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Vol. 40, No. 4, 2008
Issue release date: May 2008

Matching the Diameter of ePTFE Bypass Prosthesis with a Native Artery Improves Neoendothelialization

Cikirikcioglu M. · Pektok E. · Cikirikcioglu Y.B. · Osorio-da Cruz S. · Tille J.-C. · Kalangos A. · Walpoth B.H.
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Abstract

Background and Aim: The undersizing of the bypass graft diameter compared to native artery changes blood flow characteristics and velocity which may affect conduit neo-endothelialization, intimal hyperplasia reaction and patency. The aim of this study was to evaluate conduit neoendothelialization, intimal hyperplasia reaction and patency results between undersized and matched ePTFE grafts. Material and Methods: In 16 male Sprague-Dawley rats, undersized (1-mm internal diameter) and matched (2-mm internal diameter) ePTFE grafts were anastomosed end-to-end in the infrarenal abdominal aorta. Blood flow volume per minute was measured and wall shear stress was calculated for each group. After 3 weeks of follow-up, angiography was performed via the left carotid artery just before sacrifice. Conduit neoendothelialization and intimal hyperplasia reaction were measured by computer-assisted morphometry. Results: Wall shear stress was 8 times higher for the undersized group (840.56 vs. 105.07 mPa). Three weeks after implantation, conduit neoendothelialization was better in matched grafts compared to undersized grafts (441 vs. 574 µm, p = 0.008). Intimal hyperplasia reaction was similar for both groups (8.7 vs. 6.7 µm2/µm for undersized and matched grafts, respectively). Patency rate was 7/8 for undersized and 8/8 for matched ePTFE grafts. Conclusion: Although the graft patency and the intimal hyperplasia reaction were not different between the two groups after 3 weeks, matched grafts had a significantly better endothelialization compared to undersized grafts. This short-term beneficial effect may influence long-term patency results.



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References

  1. Cronenwett JL: Infrainguinal occlusive disease. Semin Vasc Surg 1995;8:284–288.
  2. Klinkert P, Post PN, Breslau PJ, van Bockel JH: Saphenous vein versus PTFE for above-knee femoropopliteal bypass. A review of the literature. Eur J Vasc Endovasc Surg 2004;27:357–362.
  3. Sarkar S, Salacinski HJ, Hamilton G, Seifalian AM: The mechanical properties of infrainguinal vascular bypass grafts: their role in influencing patency. Eur J Vasc Endovasc Surg 2006;31:627–636.
  4. Ballyk PD, Walsh C, Butany J, Ojha M: Compliance mismatch may promote graft-artery intimal hyperplasia by altering suture-line stresses. J Biomech 1998;31:229–237.
  5. Tiwari A, Cheng KS, Salacinski H, Hamilton G, Seifalian AM: Improving the patency of vascular bypass grafts: the role of suture materials and surgical techniques on reducing anastomotic compliance mismatch. Eur J Vasc Endovasc Surg 2003;25:287–295.
  6. Binns RL, Ku DN, Stewart MT, Ansley JP, Coyle KA: Optimal graft diameter: effect of wall shear stress on vascular healing. J Vasc Surg 1989;10:326–337.
  7. Walsh D: Technical adequacy and graft thrombosis; in Rutherford RB (ed): Vascular Surgery. Philadelphia, WB Saunders, 2000, pp 708–726.
  8. Kent KC, Liu B: Intimal hyperplasia-still here after all these years. Ann Vasc Surg 2004;18:135–137.
  9. Baumgartner N, Dobrin PB, Morasch M, Dong Q, Mrkvicka R: Influence of suture technique and suture material selection on the mechanics of end-to-end and end-to-side anastomoses. J Thorac Cardiovasc Surg 1996;111:1063–1072.
  10. Cikirikcioglu M, Bowlin G, Cikirikcioglu YB, Djebaili K, Tille JC, Kalangos A, Walpoth B: Biodegradable poly-diaxonone grafts for replacement of the abdominal aorta in the rat model. 40th Congr Eur Soc Surg Res, May 2005, Konya, Turkey.
  11. Cikirikcioglu M, Yang S, Tille JC, Kalangos A, Walpoth BH: In vivo stem cell seeding of synthetic vascular grafts. 32nd Eur Soc Artif Organs Congr, October 2005, Bologna, Italy.
  12. Celebi G: Basic principles in vascular surgery: rheology, viscosity, resistance and compliance; in Duran E (ed): Textbook of Cardiovascular Surgery. Istanbul, Capa Tip Kitabevi, 2004, pp 551–562.
  13. Windberger U, Bartholovitsch A, Plasenzotti R, Korak KJ, Heinze G: Whole blood viscosity, plasma viscosity and erythrocyte aggregation in nine mammalian species: reference values and comparison of data. Exp Physiol 2003;88:431–440.
  14. Greenwald SE, Berry CL: Improving vascular grafts: the importance of mechanical and haemodynamic properties. J Pathol 2000;190:292–299.
  15. Davies MG, Hagen PO: Pathobiology of intimal hyperplasia. Br J Surg 1994;81:1254–1269.
  16. Painter TA: Myointimal hyperplasia: pathogenesis and implications. 1. In vitro characteristics. Artif Organs 1991;15:42–55.
  17. Painter TA: Myointimal hyperplasia: pathogenesis and implications. 2. Animal injury models and mechanical factors. Artif Organs 1991;15:103–118.
  18. Dobrin PB, Mirande R, Kang S, Dong Q, Mrkvicka R: Mechanics of end-to-end artery-to-PTFE graft anastomoses. Ann Vasc Surg 1998;12:317–323.
  19. Barnes RW: Hemodynamics for the vascular surgeon. Arch Surg 1980;115:216–223.
  20. Weston MW, Rhee K, Tarbell JM: Compliance and diameter mismatch affect the wall shear rate distrubution near an end-to-end anastomosis. J Biomechanics 1996;29:187–198.
  21. Okadome K, Miyazaki T, Onohara T, Yamamura S, Sugimachi K: Hemodynamics and the development of anastomotic intimal hyperplasia of the polytetrafluoroethylene graft in the dog. Int Angiol 1991;10:238–243.
  22. Treiman GS, Lawrence PF, Bhirangi K, Gazak CE: Effect of outflow level and maximum graft diameter on the velocity parameters of reversed vein bypass grafts. J Vasc Surg 1999;30:16–25.


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