True aneurysms of the femoral and popliteal arteries are the most common peripheral arterial aneurysms. An alteration in the balance between production and degradation of vascular wall constituents, resulting from the culmination of immunological, inflammatory, mechanical, and genetic factors, leads to aneurysm formation. Popliteal artery aneurysms will lead to symptoms in 60–70% of patients and limb loss can occur in up to half of the symptomatic patients if not treated. Femoral artery aneurysms are believed to have a similar natural history, which may also lead to limb loss. Physical exam and/or ultrasound screening of select at-risk patients must be performed early for the best treatment outcomes. Timely intervention in the form of open surgical bypass is the gold standard treatment with universally-accepted long-term results. For popliteal and select femoral aneurysms, endovascular treatment has emerged with feasible mid-term results and may be an alternate option in selected patients.

Endometrial stromal sarcoma metastases usually occur within the pelvis and rarely involve the great vessels or the heart. We present the case of a 55-year-old woman who was referred for endovascular therapy to treat presumed thrombosis of the inferior vena cava. The suspected thrombus was recalcitrant to endovascular removal with use of an AngioVac venous drainage device. Results of an intraprocedural transvenous biopsy revealed the mass to be the intravascular extension of an endometrial stromal sarcoma. The patient underwent surgical excision of the tumor, and, shortly thereafter, a hysterectomy and salpingo-oophorectomy. This complex case highlights both the rarity of malignancy masquerading as caval thrombus and the importance of multispecialty collaboration.

Background: Common femoral endarterectomy (CFE) for limited arterial occlusive disease is considered a fairly low-risk operation of short duration. This study investigated the timing of 30-day outcomes as they related to hospital discharge and predicted the risk of operative mortality of this procedure.Methods: All patients in the National Surgical Quality Improvement Program database who underwent isolated CFE between 2005 and 2010 were selected for the test sample. We identified postoperative mortality and morbidities occurring before and after hospital discharge. A risk calculator for 30-day mortality, developed in the test sample using logistic regression, was validated in a new sample of cases from 2011 to 2012.Results: A total of 1843 CFEs reported from 2005 to 2010 met the inclusion and exclusion criteria. The average operative time was 146 +/- 69.5 minutes (median, 133; interquartile range, 98-179 minutes), and 10% of patients needed to return to the operating room. The average length of stay was 4 +/- 7.5 days (median, 3; interquartile range, 2-5 days); 91% of patients were discharged <= 1 week of surgery. Occurrences of cardiovascular events, renal dysfunction, and pulmonary complication were relatively low. There was 3.4% mortality and 8% wound-related complications, 30% and 86% of which occurred after hospital discharge, respectively. Overall, there was a 15% risk of combined mortality/morbidity, and >60% of these events occurred after discharge. The independent predictors of 30-day mortality were age, nonindependent functional status, preoperative dialysis, sepsis, emergency status, and American Society of Anesthesiologists Physical Status Classification 4 or 5, and the association between risk strata and death in the validation sample was strong (phi = 0.29) and significant (P < .001).Conclusions: CFE is not as "benign" a procedure as previously believed. The risks of death and wound complications are not insignificant, and a high percentage of these complications occurred after patients were discharged from the hospital. Patients should be carefully selected, especially in the elderly population, and close postoperative follow-up should be considered.

