Can we use long PTFE graft for tibial bypass and limb salvage?

 

Generally, it is accepted that autogenous veins (GSVs) work better as Tibial artery bypass grafts. It could be due to the better compliance of the autogenous grafts with less intimal hyperplasia at the anastomotic junctions. Graft patency rate comes down as anastomosis goes down from the thigh to the ankle level. The photograph is showing the PTFE graft in the subcutaneous tissue and looks healthy. The surgeon feels happy to see such a result, but it is difficult to predict the future patency of the graft. Thrrombogenisity is high in such grafts, progressive vascular disease ( atherogenicity, intimal hyperplasia) make it difficult to predict patency.

Should IVC filters be retrieved or left behind?

 IVC filters are used to prevent pulmonary thromboembolism when the adequate anticoagulation is not effective, or contra indicated. There has been a tremendous growth in placement of retrievable IVC filters in the past decade, yet most of the devices are not removed. Unretrieved IVC filters have several well-known complications that increase in frequency as the filter dwell time increases. These complications include cava wall penetration, filter fracture or migration, cava thrombosis and an increased risk for lower extremity deep vein thrombosis (DVT). The risks of complex filter retrievals should be compared with those of life-long anticoagulation associated with an unretrieved filter and should be individualized. The removal of IVC filters requires specific skills and expertise.

• Daye D, Walker TG. Novel and Advanced Techniques for Complex IVC Filter Retrieval. Curr Treat Options Cardiovasc Med. 2017 Apr;19(4):28. doi: 10.1007/s11936-017-0529-3.