brachial vein preserved vein allograft fistulas for hemodialysis.

Vein allografts were obtained from varicose vein patients in whom stripping and ligation was indicated. Proximal 30 cms of the long saphenous vein was removed and stored at -30 degrees C. A-V fistulas were constructed in the upper arm between brachial artery and the brachial or cephalic vein in dialysis patients. All these allograft vein recipients had major blood groups identical to the donors. Clinical experience over a two year period revealed a 100% long term patency. Complications including early graft thrombosis, superficial wound infection, hematoma formation and local edema were few and easily managed. Allograft rejection was not a problem in this series of patients. The large diameter grafts in upper arm position function well. They are convenient for the patient and preferred by dialysis personnel as a direct site for venepuncture. An initial experience suggests that preserved vein allografts may become the preferred material for arteriovenous fistulas.