Open thoracoabdominal aneurysm repair (TAR) results in major postoperative pulmonary complications in chronic obstructive pulmonary disease (COPD) patients. This study investigates whether a hybrid procedure (HYBRID) is a good alternative for this patient population. All patients who underwent TAR (Current Procedural Terminology code 33877) and HYBRID (visceral debranching and thoracic endovascular aortic repair) from 2005 to 2010 were identified from the National Surgical Quality Improvement Program database. Outcomes for TAR were compared between patients with and without COPD. For COPD patients, 30-day outcomes were compared between the TAR and HYBRID approach. Of 575 patients who received TAR, 154 (27%) had COPD. Compared with patients without COPD, patients with COPD were older, more likely to be malnourished, use steroids, and have American Society of Anesthesiologists class 4 or 5. COPD resulted in a significantly higher risk of prolonged intubation (46% vs 33%; P = .003). When HYBRID (n = 27) was compared with TAR (n = 575) for all patients, it had a significantly longer operative time (7.0 ± 1.7 vs 5.8 ± 2.4 hours; P = .0017), higher risk of stroke (11.1% vs 2.4%; P = .008), and no significant difference in pulmonary complications (Table). Furthermore, for COPD patients, multivariate analysis showed HYBRID was associated with significantly higher rates of deep venous thrombosis/stroke (odds ratio, 13.6 vs 0.9; P = .02) and prolonged intubation (odds ratio, 16.0 vs 1.8; P = .003). COPD patients should not be automatically excluded from open TAR because the HYBRID procedure may not represent a safer alternative.TablePreoperative variables and postoperative outcomes after HYBRID and TAROpen thoracoabdominal (TAR)All patients (with and without COPD)COPD patients onlyCOPD (n = 154)No COPD (n = 421)PHYBRID (n = 27)TAR (n = 575)PHYBRID (n = 9)TAR (n = 154)PAge71.1 (7.7)69.0 (10.6).0173.9 (8.1)69.5 (10.0).0374.0 (7.6)71.1 (7.8).28Albumin3.7 (0.5)3.8 (0.6).033.67 (0.5)3.8 (0.6).493.9 (0.5)3.7 (0.5).51Steroids13 (8.4%)13 (3.1%).0061 (3.7%)26 (4.5%).991 (11.1%)13 (8.4%).56ASA class 4/582 (53.3%)175 (41.7%).0112 (44.4%)257 (44.8%).975 (55.6%)82 (53.3%).99Operative time, hours5.9 (2.6)5.8 (2.4).867.0 (1.7)5.8 (2.4).0026.8 (2.1)5.9 (2.6).29Mortality18 (11.7%)40 (9.5%).446 (22.2%)58 (10.1%)0.063 (33.3%)18 (11.7%).09Stroke5 (3.3%)9 (2.1%).543 (11.1%)14 (2.4%).0083 (33.3%)5 (3.3%).01Prolonged intubation71 (46.1)138 (32.8%).0038 (29.6%)209 (36.4%).486 (66.7%)71 (46.1%).31(% or SEM) Open table in a new tab

OBJECTIVE:This study investigates whether this practice is supported by multicenter prospectively collected data.BACKGROUND:Currently, open abdominal aortic aneurysm (AAA) repair (OPEN) is preferred over endovascular repair (EVAR) in patients with chronic renal insufficiency because of the concern that the contrast load used for EVAR may result in postoperative dialysis.METHODS:Patients who underwent EVAR and OPEN for infrarenal AAA were identified in the NSQIP database from 2005 to 2010. Preoperative renal function was assessed by estimated glomerular filtration rate (eGFR) calculated by the Chronic Kidney Disease Epidemiology Collaboration equation. Patients with chronic renal insufficiency were further stratified into 2 different groups: moderate (eGFR = 30-60 mL/min) and severe (eGFR <30 mL/min) renal dysfunction. Multivariate regression model was used for data analysis.RESULTS:We identified 13,191 patients who underwent AAA repair: 9877 patients underwent EVAR and 3314 underwent OPEN. Forty percent of patients had eGFR of less than 60 mL/min. OPEN in patients with moderate renal dysfunction resulted in significantly higher mortality, cardiovascular events, and combined outcomes. However, in patients with severe renal dysfunction, these outcomes were similarly high in both OPEN and EVAR. Most importantly, OPEN in patients with moderate renal dysfunction resulted in 5.2 times higher risk of dialysis.CONCLUSIONS:Contrary to current practice, and despite the use of contrast, EVAR should be the first choice in patients with moderate renal dysfunction if they have the appropriate anatomy. Higher threshold for AAA repair with either OPEN or EVAR should be applied in patients with severe renal dysfunction because postoperative complications were significantly high with either approach.

