Hany Zayed, Jennifer Fitzpatrick, Anwar Ahmad, Bijan Modarai, Hisham Rashid
Vascular Surgery, Kings Health Partners, London, United Kingdom.
OBJECTIVES: We report our experience with the use of a novel Thermo-Sensitive Polymer (LeGoo) for distal vessel control during Infra-Popliteal Bypasses (IPB) in patients with severe leg ischemia.
METHODS: Retrospective analysis of all IPB procedures performed using LeGoo from January 2010 till April 2011. We specifically looked at technical success in achieving bloodless anastomotic field, intraoperative LeGoo-related complication and re-intervention for anastomosis-related lesion during follow-up.
RESULTS: Thirty-four IPBs using LeGoo were performed during the study period. The distal anastomosis was performed to the Anterior tibial artery (n=9), Posterior tibial artery (n=7), Peroneal artery (n=5), Tibio-Peroneal trunk (n=6) and Dorsalis Pedis artery (n=7). Follow-up period ranged from 4 to 24 months. They were all enrolled in a duplex graft surveillance programme and were offered intervention for threatened grafts. Twenty-three patients completed at least 1 year follow-up. Bloodless anastomotic field was achieved in 32 patients. One patient needed a Fogarty catheter-assisted retrieval of the occlusive polymer plug for the outflow vessel. Five patients needed salvage angioplasty, 2 of them for a distal anastomosis-related stenosis. Four grafts occluded during follow-up, one was successfully thrombolysed and 2 patients had a major amputation.
CONCLUSIONS: LeGoo is a potentially safe and useful device to achieve a bloodless distal anastomotic filed in patients undergoing IPBs. This may be particularly important in constructing the anastomosis to a calcified distal vessel. A large randomized controlled study is needed to support our findings.
AUTHOR DISCLOSURES: A. Ahmad, Nothing to disclose; J. Fitzpatrick, Nothing to disclose; B. Modarai, Nothing to disclose; H. Rashid, Nothing to disclose; H. Zayed, Nothing to disclose.
Posted April 2012