introduction
play

Introduction of an Adequate Saphenous Vein Lack of usable GSV is - PowerPoint PPT Presentation

Sep 14, 2022 •292 likes •419 views

Bypass Surgery Options in the Absence Introduction of an Adequate Saphenous Vein Lack of usable GSV is common: 20-40% Matthew T. Menard, M.D . Re-operative lower extremity bypass Brigham and Womens Hospital Prior CABG, vein

  1. Bypass Surgery Options in the Absence Introduction of an Adequate Saphenous Vein • Lack of usable GSV is common: 20-40% Matthew T. Menard, M.D . • Re-operative lower extremity bypass Brigham and Women’s Hospital • Prior CABG, vein stripping Harvard Medical School PREVENT III PREVENT III Conduit Type Vein Graft Size Schanzer, JVS 2007 Schanzer, JVS 2007 1

  2. PREVENT III General Strategies High vs Low Risk Conduit • Perform the best, most durable procedure possible. • Use the best available autogenous vein. Schanzer, JVS 2007 Options Re-operative Survey: Challenges • Contralateral Greater Saphenous Vein • Arm Vein • Vascular bad actors: Intimal hyperplasia, • Lesser Saphenous Vein sclerotic veins, hypercoagulable states, etc • Scarring • Cryopreserved vein • More advanced disease. • Prosthetic grafts • Endovascular/hybrid 2

  3. CLV Harvest and Fate of the Contralateral GSV Contralateral Limb • Only 16% needed intervention in contra leg • 12% bypass • 4% amputation JVS 2002 3

  4. Infrainguinal Bypass in the Absence of GSV: Arm Vein Lesser Saphenous Vein Disadvantages: Advantages: • Same operative field. • Can be tenuous quality • Can be qualitatively similar to GSV. » Antecubital scarring » Focal phlebitis, sclerosis Disadvantages: » Short vein segments. • Tedious exposure. • Unreliable quality. • Tedious harvest of basilic/brachial vein • Short vein segments. • Prone to twisting Composite Vein Grafts: Demographics (Chew 1998) • 154 patients • Limb salvage in 90% • Redo: 48% 4

  5. Number of Segments Patency of Composite Grafts 110 100 90 LS 79% + 5% % Cumulative Patency 80 SP 65% + 5% 70 3 Seg 60 50 PP 44% + 5% 23% 2 Seg 40 75% 30 20 10 4 Seg 0 0 10 20 30 40 50 60 70 2% Time (months) Composite Vein Grafts Chew, JVS, 2001 5

  6. Patency Rates Prosthetic Grafts 90 Cumulative Patency (%) 80 70 Primary Patency Rate 60 50 Primary Assisted Patency Rate 40 30 Secondary Patency Rate 20 10 0 1 4 7 10 13 16 19 22 Months P=ns, Log-rank test Summary of meta-analysis data since 1981 Distaflo Grafts carbon lined engineered cuffs 6

  7. Distaflo Grafts 7

  8. Propaten: Thromboresistant lumenal graft surface Linton patch Heparin Bonded PTFE • Italian, 7 center, retrospective review • 425 bypass for CLI (101 AK, 324 BK) • 36 month results: PP 61%, SP 70% • No diff AK vs BK Pulli et al, JVS, 2010;51:1167 8

  9. Miller cuff St. Mary’s boot Tyrell MR, Wolfe JHN; Br J Surg 1991 Tyrell MR, Wolfe JHN; Br J Surg 1991 9

  10. Tyrell MR, Wolfe JHN; Br J Surg 1991 Tyrell MR, Wolfe JHN; Br J Surg 1991 Tyrell MR, Wolfe JHN; Br J Surg 1991 Tyrell MR, Wolfe JHN; Br J Surg 1991 10

