Role of arteriovenous shunts in venous reconstruction

Jugular venous autografts were inserted into both superficial femoral veins of twenty dogs. In half of these dogs (group A) a side to side distal arterial venous shunt was established whereas in the remaining ten dogs (group B) a distal H type arteriovenous shunt was created. The autografts in the limb without a distal arteriovenous fistula served as controls. Patency was determined by serial angiograms postoperatively. Early patency of autogenous vein grafts in the lower extremities was increased with the use of adjuvant distal arterial venous fistulas. The H type arteriovenous shunt was associated with higher patency of the venous graft, less morbidity, and greater ease of repair than was the side to side arteriovenous shunt. Forty-five per cent of the control grafts thrombosed within the first three postoperative days but 89 per cent were patent at six weeks, indicating the frequent occurrence of recanalization. Recent reports from Vietnam have emphasized the importance of venous repairs, particularly in the lower extremities. Additional experimental and clinical efforts are needed to evaluate the usefulness of autogenous vein grafts in the venous system.