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25.4 Graft structure influence the healing of endoluminal stented vascular grafts
23rd World Congress of the ISCVS
25.3 The Aortic Stretch PTFE Graft Versus Uncoated and Coated Dacron Graft: a Prospective Non-randomized Study K. KTENIDIS J. ALBRECHT-FRijH, W REZFENHAUSER and S. HORSCH, Cologne, Germany April 1991 the new aortic stretch PTFE graft was introduced into clinical practice. A serious rival for the aortic Dacron graft was born. The stretch PTFE graft offers several advantages over the Dacron graft: impermeability and no requirement of preclotting; more resistance to dilatation, to infection (lesser bacterial adherence) and to pseudoaneurysm formation; easy thrombectomy because of their smooth inner surface. We report from our experiences with the new stretch PTFE aortic graft. In the framework of a prospective, nonrandomized study a comparison was made between the results with the new graft (stretch PTFE) and our previous standard grafts (uncoated and coated Dacron graft). Patients with suprarenal or ruptured abdominal aortic aneurysms were excluded from this study. From January 1996 to November 1996 161 consecutive patients were included. There are 122 males and 39 females with the mean age of 65.7 years (range 42-88 years). These received 112 aortic bifurcated grafts, 39 tube grafts and 10 aortofemoral bypasses. Arterial reconstruction was necessary because of aortic aneurysmal (n = 126) or aortoiliac occlusive disease (n = 35). The perioperative control included real-time und color coded sonography, digital substraction angiography (intravenous) and abdominal computer topography. The hospital mortality was 1.8%. The primary (secondary) patency rate was 96% (100%) for the PTFE group (n = 51) and 98% (100%) for the uncoated (n = 53) and coated (n = 57) Dacron group. Intraoperatively we found excellent handling and suturing characteristics of the PTFE stretch graft in comparison to Dacron prosthesis. The needle hole bleeding was minimal because of the use of Gore-Tex suture and low-dose intravenous heparinization intraoperatively. In conclusion, PTFE stretch grafts seem suitable conduits for use in aortoiliac reconstructions. In comparison to the Dacron the PTFE stretch graft offers minimal graftrelated complications (thrombosis, infections, graft dilatation).
were constructed with a 5 pm ePTFE wrap covering only half of the external circumference. Specimens were harvested after 6 weeks and evaluated for endothelial (EC) repaving; intima/ media anastomotic height ratios (IMHR), capillary ingrowth and neointimal thickness (NT) by morphometric analysis. Data were analyzed by ANOVA and are summarized below.
Graftdesign
Endothelial Capillaries Neointimal Proximal Distal repaving (per 40 X thickness anastomotic anastomotic lMHR (pm) 1MHR (pm) field) (“W iv)
30km W 30wmNW 60/20 k m W 60/2Opm N W
22+3* 19.324” 131$23* 0.3 * 0.04 0.23 t 0.04$ 72 + 22.2 50.4 f 8 80 2 19*t 0.24 = 0.04 0.3 * 0.03$ 25 + 9.4’ 38 ct 5.2 277 t 44 0.33 + 0.07 0.4 + 0.05 88 2 7.2 45 2 11.4 76 zt 10*/t 0.31 zt 0.07 0.4 t 0.06
In
25.4 Graft Structure Influences the Healing of Endoluminal Stented Vascular Grafts D.A. WEATHERFORD, R.T. MOULTON, P.H. GlNGRAS, M .H. GOLDMAN, S.L. STEVENS, M .B. FREEMAN and J.E. SACKMAN, Knoxville, Tennessee,USA Endovascular grafts (EVG) has been proposed as alternate therapy for treatment of vascular diseases. Graft structure is known to significantly influence healing and patency of standard bypass grafts (SBG), but its effect on EVG has not been previously reported. The aim of this study was to evaluate the effect of graft porosity and design on the healing of EVG. Ten dogs underwent infrarenal endovascular placement of 30 pm or 60/20 pm graduated porosity ePTFE grafts. Grafts
126
* Significant at P < 0.05; tsignificant from 30 W P < 0.05; $significant from 60/20 grafts of similar design P < 0.05. W = wrapped; N W = not wrapped.
