Externally Supported Extra-anatomical Venous Bypass to Treat Upper Limb Ischemia with Shoulder Prosthetic Infection

Vigliotti, Rossella Chiara; Montelione, Nunzio; Franceschi, Francesco; Franceschini, Edoardo; Zardi, Enrico Maria; Spinelli, Francesco; Stilo, Francesco

doi:10.1016/j.avsg.2020.07.002

Cited by 2 publications

(7 citation statements)

References 22 publications

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“…During this study period, 16 patients underwent vein graft bypass using the external vascular support FRAME TM as scaffolding. For 13 patients (81.2% of the sample), the use of FRAME TM was driven by the presence of ectasic or varicose veins; in 3 patients (18.8%), the external vascular support was used with the aim to avoid compression, considering the extra-anatomical course of the venous graft: (i) in one patient with arm ischemia, an axillary-brachial extra-anatomical vein graft bypass was performed due to skin infection after shoulder prosthesis [30]; (ii) in one patient, an external iliac artery to deep femoral artery venous graft was placed in an extraanatomical way, avoiding the infected field in the groin due to a previous common femoral to deep femoral artery ePTFE bypass; (iii) for the third patient a superficial femoral artery to anterior tibial artery venous graft was tunneled in a lateral position, avoiding an infected wound in the medial region of the leg (Figure 3A,B). Out of the 13 patients treated for CLTI, 8 (61.5%) were at WIfI clinical stage 3, while 5 patients (38.5%) were at clinical stage 4.…”

Section: Resultsmentioning

confidence: 99%

“…During a median follow-up of 32 (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) months (range 3-72), two patients died (one from acute coronary syndrome 2 months after the index procedure, and one from lung cancer after 2 years). Two occlusions were registered at 6 and 13 months.…”

Section: Resultsmentioning

confidence: 99%

“…Still today, there is little evidence regarding bypasses performed with varicose venous material and external vascular support. In addition, there are very few studies that have assessed the value of FRAME TM as a new scaffolding material in peripheral vascular bypass [30,32] as analyzed in our series.…”

Section: Discussionmentioning

confidence: 99%

“…Another important aspect is the potential role of avoiding compression in extraanatomical venous grafts. Starting from an already reported experience [30], in which FRAME was used to scaffold a GSV axillary-brachial bypass in an extra-anatomical fashion to avoid scar tissue and infected fields in the shoulder, we decided to use this technique in two other cases with satisfactory results.…”

Section: Discussionmentioning

confidence: 99%

“…Following this evidence, studies were also conducted on humans, involving the use of a polyester mesh with acceptable short-term patency [29][30][31][32][33]. Also, the use of venous bypass procedures that circumvent the "normal" anatomic pathways could expose the graft to failure due to possible compression.…”

Section: Introductionmentioning

confidence: 99%

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External Scaffold for Venous Graft to Treat Chronic Limb-Threatening Ischemia: Results of the FRAME Vascular Support

Montelione,

Catanese,

Nenna

et al. 2024

JCM

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Background: The surgical treatment of chronic limb-threatening ischemia and optimal conduit choice are extensively debated. The presence of suboptimal autologous material, such as varicosities or venous aneurysms, might impair long-term outcomes. Therefore, kink-resistant external supports have been advocated in the recent literature to improve the conduit quality and outcomes. This study analyzes the FRAME external support in venous ectasic grafts in patients with chronic limb-threatening ischemia. Methods: From September 2017 to September 2023, a total of sixteen patients underwent CLTI surgery with FRAME external support for venous grafts. The inclusion criteria for FRAME applications were varicose or ectasic autologous material with a diameter ≥ 4.5 and ≤ 8 mm in an isolated segment or in the entire vein and a higher risk of bypass extrinsic compression (e.g., extra-anatomical venous bypass course). Results: Technical success and intraoperative patency were achieved in all cases. At 30 days, the limb salvage and survival rates were 100%. The primary bypass patency was 93.7% due to an early graft occlusion. No graft infection was registered. In one case, dehiscence of the surgical wound was treated by surgical debridement and antibiotic therapy. Minor amputation was required in four patients. Over a median follow-up of 32 months, two occlusions were observed; one was treated with reoperation and the other with major amputation. The primary patency was 68.7% and the assisted primary patency was 75%. Limb salvage rates observed during the entire follow-up period were 87.5%. No graft infections or dilatation of the reinforced veins were registered. Conclusions: For patients with CLTI undergoing infrainguinal bypass, satisfactory results in terms of patency and limb salvage rates were achieved using the autologous venous material, even if ectasic or varicose, with the vascular external support FRAME.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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External Scaffold for Venous Graft to Treat Chronic Limb-Threatening Ischemia: Results of the FRAME Vascular Support

Montelione,

Catanese,

Nenna

et al. 2024

JCM

Self Cite

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External Support of Autologous Internal Jugular Vein Grafts with FRAME Mesh in a Porcine Carotid Artery Model

Chlupac,

Frank,

Sedmera

et al. 2024

Biomedicines

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Background: Autologous vein grafts are widely used for bypass procedures in cardiovascular surgery. However, these grafts are susceptible to failure due to vein graft disease. Our study aimed to evaluate the impact of the latest-generation FRAME external support on vein graft remodeling in a preclinical model. Methods: We performed autologous internal jugular vein interposition grafting in porcine carotid arteries for one month. Four grafts were supported with a FRAME mesh, while seven unsupported grafts served as controls. The conduits were examined through flowmetry, angiography, macroscopy, and microscopy. Results: The one-month patency rate of FRAME-supported grafts was 100% (4/4), whereas that of unsupported controls was 43% (3/7, Log-rank p = 0.071). On explant angiography, FRAME grafts exhibited significantly more areas with no or mild stenosis (9/12) compared to control grafts (3/21, p = 0.0009). Blood flow at explantation was higher in the FRAME grafts (145 ± 51 mL/min) than in the controls (46 ± 85 mL/min, p = 0.066). Area and thickness of neo-intimal hyperplasia (NIH) at proximal anastomoses were similar for the FRAME and the control groups: 5.79 ± 1.38 versus 6.94 ± 1.10 mm2, respectively (p = 0.558) and 480 ± 95 vs. 587 ± 52 μm2/μm, respectively (p = 0.401). However, in the midgraft portions, the NIH area and thickness were significantly lower in the FRAME group than in the control group: 3.73 ± 0.64 vs. 6.27 ± 0.64 mm2, respectively (p = 0.022) and 258 ± 49 vs. 518 ± 36 μm2/μm, respectively (p = 0.0002). Conclusions: In our porcine model, the external mesh FRAME improved the patency of vein-to-carotid artery grafts and protected them from stenosis, particularly in the mid regions. The midgraft neo-intimal hyperplasia was two-fold thinner in the meshed grafts than in the controls.

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Externally Supported Extra-anatomical Venous Bypass to Treat Upper Limb Ischemia with Shoulder Prosthetic Infection

Cited by 2 publications

References 22 publications

External Scaffold for Venous Graft to Treat Chronic Limb-Threatening Ischemia: Results of the FRAME Vascular Support

External Scaffold for Venous Graft to Treat Chronic Limb-Threatening Ischemia: Results of the FRAME Vascular Support

External Support of Autologous Internal Jugular Vein Grafts with FRAME Mesh in a Porcine Carotid Artery Model

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