Abstract:Either Dacron or PTFE grafts can be used in femoropopliteal bypass grafting with no significant differences in midterm graft patency at 5 years (49.2% vs 38.4%) when the autologous saphenous vein is unavailable.
“…A contemporary meta-analysis of femoropopliteal bypass grafts found patency to be 60.2% at 3 years and 49.2% at 5 years. [7] Furthermore, aortofemoral bypass grafts have shown to have 9.4% yearly thrombosis rate and a 5 year patency of 59%. [8] Some of the various techniques for endograft recanalization are included as CDT, Fogarty thrombectomy, and laser recanalization.…”
Anomalous aortic origin of the left coronary artery (AAOLCA) is a rare occurrence. This anomaly may lead to myocardial ischemia and, therefore, surgical repair is recommended to improve long-term survival in these patients. We present a case of successful mobilization of an anomalous left main coronary artery, pulmonary artery translocation, and interposition graft to the right pulmonary artery with a late complication of the right pulmonary artery graft occlusion. This case illustrates the difficulty in the recanalization of pulmonary artery graft occlusion and stenosis, and highlights the utility of treatment via a staged approach.
“…A contemporary meta-analysis of femoropopliteal bypass grafts found patency to be 60.2% at 3 years and 49.2% at 5 years. [7] Furthermore, aortofemoral bypass grafts have shown to have 9.4% yearly thrombosis rate and a 5 year patency of 59%. [8] Some of the various techniques for endograft recanalization are included as CDT, Fogarty thrombectomy, and laser recanalization.…”
Anomalous aortic origin of the left coronary artery (AAOLCA) is a rare occurrence. This anomaly may lead to myocardial ischemia and, therefore, surgical repair is recommended to improve long-term survival in these patients. We present a case of successful mobilization of an anomalous left main coronary artery, pulmonary artery translocation, and interposition graft to the right pulmonary artery with a late complication of the right pulmonary artery graft occlusion. This case illustrates the difficulty in the recanalization of pulmonary artery graft occlusion and stenosis, and highlights the utility of treatment via a staged approach.
“…All grafts, especially small-caliber synthetic bypass below 6 mm, face the problems of thrombosis, immune rejection, and biodegradation [43]. Although there is no relevant difference according to patency rates between the materials used at present in cardiovascular patients, it has been shown in several in vivo trials that synthetic grafts are inferior to autologous substitutes [44]. Especially for long term applications the patency rates are much lower with nearly 70% (71% of PET and 74% of ePTFE) after one year and 58% (59% of PET and 56% of ePTFE) after three years compared to 90% and 81% for autologous prostheses, respectively [43,[45][46][47][48].…”
a b s t r a c tSphingosine-1-phosphate (S1P) has been known to promote endothelial cell (EC) proliferation and protect Syndecan-1 (SDC1) from shedding, thereby maintaining this antithrombotic signal. In the present study, we investigated the effect of S1P in the construction of a functional tissue-engineered blood vessel by using human endothelial cells and decellularized human umbilical vein (DHUV) scaffolds. Both human umbilical vein endothelial cells (HUVEC) and human cord blood derived endothelial progenitor cells (EPC) were seeded onto the scaffold with or without the S1P treatment. The efficacy of recellularization was determined by using the fluorescent marker CellTracker CMFDA and anti-CD31 immunostaining. The antithrombotic effect of S1P was examined by the anti-aggregation tests measuring platelet adherence and clotting time. Finally, we altered the expression of SDC1, a major glycocalyx protein on the endothelial cell surface, using MMP-7 digestion to explore its role using platelet adhesion tests in vitro. The result showed that S1P enhanced the attachment of HUVEC and EPC. Based on the anti-aggregation tests, S1P-treated HUVEC recellularized vessels when grafted showed reduced thrombus formation compared to controls. Our results also identified reduced SDC1 shedding from HUVEC responsible for inhibition of platelet adherence. However, no significant antithrombogenic effect of S1P was observed on EPC. In conclusion, S1P is an effective agent capable of decreasing thrombotic risk in engineered blood vessel grafts.
Statement of SignificanceSphingosine-1phosphate (S1P) is a low molecular-weight phospholipid mediator that regulates diverse biological activities of endothelial cell, including survival, proliferation, cell barrier integrity, and also influences the development of the vascular system. Based on these characters, we the first time to use it as an additive during the process of a small caliber blood vessel construction by decellularized human umbilical vein and endothelial cell/endothelial progenitor. We further explored the function and Contents lists available at ScienceDirect Acta Biomaterialia j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l oc a t e / a c t a b i o m a t mechanism of S1P in promoting revascularization and protection against thrombosis in this tissue engineered vascular grafts. The results showed that S1P could not only accelerate the generation but also reduce thrombus formation of small caliber blood vessel.
“…Previous studies have reported patency rates for above-knee grafts as low as 62% at 3 years and 46% at 5 years [1][2][3] . Abnormal junction haemodynamics, wall shear stress (WSS), suture line injury and material mismatch are the most frequently mentioned factors responsible for graft failure.…”
Objective. Abnormal haemodynamics is commonly agreed to be a major contributor to the development of distal anastomotic intimal hyperplasia. A new vascular graft design proposed by computational studies was used to demonstrate its surgical feasibility and to compare it with the conventional graft in a porcine model. Method. The device was used in 12 eight-month-old pigs, six received the new graft and six had a conventional graft. The proximal graft end was implanted into the aorta, the distal graft end was implanted into the iliac artery. The host artery was ligated in order to simulate occlusion. At 20 weeks after surgery the pigs were killed and the device was excised for histological and morphometric analysis. Results. In five experimental grafts the reconstruction was occluded due to thrombosis; only one prosthesis was patent showing a minimum of neointimal hyperplasia. In the control group too only three of the six grafts were patent. A histological analysis revealed, as the cause of occlusion, fibrous tissue overgrowth corresponding in structure to neointimal hyperplasia. Differences in the number of obliterations and in occlusion rates between the profiles of the two groups were evaluated using the median test (P<0.05). The results were not statistically significant. Conclusion. Although mathematical modelling had shown significant haemodynamic benefits of a naturally bifurcated graft, our study did not confirm its superiority over conventionally used prostheses.
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