A simple guideline to facilitate axial alignment of vascular grafts

A Simple Guideline to Facilitate Axial Alignment of Vascular Grafts lbrahim M. Ibrahim, MD, Englewood, New Jersey Irving I. Dardik, MD, FACS, Englewood, New Jersey Herbert Dardik, MD, FACS, Englewood, New Jersey

Maintenance of proper graft alignment and orientation is critical for the successful conclusion of any vascular reconstructive procedure requiring a bypass. This is usually quite simple in aortoiliac reconstructions. When the graft must be placed through the subsartorial canal for a femoropopliteal bypass, a variety of compulsive technics are employed by surgeons to prevent graft rotation or twisting. If the proximal anastomosis is performed first, then temporary release of the proximal clamp to allow the pulsatile column of blood to enter the graft will help confirm proper orientation. This then requires careful cleansing of the graft to prevent any residual thrombus from lining its inner surface. If the distal anastomosis is performed first, a balloon catheter can be inserted, inflated, and then retracted to eliminate any rotation by having the graft spiral into the proper plane. However, the passage of a balloon catheter in itself may cause further trauma to a vein graft and may be insufficient to derotate a synthetic graft. Other technics have been described such as suturing a silk guideline along one axis of the graft [1] or marking the graft with dyes such as methylene blue. However, none are foolproof and most are timeconsuming. We have recently employed with satisfaction straight and bifurcated grafts that incorporate a guideline to prevent graft rotation. The guideline consists of Dacron@ fiber dyed with carbon black and incorporated into the graft during its construction, as a single guideline for straight tubes and a parallel set of lines for bifurcation grafts. (Figure 1.)

From the Department of Surgery, Englewood Hospital, Englewocd, New Jersey. Reprint requests should be addressed to H. Dardik, MD, 1555 Center Avenue, Fori Lee, New Jersey 07024.

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We have employed these grafts in the aortoiliac, aortofemoral, femorofemoral, femoropopliteal,’ and axillofemoral locations. (Figure 2.) The operative procedure is vastly facilitated by having these guidelines already incorporated in the graft. The surgeon simply places the graft limb in the appro-

Figure 1. Straight and bifurcation grafts Incorporating

The American Journal of Surgery

Axial Alignment of Vascular Grafts

priate position either by direct vision as with aortoiliac grafts or by simple passage of the graft through the appropriate tunnel. Additionally, we have found the graft useful for constructing composites for bypass procedures to below the knee where autogenous saphenous vein has been used to cross the knee joint. This simple guideline facilitates the passage of the graft, thereby not only shortening operative time but also providing the operator with specific assurance that the graft is properly aligned.

Summary

The proper orientation of vascular prostheses is essential for successful performance of vascular reconstructions. To prevent axial rotation of grafts, particularly in long tunnels such as in the axillofemoral or subsartorial position, vascular prostheses with a simple guideline incorporated within their fibers were employed. The advantages of these grafts are discussed.

References Figure 2. Operative view of femoral limb anastomosis an of axillofemoral graft with guideline.

VohIme 133, June 1977

1. Linton RR: Atlas of Vascular Surgery. Philadelphia, WB Saunders, 1973, p 420.

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