  11. Dardik H, et al J Vasc Surg 1996 Taylor patch Secondary Patency Alternative Vein Prosthetic 100 90 80 70 % Patency 68.8% 60 68.4% 50 P=0.488 40 30 20 Number at risk 10 33 25 21 AV 17 12 10 0 52 34 25 Pros 14 9 8 0 12 24 36 48 60 Months 11

  12. Summary • Do the best operation/procedure you can • Use the best vein available. • Prosthetic is reasonable option, and is better than bad vein • Need for appropriate creativity in hybrid era 12

Download Presentation
Download Policy: The content available on the website is offered to you 'AS IS' for your personal information and use only. It cannot be commercialized, licensed, or distributed on other websites without prior consent from the author. To download a presentation, simply click this link. If you encounter any difficulties during the download process, it's possible that the publisher has removed the file from their server.

Recommend

INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION

INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION

TRAINING COURSE ON SOCIAL PROTECTION & FORMALIZATION TRINIDAD AND TOBAGO MARCH 15, 2017 INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION Design of the NIS Assistance from the

547 views • 23 slides
INTRODUCTION Introduction 2/42 INTRODUCTION Alternations I am giving bread to the

INTRODUCTION Introduction 2/42 INTRODUCTION Alternations I am giving bread to the

Patterns of variation in the expression of case and agreement Andrs Brny Leiden University Centre for Linguistics 9 November 2019, BaSIS Workshop a.barany@hum.leidenuniv.nl INTRODUCTION Introduction 2/42 INTRODUCTION

1.37k views • 42 slides
Introduction Introduction Introduction Introduction Outline Motivation Failures

Introduction Introduction Introduction Introduction Outline Motivation Failures

Introduction Introduction Introduction Introduction Outline Motivation Failures Definition and concepts Process and product properties Principles SE Approaches Motivation Software and the economy The economies of

1.03k views • 49 slides
Introduction Introduction Introduction Nationwide Cause for Concern 1

Introduction Introduction Introduction Nationwide Cause for Concern 1

Introduction Introduction Introduction Nationwide Cause for Concern 1 https://www.cdc.gov/std/stats17/infographic.htm Introduction Epidemiology in Western Colorado CPHE Surveillance Data Report, May 2018 Chlamydia Epidemiology in Western

977 views • 39 slides
DAQ introduction Purpose of this talk : (1) Introduction for those who have not been in every

DAQ introduction Purpose of this talk : (1) Introduction for those who have not been in every

DAQ introduction Purpose of this talk : (1) Introduction for those who have not been in every meeting (2) Some ideas of diagrams for section 7.1 (Introduction) of TP. Giles Barr 25 Jan 2018, Pembroke College On DUNE, the reality is there is a

474 views • 10 slides
INTRODUCTION cf. Schneider, Chapter 1 INTRODUCTION THEY ARE OUT TO GET YOU INTRODUCTION WHAT

INTRODUCTION cf. Schneider, Chapter 1 INTRODUCTION THEY ARE OUT TO GET YOU INTRODUCTION WHAT

ADVANCED COMPUTER SECURITY INTRODUCTION cf. Schneider, Chapter 1 INTRODUCTION THEY ARE OUT TO GET YOU INTRODUCTION WHAT IS SECURITY? A systems security policies describe What the system is supposed to do Store and provide access

479 views • 16 slides
Overview Introduction to SMIL Introduction to W3C and XML Introduction to SMIL

Overview Introduction to SMIL Introduction to W3C and XML Introduction to SMIL

Overview Introduction to SMIL Introduction to W3C and XML Introduction to SMIL Writing a SMIL file Adding Media Objects Martin Halvey Clipping media files January 2008 Timing and Synchronising Layout World Wide

387 views • 14 slides
14 Introduction Introduction Bad guys can put malware into Example: hosts

14 Introduction Introduction Bad guys can put malware into Example: hosts

Introduction Introduction source Encapsulation ISO/OSI reference model message M application segment H t H t M transport network datagram H n H n H t M presentation: allow applications to frame link H l H n H t M interpret

