Reconstruction of the vena cava with the peritoneum: the effect of temporary distal arteriovenous fistula on patency (an experimental study).

Abstract

To determine the effect of increasing inferior vena cava blood flow by means of distal arteriovenous fistula on the patency of a peritoneal tube graft. In 16 mongrel dogs, a 3-4 cm long circular defect was created at the infrarenal inferior vena cava. The defect was interposed with peritoneal tube graft. A temporary distal femoro-femoral arteriovenous fistula was also constructed in 8 dogs just after the caval interposition. Graft patency was evaluated by Doppler ultrasonography and angiography. Histological evaluation was also performed. Seven dogs in each group survived. All control grafts occluded within the first week, compared to no occlusions in fistula group (Fisher's exact test, p<0.005). However one 'fistula' dog with a still patent graft was sacrificed on the 18th day due to ultrasonographically occluded arteriovenous fistula. In dogs, the peritoneum may be used as graft material for reconstruction of the inferior vena cava, provided a distal arteriovenous fistula is constructed.