Low porosity wrapping limited EC and promoted NT. Grafts of either design without wrapping had significantly greater capillary ingrowth, EC repaving and less NT. Wrapping and 60120 design promoted the greatest NT. Graft design alone (30 versus 60/20) had no influence on EC repaving, capillary ingrowth or NT. Porosity and design significantly affected IMHR only at the distal anastomosis. Previous work has demonstrated accelerated endothelialization of EVG compared to SBG in native and injured arteries. This study shows that low graft porosity, but not design significantly delays early EVG endothelialization, possibly by limiting capillary ingrowth. These data suggest that early EVG endothelialization occurs by transinterstitial EC ingrowth and that graft porosity contributes significantly to EVG healing.
25.5 Intraoperative Cine Fluoroscopy: an Adjunct for Improving Standard Vascular Operations ].G. YUAN, R.E. PARSONS, EJ. VEITH, M .L. MARZN, L.A. SANCHES, WD. SUGGS, R.T. LYON, T. OHKZ and R.A. WAIN, New York, New York, USA While intraoperative arteriography remains the “gold standard” for assessing technical adequacy following arterial reconstructions, the commonly used single-shot completion arteriogram has a limited scope and may be insensitive for technical imperfections. Moreover, it cannot be used for endoluminal, catheter-guidewire treatment of lesions that are Table A
Table B
To provide clarification and No. localization of unsuspected
Adjunctive fluoroscopically guided therapy
No.
Stenotic inflow lesion Stenotic outflow lesion Pressure gradient Retained clot Bypass target vessel
Angioplasty with stent Angioplasty without stent Thrombectomy*
14 2 3
5 6 4 6 1
*Using a double lumen balloon catheter passedover a guidewire with contrast filling of the balloon to control inflation and define intraluminal lesions.
CARDIOVASCULAR SURGERY
SEPTEMBER
1997
25.3 The Aortic Stretch PTFE Graft Versus Uncoated and Coated Dacron Graft: a Prospective Non-randomized Study K. KTENIDIS J. ALBRECHT-FRijH, W REZFENHAUSER and S. HORSCH, Cologne, Germany April 1991 the new aortic stretch PTFE graft was introduced into clinical practice. A serious rival for the aortic Dacron graft was born. The stretch PTFE graft offers several advantages over the Dacron graft: impermeability and no requirement of preclotting; more resistance to dilatation, to infection (lesser bacterial adherence) and to pseudoaneurysm formation; easy thrombectomy because of their smooth inner surface. We report from our experiences with the new stretch PTFE aortic graft. In the framework of a prospective, nonrandomized study a comparison was made between the results with the new graft (stretch PTFE) and our previous standard grafts (uncoated and coated Dacron graft). Patients with suprarenal or ruptured abdominal aortic aneurysms were excluded from this study. From January 1996 to November 1996 161 consecutive patients were included. There are 122 males and 39 females with the mean age of 65.7 years (range 42-88 years). These received 112 aortic bifurcated grafts, 39 tube grafts and 10 aortofemoral bypasses. Arterial reconstruction was necessary because of aortic aneurysmal (n = 126) or aortoiliac occlusive disease (n = 35). The perioperative control included real-time und color coded sonography, digital substraction angiography (intravenous) and abdominal computer topography. The hospital mortality was 1.8%. The primary (secondary) patency rate was 96% (100%) for the PTFE group (n = 51) and 98% (100%) for the uncoated (n = 53) and coated (n = 57) Dacron group. Intraoperatively we found excellent handling and suturing characteristics of the PTFE stretch graft in comparison to Dacron prosthesis. The needle hole bleeding was minimal because of the use of Gore-Tex suture and low-dose intravenous heparinization intraoperatively. In conclusion, PTFE stretch grafts seem suitable conduits for use in aortoiliac reconstructions. In comparison to the Dacron the PTFE stretch graft offers minimal graftrelated complications (thrombosis, infections, graft dilatation).
were constructed with a 5 pm ePTFE wrap covering only half of the external circumference. Specimens were harvested after 6 weeks and evaluated for endothelial (EC) repaving; intima/ media anastomotic height ratios (IMHR), capillary ingrowth and neointimal thickness (NT) by morphometric analysis. Data were analyzed by ANOVA and are summarized below.