Common femoral endarterectomy for limited arterial occlusive disease is performed commonly because it is considered a short and fairly low-risk procedure. This study investigates the timing of 30-day outcomes of this procedure. All patients who underwent common femoral endarterectomy in the National Surgical Quality Improvement Program database between 2005 and 2010 were selected. After the procedure's mortality and morbidities were identified, we specifically focused on the timing of event occurrences before and after hospital discharge. There were a total of 1843 common femoral endarterectomies performed during that period. The average operative time was 146 ± 69.5 minutes, and 10% of patients needed to return to the operating room. The average length of stay was 4 ± 5.8 days; 90% of patients were discharged within 1 week of surgery. Although cardiovascular events, renal dysfunction, and pulmonary complication rates were relatively low (Table), there was a 3.4% mortality rate, almost one-half of which occurred after the first week. Wound infection rate was 3%; 94% of which occurred after the first week. Overall, there was a 10% rate of combined mortality/morbidity, and more than 60% of these events occurred after the first week. Although common femoral endarterectomy is considered a relatively benign procedure, it still has significant complication rate. However, a significant percentage of these complications occurred after patients are discharged from the hospital. Close postoperative follow-up should be considered.TableThirty-day outcomes and timing of event occurrence after common femoral endarterectomyn = 1843Events n (%)Weeks after surgery123≥4Mortality62 (3.4%)31 (53.5%)12 (20.7%)4 (6.9%)11 (19.0%)Graft failure21 (1.1%)8 (38.1%)7 (33.3%)3 (14.3%)3 (14.3%)Cardio27 (1.5%)19 (70.4%)4 (14.8%)1 (3.7%)3 (11.1%)Clot25 (1.4%)8 (32.0%)6 (24.0%)8 (32.0%)3 (12.0%)Renal16 (0.9%)10 (62.5%)4 (25.0%)2 (12.5%)0 (0%)Pneumo61 (3.3%)38 (63.3%)11 (18.3%)8 (13.3%)3 (5.0%)Wound49 (2.7%)3 (6.1%)20 (40.8%)14 (28.6%)12 (24.5%)Sepsis47 (2.6%)12 (26.7%)19 (42.2%)7 (15.6%)7 (15.6%)Composite191 (10.4%)68 (36.2%)51 (27.1%)37 (19.7%)32 (17.0%) Open table in a new tab

This study investigates whether intervention should be offered to octogenarians with paravisceral abdominal aortic aneurysm (AAA) by comparing 30-day outcomes between open (OPEN) and fenestrated endovascular repair (f-EVAR). All patients who underwent OPEN (current procedural terminology code 35091) and f-EVAR (current procedural terminology code 0078T) for paravisceral AAA from 2005-2010 were identified in the National Surgical Quality Improvement Program database. The patients were further subdivided into two groups, octogenarians and younger patients (<80 years old). Thirty-day mortality and major adverse events of each procedure were compared between these age groups. Multivariate logistic regression model was used for data analysis. 976 patients received OPEN, and 358 underwent f-EVAR. 171 (17.5%) of OPEN and 78 (21.7%) of f-EVAR were octogenarians. There was no difference in the outcomes for octogenarians compared with younger patients in either OPEN or f-EVAR. In octogenarians, f-EVAR patients had similar cardiac profile, were less likely to be female, required less intraoperative blood transfusion, and had shorter operative time and hospital stay than OPEN patients. Furthermore, f-EVAR was superior to OPEN due to significantly lower rate of pulmonary complications and renal dysfunction (Table). Intervention should be offered to octogenarians with paravisceral AAA because their outcomes are comparable to younger patients. f-EVAR should be the first-line therapy for octogenarians because of clear superiority of 30-day outcomes over OPEN.TableComparison between fEVAR and OPEN for octogenariansfEVAR (n = 78)OPEN (n = 171)P valueFemale7 (9.0%)62 (36.3%)<.0001Preoperative cardiac risks70 (89.7%)156 (91.2%).71Mortality1 (1.3%)8 (4.7%).28Operative time, hours2.7 ± 1.13.8 ± 1.3<.0001Intraoperative transfusion, units0.3 ± 0.72.8 ± 2.9<.0001Length of stay, days3.9 ± 5.311.3 ± 8.7<.0001Postop cardiovascular events3 (3.9%)9 (5.3%).76Postop renal injury0 (0%)13 (7.6%).011Postop pulmonary complications1 (1.3%)42 (24.6%)<.0001 Open table in a new tab

