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Surgical A-V fistula in aortocoronary snake graft. Preliminary report
1Department of Cardiac Surgery, 2nd Medical School, University of Naples, Italy.
Insights
Creating an arterio-venous (A-V) fistula during coronary artery surgery can improve graft flow and patency, potentially preventing early graft failure. This technique showed clinical improvement and satisfactory revascularization in patients with severe angina.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Coronary artery disease often necessitates bypass grafting.
- Poor distal run-off in grafts can predict early graft failure.
- Arterio-venous (A-V) fistulas may enhance graft perfusion.
Observation:
- Four patients with severe angina underwent coronary angiography, revealing significant stenoses in major coronary arteries.
- Sequential aortocoronary bypass grafts using reversed saphenous veins were performed.
- A small A-V fistula was created into the right atrium in conjunction with the bypass grafts.
Findings:
- All four patients demonstrated clinical improvement post-operatively.
- No adverse effects were reported.
- Clinical and invasive follow-up confirmed satisfactory revascularization and graft patency.
Implications:
- Creating an A-V fistula alongside coronary artery bypass grafting is a viable strategy to improve graft flow and patency.
- This technique may reduce the incidence of early graft failure in select patients.
- Further research could explore the long-term efficacy and broader applicability of this surgical approach.
Abstract:
In coronary artery surgery, when a poor distal run of can predict an early graft failure, it might be useful to perform the last anastomosis to a low pressure chamber thus creating a small arterio-venous (A-V) fistula. From January throughout December 1984, 4 patients underwent coronary angiography for severe symptoms of angina. The coronary angiography showed multiple stenoses on the left anterior descending (LAD), ventricular branches of the circumflex (CX), and posterior descending of the right coronary artery (PD). At operation the patients received a sequential aortocoronary bypass graft with reversed saphenous vein, plus the creation of a small A-V fistula into the right atrium in order to improve the graft flow and patency. All patients experienced a clinical improvement. No adverse effects have been observed and the patients, controlled clinically with non invasive and in two cases with invasive techniques, showed satisfactory revascularization.