Grafts Flashcards
What is a miller cuff?
What is a taylor patch?
What are disadvantages of miller cuff?
Turbulence
What are disadvantages of Taylor patch?
Lose venous endothelium on half anastomosis and need a lot of vein
What is a distal vein patch?
Venous patch, prosthetic anast to it
If you can’t use vein for tibial bypass, what is the best alternative?
Heparin bonded ePTFE - some recent studies shows noninferiority
Which graft theoretically promotes lateral flow to decrease shear and decrease adhesion molecules/intimal hyperplasia?
Spiral flow graft
What graft technique is available for poor arterial runoff
“Patchula” AV fistula to decrease outflow resistance
Is there any benefit to dual antiplatelet therapy for peripheral bypass?
CASPAR trial - maybe benefit in prosthetic grafts. ASA of benefit in prosthetic grafts based on Cochrane review
How often should you survey peripheral bypass grafts?
3, 6 months then annually
What is the Bandyk criteria for graft stenosis?
PSV > 300. Ratio > 3.5
How low of a velocity predicts mid graft failure?
< 45 cm/s
What causes early (< 6 months) graft failures?
Technical - poor inflow/outflow, thrombophilia
When do grafts fail due to myointimal hyperplasia?
Mid term - 6-24 months
When do grafts fail due to progression of disease?
Late, > 24 months
What is more effective for graft occlusions - thrombolysis or thrombectomy?
< 2 weeks of symptoms - thrombolysis, > 2 weeks - thrombectomy. STILE and TOPAS trials
What are 4 contraindications to thrombolysis?
- Recent surgery
- Non viable limb
- Bleeding disorders
- Hemorhagic stroke
What are 4 CT findings consistent with graft infection?
- Peri graft air
- Peri graft fluid
- Pseudoaneurysm
- Soft tissue attenuation
Which types of graft infection organisms mandate removal?
Pseudomonas, MRSA
Which procedure has the highest incidence of graft infection?
Ax-fem (5-8%)
What is the incidence of graft infection for fem pop or fem tib?
Fem pop 1-5%, Fem tib 2 - 4%
What is the risk of graft infection with a peripheral stent?
Very low < 0.1%
What is the risk of aortofemoral graft infection?
< 3%
What is an early versus late graft infection?
early < 4 mo, late > 4 mo
What is a Szilagyi Grade 1 graft infection?
cellulitis involving the wound
What is a Szilagyi grade 2 graft infection?
infection involving subcutaneous tissue
What is a Szalgyi type 3 graft infection?
Infection of the vascular prosthesis
What is a P0 graft infection?
infection of a cavitargy graft (abdo/thoracic)
What is a P1 graft infection?
Infection of graft which entire course is non cavitary (ax fem, carotid subclavian etc)
What is a P2 graft infection?
Infection of the extracavitary portion of a graft whos origin is cavitary (e.g. femoral portion of ABF)
What is a P3 graft infection?
infection involving prosthetic patch angioplasty (femoral patch, carotid patch)
What are the 3 most severe Bunt’s classification of graft infections?
Graft enteric erosion
Graft enteric fistula
Aortic stump sepsis after excision of infected graft
When do most cavitary graft infections (e.g. aortic) occur?
Late - mean time more than 40 months
