[Use of the modified Fogarty in acute occlusions of inverted venous graft. Technique proposal]

The acute thrombosis of inverted venous graft, although less frequent than of the alloplastic prosthesis graft, represents a problem for the vascular surgeon that on one hand wants to restore the flow and on the other to preserve, as much as possible, the integrity of the venous endothelium without damaging the valvular apparatus. The two objectives are not possible, using a traditional Fogarty balloon catheter: the introduction from the proximal anastomosis, the only possible way for the presence of the valves, requires that, for the removal of the thrombotic material, the instrument is drawn back in a contrary way with unavoidable damage of the valves. Such disadvantage is eliminated using a modified Fogarty catheter, that allows to introduce the instrument in cranio-caudal direction and to draw it back in the same way, with impossibility to stop into the bottom of the valvular border and with a minimal trauma of parietal and valvular endothelium. On the other hand, distal introduction of the traditional Fogarty catheter is difficult, if not impossible, due to the presence of the valves. The use of the Fogarty catheter from the top to the bottom of the graft is feasible after appropriate modifications of the traditional catheter that allow its introduction from the tail and to draw it back towards the periphery (with inflated balloon) according to the direction of the flow. Such modifications of the Fogarty catheter are easily feasible even on the operating table and they don't require particular devices. The technique is simple, does not require additional costs (this particular modified catheter can be, like the traditional, reusable) and allows the graft patency if the thrombosis cause is eliminated.