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Increasing the prevalence of arteriovenous fistula over arteriovenous synthetic graft is critical for decreasing the morbidity and costs of dialysis patients. This is highlighted in the guidelines set forth by The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI), which encourage the increased use of autogenous vein in fistula creation. In addition to the basilic and cephalic veins, another source of autogenous vein is the brachial vein, a deep vein of the upper arm. Here we describe 2 patients with absence of adequate superficial veins, in whom a transposed brachial vein was used for the creation of an arteriovenous fistula.

A critical step in the performance of in-situ bypass is to produce incompetence of the venous valves. Currently, there are several commercially available valvulotomes designed to fulfill this task. The purpose of the present work was to evaluate, in an ex-vivo system simulating an in-situ bypass, the efficiency of valve cutting and the degree of luminal damage produced by four of the most commonly used instruments (Reusable LeMaitre, Expandable LeMaitre, Gore Eze-Sit, and Mills). Cryopreserved cadaveric veins (2.5–6 mm diameter) were mounted in a perfusion chamber and submerged in Ringer's lactate. The same buffer containing 0.6% papaverine was infused at a pressure of 100 mm Hg through a catheter inserted into the proximal end of the vein. The valvulotome to be evaluated was introduced through the distal end of the vein, advanced beyond the most proximal valve and withdrawn at a rate similar to that used clinically through the full length of the vein. The vein was opened longitudinally and the efficacy of valve cutting (expressed as percent of individual valve cut) and presence of luminal damage were carefully evaluated by means of a dissecting microscope. Thirty-three valves in seven segments of veins (mean size 4.35 ±0.86 mm) were tested with the Reusable LeMaitre valvulotome. The percent of valvular cutting was 29.9 ±33.4. The Expandable LeMaitre valvulotome was tested in 22 valves contained in five segments (vein diameter 4.07 ±1.04 mm) and the percent of valvular cutting was 89.2 ±15.7. The Gore Eze-Sit valvulotome produced a 80.6 ±25.5% of cutting in the 32 valves contained in the seven venous segments tested (vein diameter 3.67 ±0.42 mm). The Mills valvulotome was tested in five segments of vein containing 20 valves and there was a 82.1 ±24.0% of valve cutting after valvulotomy (diameter 3.67 ±0.57 mm). Statistical analysis demonstrated a significant difference with less cutting (p < 0.0001) when the results of the Reusable LeMaitre valvulotome were compared against each of the other three valvulotomes. Luminal damage was detected in one instance after use of the Mills valvulotome. The Expandable LeMaitre, Gore Eze-Sit, and Mills valvulotomes demonstrated consistent efficacy in valve cutting, the Mills valvulotome producing injury to the wall in one occasion. The Reusable LeMaitre valvulotome gave significantly poorer results, most likely related to failure of engagement of the circular blade. Because of the presently demonstrated safety and efficacy, and avoidance of need for long skin incisions, the Expandable LeMaitre and Gore Eze-Sit are the most promising of the four tested valvulotomes. [ABSTRACT FROM AUTHOR]

Discusses a research on the banding of incompetent saphenous vein. Separation and fragmentation of the muscle bundles; Performance of surgery on an ambulatory basis; Correction of the valvular incompetence.

Vena cava interruption using the Greenfield filter has proved to be a safe and effective method. In a series of 156 patients receiving the filter, published by Greenfield, the patency rate was 98%, and there was no mortality secondary to the filter placement. The incidence of recurrent pulmonary embolism resulting from the proximal propagation of a thrombus has been reported to be 5%. The present work reports on a case of recurrent pulmonary embolism resulting from the proximal propagation of a thrombus originating in a Greenfield filter. [ABSTRACT FROM AUTHOR]