TY - JOUR
T1 - Inflow Failure of Grafts Originating in the Axillary Artery
AU - Quiñones-Baldrich, William J.
AU - Freischlag, Julie A.
AU - Machleder, Herbert I.
AU - Busuttil, Ronald W.
AU - Moore, Wesley S.
PY - 1988
Y1 - 1988
N2 - During the last three years we identified three distinct entities which compromised inflow and led to thrombosis of axillofemoral or axillopopliteal grafts. The first patient had recurrent thrombosis of a right axillopopliteal graft. Five thromboses were treated with thrombectomy and distal revisions; the last thrombosis was treated with simple thrombectomy because the patient had right thoracic outlet axillosubclavian artery compression in his usual sleeping posture. Conservative posture modification resulted in continued patency for two years until the patient's death. Stenosis of the subclavian or innominate artery accounted for multiple failures in three other patients. In one no significant preoperative upper extremity pressure difference was seen, whereas differences were noted with an open graft, suggesting a vascular steal at rest. In the second patient, preoperative balloon dilatation of an innominate lesion appeared successful, but the lesion recurred six months later with hemodynamic graft failure and exercise-Induced vascular steal. The third patient had a significant kink of the axillary artery with eventual graft thrombosis secondary to “pulling” from the extraanatomic graft. We conclude that pre-and postoperative noninvasive testing, exclusion of thoracic outlet compression, and avoidance of a “pulled down” proximal anastomosis are important in preventing inflow failures of grafts originating from the axillary artery.
AB - During the last three years we identified three distinct entities which compromised inflow and led to thrombosis of axillofemoral or axillopopliteal grafts. The first patient had recurrent thrombosis of a right axillopopliteal graft. Five thromboses were treated with thrombectomy and distal revisions; the last thrombosis was treated with simple thrombectomy because the patient had right thoracic outlet axillosubclavian artery compression in his usual sleeping posture. Conservative posture modification resulted in continued patency for two years until the patient's death. Stenosis of the subclavian or innominate artery accounted for multiple failures in three other patients. In one no significant preoperative upper extremity pressure difference was seen, whereas differences were noted with an open graft, suggesting a vascular steal at rest. In the second patient, preoperative balloon dilatation of an innominate lesion appeared successful, but the lesion recurred six months later with hemodynamic graft failure and exercise-Induced vascular steal. The third patient had a significant kink of the axillary artery with eventual graft thrombosis secondary to “pulling” from the extraanatomic graft. We conclude that pre-and postoperative noninvasive testing, exclusion of thoracic outlet compression, and avoidance of a “pulled down” proximal anastomosis are important in preventing inflow failures of grafts originating from the axillary artery.
KW - Axillopopliteal grafts
KW - axillofemoral grafts
KW - graft thomboses
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U2 - 10.1016/S0890-5096(07)60019-3
DO - 10.1016/S0890-5096(07)60019-3
M3 - Article
C2 - 3191013
AN - SCOPUS:0024049438
SN - 0890-5096
VL - 2
SP - 303
EP - 308
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
IS - 3
ER -