Collagen-presealed or Uncoated Aortic Bifurcation Dacron Prostheses: A 5-Year Clinical Follow-up Study

Abstract

A total of 70 patients undergoing replacement of the aortic bifurcation between October 1983 and June 1985, were studied 5 years postoperatively for graft patency. In 35 cases a collagen-coated knitted Dacron prosthesis (group I) was implanted, while an identical, but uncoated, Dacron graft was used in a second group of 35 patients (group II). Distribution of vascular risk factors were similar in both patient groups. The underlying disease was aortoiliac occlusive disease in 24 patients of group I and in 33 of group II. Aortoiliac aneurysmal disease was present in 10 patients of group I and in 2 patients of group II. One patient of group I was suffering from Takayasu's disease of the descending type. At follow-up, all grafts were patent in group I, while in group II 8 distal limb occlusions occurred between 6 and 46 months postoperatively. This represents a 5-year limb patency rate of 100% for collagen-presealed grafts versus 88.6% for uncoated prostheses (p less than 0.01). A higher incidence of distal anastomotic aneurysms was found in group I (7/70 limbs) compared to group II (1/70 limbs) (p less than 0.05). It is concluded that long-term patency of knitted Dacron prostheses in aortic bifurcation replacement is not reduced by presealing with collagen. It appears that this type of coating may actually enhance long-term patency after reconstruction of the aortoiliac axis. The higher rate of distal anastomotic aneurysm formation in patients with presealed grafts, however, could not be correlated with a failure of the sealant material or with the underlying disease of the patients involved.

Incorporation of nitric oxide-releasing crosslinked polyethyleneimine microspheres into vascular grafts

“…Surface modifications involving albumin, 25,26 collagen, [26][27][28] polymers, [29][30][31][32] endothelial cells, 7,33,34 autologous tissue seeding, 35,36 and localized delivery of antithrombotic agents [37][38][39] have not resulted in increased long-term patency rates of such grafts in clinical applications. However, recent research involving the mechanism of thrombosis formation has suggested that NO may be crucial for the prevention of thrombosis.…”

Myocardial Performance Index and Tissue Doppler Systolic Wave Velocity Are Preload Dependent

“…The presence of hemostatic aortic graft material in this case was Hemashield (Boston Scientific), which, although hemostatic, has not been associated with acute intravascular thrombosis. 9,10 The mechanism of this fatal thoracic aortic thrombosis is unclear. Fatal thrombosis has been reported in adult DHCA; the antifibrinolytic, however, was not aprotinin but aminocaproic acid.…”

“…9 By contrast, in Jamaica, where transfusion practices are far more conservative, a study of 250 patients documented an infection rate of 2%. 10 Rather than preventing acute sickle problems, transfusion can actually precipitate acute pain 11 and pulmonary complications. 12 We do not suggest that our review is the last word on management or even that the model we outline explains all aspects of sickle cell disease.…”