BACKGROUND:To evaluate our experience with staged carotid endarterectomy (CEA) followed by coronary artery bypass grafting (CABG) within the perioperative period for patients with severe carotid and coronary artery disease. METHODS:From 1998 to August of 2010, 40 patients who were referred for isolated coronary surgery were found to have significant carotid disease. All patients underwent CEA followed by subsequent CABG within 30 days of the CEA. Severe carotid stenosis was defined as >70%. RESULTS:Average patient age was 65.5 ± 10.6 years and 32 (80%) were male. Severe carotid stenosis was unilateral in 37 of the patients, bilateral in 3, and asymptomatic in 37. Patients underwent CEA with either patch angioplasty or eversion technique. General anesthesia with selective shunting was used in all cases. There were zero deaths, zero strokes, and one myocardial infarction (MI) (2.5%) immediately after CEA. After CEA, CABG was performed within 30 days. The average interval between procedures was 6.87 days. There were two (5.0%) deaths, one from MI and the other from multisystem organ failure. There were two strokes (5.0%), with one having permanent effects. The perioperative mortality, stroke, and MI rates after both operations were 5.0%, 5.0%, and 5.0%, respectively. CONCLUSIONS:Staging of CEA followed by CABG in the immediate perioperative period may be an acceptable approach to patients with severe carotid and coronary disease. Despite the presence of known severe coronary disease, the performance of CEA under general anesthesia as the initial procedure was well tolerated. We propose that this strategy may be a possible option for patients who present with severe disease in both coronary and carotid distributions. The results of our study, though based on a limited cohort, suggest that this approach of staged CEA-CABG within the perioperative period <30 days is reasonable.

Purpose:To evaluate the feasibility and safety of using the 8-F Angio-Seal vascular closure device (VCD) to seal large-caliber (>8-F) access sites during percutaneous endovascular interventions.Methods: A retrospective review was undertaken of 42 consecutive patients (34 men; mean age 67.8 years, range 36-94) undergoing percutaneous peripheral interventions with sheaths ranging from 9-F to 12-F and subsequent closure using 8-F Angio-Seal VCDs. Single-wall puncture (n=48) of the common femoral artery was guided by ultrasound in 46 cases and palpation in 2. Forty procedures required therapeutic heparinization during the interventional procedure; protamine was administered in only 5. Per protocol, manual pressure was held for 15 minutes. Clinical and/or imaging follow-up was available in all cases within 3 months after the procedure.Results: Immediate technical success was achieved in all cases, with hemostasis obtained within 5 minutes (no oozing or hematoma). The overall complication rate was 4.1% (2/48); one hematoma requiring surgical repair occurred 10 hours after VCD deployment. An asymptomatic pseudoaneurysm was discovered on follow-up imaging and was treated with ultrasound-guided thrombin injection with complete resolution.Conclusion: The use of the 8-F Angio-Seal VCD to close large-caliber arteriotomies ranging from 9-F to 12-F is feasible and safe, with a low complication rate. J Endovasc Ther. 2012;19:497-500

Venous bullet embolism is a rare and complicated occurrence reported in approximately 0.3% of penetrating trauma. The management of bullet emboli is decided on a case-by-case basis, balancing the risk of the embolus itself against those associated with extraction. We report a case of a 19-year-old man who sustained a gunshot wound to the anterior chest, which migrated to the left internal iliac vein in a retrograde fashion. We were able to successfully retrieve the missile using an endovascular approach, thereby minimizing the morbidity associated with an open procedure.

Le but de cette étude était de déterminer quelles caractéristiques de la zone d’ancrage proximale étaient prédictives de l’apparition d’endofuite de type IA précoce et tardive après le traitement endovasculaire d’un anévrysme de l’aorte abdominale sous-rénale (EVAR). Nous avons évalué 146 patients qui ont eu une EVAR entre janvier 2006 et mars 2007. Dans la cohorte, les angioscanners de 100 (68,5%) patients étaient disponibles, montrant la mesure détaillée des paramètres proximaux du collet, incluant le diamètre, la longueur, les calcifications, le thrombus, l’angulation sus et sous-rénal, et la morphologie conique. L’ensemble des données numériques ont été traitées pour obtenir des mesures de ligne centrale. Les dossiers médicaux et les angioscanners de suivi ont été revus. L'âge moyen des patients était de 72,7 ans, avec 78% d’hommes. Parmi ces patients, 66% ne complétaient pas les instructions d'usage du dispositif d’EVAR Zenith, et 50% ne complétaient pas les instructions d'usage pour du dispositif AneuRx. Neuf patients ont eu une endofuite de type IA peropératoire. Un taux de succès technique primaire assisté de 100% a été obtenu avec l'utilisation supplémentaire d’angioplasties (n = 4), de stents nus (n = 3), et d’extension couverte (n = 2). Il y avait une association significative entre l’apparition d’une endofuite de type IA et l’ampleur de l'angle sous-rénal (p < 0,01) ; les autres paramètres n'étaient pas significatifs. Au cours du suivi (moyen 587 jours), aucun patient n'a développé une endofuite de type IA, et il n'y a eu aucun décès lié à l’anévrysme. Nos données indiquent que l'angulation sous-rénale est liée à l’incidence d’endofuite de type IA peropératoire, mais les autres facteurs souvent indicateurs d’une l'anatomie défavorable du collet ne sont pas des facteurs prédictifs significatifs. D'ailleurs, toutes les endofuites de type IA dans cette cohorte ont été éliminées avec succès en peropératoire, et la durabilité a été confirmée par la surveillance postopératoire. Ces données démontrent que l'anatomie difficile du collet est associée au recours de gestes supplémentaires endovasculaires peropératoires, et qu’une exclusion efficace et durable de l'anévrysme peut alors être obtenue.

