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OBJECTIVE -- Vascular surgery is a rapidly evolving field where new technologies are being developed and introduced every year. The Gore Hybrid Vascular Graft (GHVG) is a polytetrafluoroethylene (PTFE) graft with a self-expanding Nitinol-reinforced segment that deploys to provide sutureless anastomosis. Certain situations make clamping an artery, or otherwise getting proximal control a significant challenge. We have found that the GHVG affords an opportunity to rescue otherwise trying procedures.
METHODS -- We retrospectively identified patients who had received a GHVG in complex revascularization procedures. We did not include the dialysis access cases in which a GHVG was used.
RESULTS -- We identified 45 patients with ages ranging from 24 to 92. We used 2 grafts during the same procedure in 9 patients and used 3 in one patient for a total of 56 grafts used. Out of the 45 cases, 38 were emergent or urgent while only 7 were elective. 38 cases were in patients with limb ischemia due to peripheral vascular disease or with iliac dissection or rupture due to instrumentation. 5 cases were in patients with aortic dissection and 2 in patients with complex aortic aneurysms. The majority of the patients with peripheral vascular disease had prior revascularization procedures. The nitinol reinforced stent was placed in the external iliac artery in 26 out of the 56 grafts. There were 4 cases of surgical site infections, 1 hematoma, and 1 seroma. There was a total of 4 graft loss out of the 56. There were 4 deaths, all of them in patients with severe cardiac disease and multiple other comorbidities, but were due to events unrelated to the procedure.
CONCLUSION -- The GHVG can be a valuable salvage tool in emergent/urgent vascular bypass procedures in sick patients with difficult anatomy and or with multiple previous surgeries.