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Researchers from University of Rochester describe findings in sternotomy
2009 AUG 3 - (NewsRx.com) -- According to a study from the United States, "Given the increasing numbers of patients requiring long-term hemodialysis, there is an inevitably increasing population of patients with occluded central venous in flow (subclavian, innominate, and caval) despite access or access possibilities in the arm. In an effort to avoid sternotomy, we have attempted to treat these patients with a substernally tunneled subclavian to right atrial bypass." "treated in this fashion have an existing fistula with symptomatic venous hypertension or good fistula options but complete central vein obstruction, a patent subclavian/axillary vein to the costoclavicular junction, and no other options in the contralateral arm. Claviculectomy is performed and the subclavian vein isolated. Through a third intercostal space ''minipericardiotomy,'' the right atrial appendage is exposed. A retrosternal tunnel is fashioned, and bypass is performed from the subclavian vein to atrial appendage. Eleven patients aged 20-70 (mean 46) years underwent surgery at our institution between February 2004 and March 2007. Three bypasses were performed with autogenous vein (two femoral and one saphenous), while eight were performed with polytetra-fluoroethylene in an effort to preserve the superficial femoral vein for later leg bypass. There was one early mortality due to sepsis, and early morbidity was limited to one patient with a symptomatic pericardial effusion. Mean follow-up was 16 (range 3-43) months. Sixty-seven percent and 33% of arteriovenous fistulas remained functional at 6 and 10 months, respectively; and one patient's fistula remained functional at 21 months. Four patients (36%) developed central bypass stenosis or occlusion, one requiring a redo bypass and three angioplasty. Infection occurred in two patients (18%), with removal of autogenous vein graft in one. While a significant number of these bypasses fail, upper extremity access is maintained in a reasonable number of patients (67% at 6 months) who are not candidates for local repair or stenting and would thus have no other upper extremity access options," wrote C. Glass and colleagues, University of Rochester. The researchers concluded: "This technique offers an alternative to sternotomy and brachiocephalic vein reconstruction, although the superiority of one method over the other will require direct comparison." Glass and colleagues published the results of their research in Annals of Vascular Surgery (Subclavian Vein to Right Atrial Appendage Bypass without Sternotomy to Maintain Arteriovenous Access in Patients with Complete Central Vein Occlusion, a New Approach. Annals of Vascular Surgery, 2009;23(4):465-468). For additional information, contact K. Illig, University of Rochester, Division Vascular Surgery, Medical Center, 601 Elmwood Avenue, Box 652, Rochester, NY 14642, USA. The publisher of the journal Annals of Vascular Surgery can be contacted at: Elsevier Science Inc., 360 Park Avenue South, New York, NY 10010-1710, USA. Keywords: United States, Box, Angiology, Axillary Vein, Business, Hemodialysis, Hypertension, Patents, Renal Dialysis, Sternotomy, Subclavian Vein, Surgery, University of Rochester. This article was prepared by Biotech Business Week editors from staff and other reports. Copyright 2009, Biotech Business Week via NewsRx.com.
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