In a previous study, which investigated the tensions at the proximal and distal end-to-end anastomoses of a vascular prosthesis, no significant differences were found in the longitudinal forces between the two anastomotic sites after different periods of implantation. The present follow-up study was devised to study the longitudinal forces at a proximal side-to-end and a distal end-to-side anastomosis using a warp knitted polyester prosthesis implanted as a canine thorocoabdominal bypass. The external surface of the prosthesis contained a specially printed "tension indicator" design, which enabled changes in length to be assessed photographically at the two anastomoses at the time of implantation and at sacrifice. The longitudinal force at each site was then calculated using a relationship obtained experimentally between the total longitudinal force and the changes in length of the virgin graft in vitro. The in vitro measurements on the prosthesis were performed using a computer-controlled laser calibration system. Although the results showed a tendency toward a gradual loss in longitudinal force at both anastomoses over 7 months in situ, statistical analysis showed no significant difference in the longitudinal force at the two anastomotic sites after any period of implantation. Histopathological and textile analysis also showed that the characteristics of the prostheses were similar at both anastomotic sites. This does not mean, however, that the intramural stress concentrations experienced by the two sites were the same. While comparing the level of the longitudinal forces measured in this study with those observed in the previous thoracic aorta study using end-to-end anastomoses, no significant differences were observed due to the different types of anastomoses. It would appear that the longitudinal force is not one of the main etiological factors that cause the formation and localization of anastomotic failure.
The longitudinal forces under which arterial prostheses are held in situ are of great importance. The tension caused by the longitudinal force may be one of the factors involved in the formation of anastomotic false aneurysms. In order to measure the changes in the longitudinal force at both proximal and distal end-to-end anastomoses over different periods of implantation, we devised an experimental study in which the changes in length of a warp-knitted polyester VP1200K (Vascutek Ltd., Inchinnan, Scotland) arterial prosthesis, used as a thoracic aorta substitute in the dog, were recorded photographically at implantation and removal. The longitudinal forces acting at the two sites were then calculated using a linear relationship between the longitudinal force and the changes in length of a virgin prosthesis, which was found experimentally in vitro using a computerized laser calibration system. One-tailed Student's t-test showed no significant difference between the length indicator values at the two anastomotic sites at different periods of implantation except during the 1-month period. Textile analysis of the explanted prostheses and histopathologic observations confirmed this similar behavior at the two anastomotic sites. These observations were contrary to the theoretic prediction regarding the effect of forces applied by drag and tissue ingrowth. Nevertheless, analysis of variance confirmed that there was no difference evident at the two sites between different implantation periods. These observations may explain why the formation of anastomotic false aneurysms is less common at end-to-end anastomoses.
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