Temporary arteriovenous fistula for venous reconstruction using synthetic graft: a clinical and experimental...

This report discusses venous reconstructive surgery combined with a temporary distal arteriovenous fistula creation for ilio-femoral vein obstruction. One patient who had long standing, high degree edema of the left lower extremity due to postphlebitic syndrome and four patients who had acute occlusion of the iliac vein were treated by means of extra-anatomical femoro-femoral vein bypass grafting combined with temporary distal femoro-saphenous arteriovenous (a-v) fistula creation. An expanded polytetrafluoroethylene (EPTFE) graft was selected for this procedure instead of a cross-over saphenous vein. The surgically created a-v fistula was effective in keeping the implanted grafts patent for a long time in three out of the five patients. In animal experiments, the bilateral iliac veins of mongrel dogs were replaced with several kinds of synthetic graft. Femoro-femoral a-v fistulae were made only on the left side. In 26 animals, 84.6% of the synthetic grafts on the a-v fistula side were patent, whereas only 11.5% of the grafts on the control side were patent. This investigation clearly demonstrates that the increased blood flow velocity through the created distal a-v fistula preserved the patency of synthetic vein grafts.