BACKGROUND:The purpose of this study was to determine which proximal seal zone characteristics were predictive of early and late type Ia endoleak development after endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysmal disease.METHODS:We evaluated 146 patients who underwent EVAR between January 2006 and March 2007. In the cohort, high-resolution computed tomography images of 100 (68.5%) patients were available, which showed detailed measurement of proximal neck parameters, including diameter, length, calcification, thrombus, suprarenal and infrarenal angles, and reverse taper morphology. Postprocessing of digital data sets was performed to obtain centerline-of-flow measurements. Relevant medical records and follow-up computed tomography scans were reviewed.RESULTS:Mean age of the patients was 72.7 years, with 78% being male. Of these patients, 66% did not satisfy the instructions for use for the Zenith EVAR device, and 50% did not satisfy the instructions for use for the AneuRx device. Nine patients had intraoperative type Ia endoleaks. A 100% assisted primary technical success rate was achieved with the adjunctive use of angioplasty (n = 4), uncovered stent (n = 3), and extension cuff (n = 2) placement. There was a significant association between type Ia endoleak development and magnitude of the infrarenal angle (p < 0.01); however, other parameters were not significant. At follow-up (mean, 587 days), no patient had a type Ia endoleak, and there were no aneurysm-related deaths.CONCLUSIONS:Our data indicate that infrarenal angle is related to intraoperative type Ia endoleak occurrence, but other factors often thought to be indicative of adverse neck anatomy are not significant predictors. Moreover, all type Ia endoleaks in this cohort were successfully eliminated intraoperatively, and durability was confirmed on postoperative surveillance. These data demonstrate that challenging neck anatomy is associated with the need for intraoperative endovascular adjuncts, and that effective and durable aneurysm exclusion should still be expected.

L’hyperplasie myointimale est un résultat pathologique de la réponse inflammatoire normale du corps aux dommages des vaisseaux sanguins et est la principale cause d’échec des pontages artériels périphériques. Puisque les agents immunosuppresseurs sont connus pour diminuer l’inflammation, nous avons présumé que les résultats des pontages des membres inférieurs chez les greffés rénaux doivent être supérieurs à ceux des hémodialysés. le registre de chirurgie vasculaire d’un centre de soin tertiaire simple a été rétrospectivement passé en revue pour identifier les patients qui ont subi des procédures de pontages aux membres inférieurs. Tous les patients présentant une histoire de transplantation rénale ont été choisis pour l’analyse. Un groupe consécutif de patients pontés présentant une insuffisance rénale dialysée a été choisi comme groupe témoin. Le critère de jugement primaire était la survie sans amputation. La reconstruction vasculaire pour maladie vasculaire chronique périphérique a donné un taux de survie sans amputation de 82% à 1 an dans le groupe témoin par rapport seulement à 22% dans le groupe avec transplantation rénale (p = 0,02), qui correspondait exactement à perméabilité primaire à 1 an. Les patients ont été opérés pour claudication sévère (n = 1), douleur de décubitus (n = 1), et troubles trophiques (n = 17). Il n’y avait aucune différence entre les groupes en ce qui concerne l’indication opératoire ou les états de comorbidités. Ces données suggèrent un effet délétère de l’immunosuppression sur les résultats des pontages aux membres inférieurs aux doses exigées pour empêcher le rejet du greffon. Cette conclusion, qui a été à peine rapportée, sous-estime l’importance de la recherche de la maladie vasculaire périphérique dans la population de greffe et la nécessité d’une intervention précoce une fois médicalement indiquée.

