Venous reconstruction by endvenectomy with temporary arteriovenous fistula for stasis syndrome of lower extremity: experimental and clinical studies.

Effect of the temporary arteriovenous fistula on venous reconstruction for stasis syndrome of the lower extremity was studied experimentally and clinically. The canine iliac vein was replaced with an autogenous vein graft in which the intimal surface was roughened by scrubbing with sponge. A temporary arteriovenous fistula which was closed surgically three or four weeks later was created between the femoral vessels. The patency rate for twenty-one grafts was 80.9 per cent for one to thirty-six weeks (mean 8 weeks), in contrast to complete failure in the control group in which no arteriovenous fistula was created. Adequate healing of the luminal surface of the grafts were experimentally demonstrated by light microscopic examination and en face silver staining of the endothel-like cells with the aid of patent arteriovenous fistula for three weeks. This procedure was clinically applied in four patients with stasis syndrome of the lower extremities. Good function of the reconstructed venous segments in three of four patients was observed for the last 3 to 8 years after the operations. A looping technique using 2-0 monfilament nylon around the fistula devised by us was very helpful to make easy the shunt closure later. Open endvenectomy with a temporary arteriovenous fistula is believed to be an acceptable approach for segmental chronic occlusive lesion in the iliac vein.