583 views • 4 slides
Previous Lecture Introduction to SMIL 2 Introduction to W3C and XML Introduction to SMIL

Previous Lecture Introduction to SMIL 2 Introduction to W3C and XML Introduction to SMIL

Previous Lecture Introduction to SMIL 2 Introduction to W3C and XML Introduction to SMIL Writing a SMIL file Adding Media Objects Martin Halvey Clipping media files January 2008 Timing and Synchronising Layout

322 views • 8 slides
Lecture 1 Andreas Habegger Introduction Zynq Introduction Zynq Introduction Zynq PS vs. PL

Lecture 1 Andreas Habegger Introduction Zynq Introduction Zynq Introduction Zynq PS vs. PL

Introduction Zynq Lecture 1 Andreas Habegger Introduction Zynq Introduction Zynq Introduction Zynq PS vs. PL Processing System Processor Peripherals Data Buses AXI Bus Conclusion BTE5380 - Embedded Systems Octobre 2014 Andreas Habegger

1.81k views • 30 slides
2018.06 01 SMILE5 Introduction S E 5 02 Alpha Cloud M I L 03 Company Introduction 04

2018.06 01 SMILE5 Introduction S E 5 02 Alpha Cloud M I L 03 Company Introduction 04

2018.06 01 SMILE5 Introduction S E 5 02 Alpha Cloud M I L 03 Company Introduction 04 Project References S E 5 PART.1 SMILE5 Introduction M I L Introduction STORION-SMILE5 Residential Energy Storage System Inverter 5kW Output Input

1.06k views • 25 slides
Introduction to CICS Course introduction Course introduction What is CICS? What is an

Introduction to CICS Course introduction Course introduction What is CICS? What is an

Introduction to CICS Course introduction Course introduction What is CICS? What is an application server? Why use an application server? Course introduction Services provided by CICS How CICS applications are defined Scaling CICS to meet

1.84k views • 146 slides
Network Visualization Introduction Presented by Shahed Introduction Introduction Basic

Network Visualization Introduction Presented by Shahed Introduction Introduction Basic

Network Visualization Introduction Presented by Shahed Introduction Introduction Basic building blocks Node Links (relationship between nodes) Spatial information Network data

584 views • 9 slides
Introduction Introduction (1) Main argument of the paper: universities are not only

Introduction Introduction (1) Main argument of the paper: universities are not only

Le jugement des pairs comme outil de management des universits Peer-review as a management tool Christine Musselin (CSO, Sciences Po et CNRS) Avril 2013, Lirrsistible ascension du capitalisme acadmique Introduction Introduction (1)

590 views • 28 slides
Introduction Introduction to storage and to storage and filesystems filesystems Introduction

Introduction Introduction to storage and to storage and filesystems filesystems Introduction

Moreno Baricevic Gilberto Daz Axel Kohlmeyer Stefano Cozzini ULA ICTP CNR-IOM DEMOCRITOS Merida, VENEZUELA Trieste, ITALY Trieste, ITALY Introduction Introduction to storage and to storage and filesystems filesystems Introduction

1.19k views • 51 slides
JABLOTRON JA-100 introduction November 2011 Introduction Todays goals First introduction of

JABLOTRON JA-100 introduction November 2011 Introduction Todays goals First introduction of

JABLOTRON JA-100 introduction November 2011 Introduction Todays goals First introduction of the brand new JA-100 alarm system Visions Basic architecture System components Setting Help us with final validations You are the FIRST ones

1.69k views • 111 slides
PERIOD 2: 1607-1754 APUSH MS. JUSTICE - BHS COMPETING MODELS OF COLONIZATION COMPETING MODELS

PERIOD 2: 1607-1754 APUSH MS. JUSTICE - BHS COMPETING MODELS OF COLONIZATION COMPETING MODELS

PERIOD 2: 1607-1754 APUSH MS. JUSTICE - BHS COMPETING MODELS OF COLONIZATION COMPETING MODELS OF COLONIZATION FAILURE & SUCCESS IN VIRGINIA ENGLANDS ATTEMPTS TO OUTMANEUVER SPAIN IN N. AM. Roanoke John White 1587 1590 -no

