Reduction of early occlusions in the high risk peripheral saphenous vein graft.

Abstract

Early thrombosis of saphenous vein grafts can only reduce long-term patency. There exists a high risk category of patients who can be identified preoperatively where early failure is increased above the 10-20% which is attributed to technical errors. A venous side-arm indwelling catheter offers a safe means of reducing early thrombosis, promptly diagnosing the occlusion when it does occur, and more clearly delineating a course of corrective action. The venous side-arm catheter provides a means by which the vascular bed at highest risk may be regionally anticoagulated while allowing systemic clotting times to remain near normal. In addition, vasoactive drugs may be infused directly into the arterial tree and perhaps most importantly, rapid and atraumatic arteriograms can be obtained postoperatively at the bedside for evaluation of questionable perfusion. Regional heparinization and postoperative arterigraphy by means to the side-branch catheter technique was used in twelve patients who otherwise had an expected occlusion rate of 75% or more with an actual early occlusion incidence of zero.