Graftdesign
Endothelial Capillaries Neointimal Proximal Distal repaving (per 40 X thickness anastomotic anastomotic lMHR (pm) 1MHR (pm) field) (“W iv)
30km W 30wmNW 60/20 k m W 60/2Opm N W
22+3* 19.324” 131$23* 0.3 * 0.04 0.23 t 0.04$ 72 + 22.2 50.4 f 8 80 2 19*t 0.24 = 0.04 0.3 * 0.03$ 25 + 9.4’ 38 ct 5.2 277 t 44 0.33 + 0.07 0.4 + 0.05 88 2 7.2 45 2 11.4 76 zt 10*/t 0.31 zt 0.07 0.4 t 0.06
In
25.4 Graft Structure Influences the Healing of Endoluminal Stented Vascular Grafts D.A. WEATHERFORD, R.T. MOULTON, P.H. GlNGRAS, M .H. GOLDMAN, S.L. STEVENS, M .B. FREEMAN and J.E. SACKMAN, Knoxville, Tennessee,USA Endovascular grafts (EVG) has been proposed as alternate therapy for treatment of vascular diseases. Graft structure is known to significantly influence healing and patency of standard bypass grafts (SBG), but its effect on EVG has not been previously reported. The aim of this study was to evaluate the effect of graft porosity and design on the healing of EVG. Ten dogs underwent infrarenal endovascular placement of 30 pm or 60/20 pm graduated porosity ePTFE grafts. Grafts
126
* Significant at P < 0.05; tsignificant from 30 W P < 0.05; $significant from 60/20 grafts of similar design P < 0.05. W = wrapped; N W = not wrapped.
Low porosity wrapping limited EC and promoted NT. Grafts of either design without wrapping had significantly greater capillary ingrowth, EC repaving and less NT. Wrapping and 60120 design promoted the greatest NT. Graft design alone (30 versus 60/20) had no influence on EC repaving, capillary ingrowth or NT. Porosity and design significantly affected IMHR only at the distal anastomosis. Previous work has demonstrated accelerated endothelialization of EVG compared to SBG in native and injured arteries. This study shows that low graft porosity, but not design significantly delays early EVG endothelialization, possibly by limiting capillary ingrowth. These data suggest that early EVG endothelialization occurs by transinterstitial EC ingrowth and that graft porosity contributes significantly to EVG healing.
25.5 Intraoperative Cine Fluoroscopy: an Adjunct for Improving Standard Vascular Operations ].G. YUAN, R.E. PARSONS, EJ. VEITH, M .L. MARZN, L.A. SANCHES, WD. SUGGS, R.T. LYON, T. OHKZ and R.A. WAIN, New York, New York, USA While intraoperative arteriography remains the “gold standard” for assessing technical adequacy following arterial reconstructions, the commonly used single-shot completion arteriogram has a limited scope and may be insensitive for technical imperfections. Moreover, it cannot be used for endoluminal, catheter-guidewire treatment of lesions that are Table A
Table B
To provide clarification and No. localization of unsuspected
Adjunctive fluoroscopically guided therapy
No.
Stenotic inflow lesion Stenotic outflow lesion Pressure gradient Retained clot Bypass target vessel
Angioplasty with stent Angioplasty without stent Thrombectomy*
14 2 3
5 6 4 6 1
*Using a double lumen balloon catheter passedover a guidewire with contrast filling of the balloon to control inflation and define intraluminal lesions.
CARDIOVASCULAR SURGERY
SEPTEMBER
1997