680 views • 64 slides
110 Ireland's Best Polkas & Slides: with Guitar Chords 110 Ireland's Best Polkas & Slides:

110 Ireland's Best Polkas & Slides: with Guitar Chords 110 Ireland's Best Polkas & Slides:

CATXJ5GIKZHC ^ PDF 110 Ireland's Best Polkas & Slides: with Guitar Chords 110 Ireland's Best Polkas & Slides: with Guitar Chords 110 Ireland's Best Polkas & Slides: with Guitar Chords Filesize: 3.87 MB Reviews Reviews This book

71 views • 4 slides
Reading: The Means Reading: The Means of Extending & of Extending & Building Funds of

Reading: The Means Reading: The Means of Extending & of Extending & Building Funds of

Reading: The Means Reading: The Means of Extending & of Extending & Building Funds of Building Funds of Knowledge Knowledge Elfrieda H. Hiebert Elfrieda H. Hiebert University of California, University of California, Berkeley

770 views • 22 slides
WELCOME TO PRIMARY 1 ORIENTATION 2019 Programme Highlights Time Programme AGENDA 2.35 p.m.

WELCOME TO PRIMARY 1 ORIENTATION 2019 Programme Highlights Time Programme AGENDA 2.35 p.m.

WELCOME TO PRIMARY 1 ORIENTATION 2019 Programme Highlights Time Programme AGENDA 2.35 p.m. to Sharing of experiences by lower block 2.50 p.m. students 2.50 p.m. to Welcome address and Sharing Session by 3.30 p.m. Principal, Mrs Shahul

887 views • 41 slides
Disclosure REBOA for Non-Compressible Torso REBOA for Non-Compressible Torso Hemorrhage:

Disclosure REBOA for Non-Compressible Torso REBOA for Non-Compressible Torso Hemorrhage:

3/7/2018 Disclosure REBOA for Non-Compressible Torso REBOA for Non-Compressible Torso Hemorrhage: Hemorrhage: I have served as a consultant for Prytime Medical Inc History and the Way Forward History and the Way Forward J.R. Taylor III

380 views • 12 slides
The XIENCE Short DAPT Program: XIENCE 90/28 Evaluating the Safety of 3-month and 1-month DAPT

The XIENCE Short DAPT Program: XIENCE 90/28 Evaluating the Safety of 3-month and 1-month DAPT

The XIENCE Short DAPT Program: XIENCE 90/28 Evaluating the Safety of 3-month and 1-month DAPT in HBR Patients Roxana Mehran, MD and Marco Valgimigli, MD, PhD on Behalf of the XIENCE 90/28 Investigators ClinicalTrials.gov: NCT03218787,

621 views • 33 slides
Approaching the Scientific Literature Sections of a paper Title Abstract Introduction

Approaching the Scientific Literature Sections of a paper Title Abstract Introduction

Approaching the Scientific Literature Sections of a paper Title Abstract Introduction Materials and Methods Results Discussion Title Usually conveys the take-home message Abstract More than just a summary!

560 views • 28 slides
Vibrational spectra of model Chromophores P. Giannozzi Democritos-INFM, Scuola Normale Superiore

Vibrational spectra of model Chromophores P. Giannozzi Democritos-INFM, Scuola Normale Superiore

Vibrational spectra of model Chromophores P. Giannozzi Democritos-INFM, Scuola Normale Superiore di Pisa, p.giannozzi@sns.it Isfahan, 2005/04/26 Work done in collaboration with V. Tozzini (NEST-INFM, SNS Pisa) Typeset by Foil T EX

362 views • 24 slides

More recommend