BACKGROUND:Myointimal hyperplasia is a pathologic result of the body's natural inflammatory response to injury of the blood vessels and a leading cause of peripheral arterial bypass failure. Because immunosuppressive agents are known to abate inflammation, we hypothesized the superior outcome of lower extremity bypass in renal transplant recipients compared with the hemodialysis population.METHODS:The vascular surgery registry at a single tertiary care center was retrospectively reviewed to identify patients who underwent lower extremity bypass procedures. All patients with a history of renal transplantation were selected for analysis. A consecutive group of bypass patients with dialysis-dependent renal failure was selected as a control cohort. The primary endpoint was amputation-free survival.RESULTS:Vascular reconstruction for chronic peripheral vascular disease yielded an amputation-free survival rate of 82% at 1 year for the those in the control group as compared with only 22% in the those with a history of renal transplantation (p = 0.02), which corresponded exactly with primary patency at 1 year. Patients were operated on for severe claudication (n = 1), rest pain (n = 1), and tissue loss (n = 17). There was no difference between the groups with regard to indication for operation or comorbid conditions.CONCLUSIONS:These data suggest a deleterious effect of immunosuppression on outcome of lower extremity bypass procedures at the doses required to prevent allograft rejection. This finding, which has been scarcely reported, underscores the importance of peripheral vascular disease screening in the transplant population and early intervention when clinically indicated.

The purpose of this study was to determine which proximal seal zone characteristics were predictive of early and late type Ia endoleak development after endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysmal (AAA) disease. We evaluated 146 patients who underwent EVAR between January 2006 and March 2007. Of the cohort, 100 (68.5%) patients had high-resolution CT images that allowed detailed measurement of proximal neck parameters, including diameter, length, calcification, thrombus, suprarenal and infrarenal angles, and reverse cone morphology. Post-processing of digital data sets (Aquarius Workstation, TeraRecon Inc, San Mateo, CA) was performed to obtain centerline-of-flow measurements. Relevant medical records and follow-up CT scans were reviewed. Mean patient age was 72.7 years with 78% being male. Fifty-two percent of patients did not satisfy the indications for use (IFU) for the Zenith EVAR device (Cook Medical Inc, Bloomington, IN), and 67% of patients did not satisfy the IFU for the Aneurx device (Medtronic Inc, Minneapolis, MN). Neck morphology data are shown in the table. Nine patients had intraoperative type Ia endoleaks. A 100% assisted primary technical success rate was achieved with adjunctive maneuvers. There was a significant association between type Ia endoleak development and magnitude of the infrarenal angle (p<0.01); however, other parameters were not significant. No type Ia endoleaks were detected during follow up (mean 587 days), and no aneurysm related deaths occurred.Tabled 1Neck and aneurysm characteristicsMeanRangeIncidenceNeck diameter23.1 mm16.2 - 41.3 mmN/ANeck length15.7 mm1.5 - 21 mmN/ANeck CalcificationN/AN/A48%Neck ThrombusN/AN/A26%Suprarenal angle18.5°3 - 41°N/AInfrarenal angle32.5°6 - 85°N/AReverse coneN/AN/A33%Max AAA diameter53 mm23 - 100 mmN/A Open table in a new tab Our data indicate that infrarenal angle is related to intraoperative type Ia endoleak occurrence. Moreover, all type Ia endoleaks in this cohort were successfully eliminated intraoperatively, and durabilitywas confirmed on postoperative surveillance. These data demonstrate that effective and durable aneurysm exclusion is the rule, not the exception, even in the presence of challenging neck anatomy.

BACKGROUND:The left internal thoracic artery is the ideal conduit for coronary artery revascularization due to superior patency compared with venous grafts. The hemodynamic effects of an arterio-venous fistula on the native in situ internal thoracic artery and the potential for coronary flow steal after revascularization with the internal thoracic artery, are not well-characterized.METHODS:Fifteen chronic hemodialysis patients with functioning left upper extremity arterio-venous fistulas were evaluated with the use of transthoracic color Doppler analysis. Flow characteristics of the left and right internal thoracic arteries at baseline, with arterio-venous fistula occluded, and during hemodialysis were recorded. Peak systolic and diastolic velocities for the right and left internal thoracic arteries were calculated for each fistula state (occluded, open, and on-dialysis). One-way analysis of variance was used to compare the different means.RESULTS:Mean flow velocity calculations failed to identify any statistically significant differences between the ipsilateral and contralateral internal thoracic artery in any fistula state. In addition, mean internal thoracic flow velocities were similar between the different fistula states.CONCLUSIONS:Changes in arteriovenous fistula flow state did not significantly alter Doppler flow hemodynamics of either the ipsilateral or contralateral in-situ internal thoracic artery. Further studies of the possible effects on internal thoracic arteries used as pedicled coronary grafts may be required.