Dacron vs Vein for Femoropopliteal Arterial Bypass

Thompson, R.J.; Burnard, Ralph J.; Weyman, Albert K.; Yashar, James J.; Hopkins, Robert W.

doi:10.1001/archsurg.1981.01380200045009

“…22 However, these are not currently viable in small-diameter (<6 mm) vascular applications, such as for coronary arteries and below-knee grafts, including those that pass through the knee. 21,23 Small diameter grafts experience low blood flow 14 and induce turbulent blood flow due to the mismatch in compliance between the inelastic synthetic graft and native vessel at the sites of anastomosis. 24 These poor mechanics are combined with a lack of endothelialization and the thrombogenic nature of the foreign surface, leading to thrombosis and luminal narrowing due to intimal hyperplasia that are reflected in their poor long-term patency.…”

Section: ■ Introductionmentioning

confidence: 99%

“…Currently, synthetic grafts composed of polymers such as polyethylene terephthalate (PET, Dacron) and expanded polytetrafluoroethylene (ePTFE, Gore-Tex) exhibit lower patency than autologous grafts but are still suitable and widely used for large diameter applications (>6 mm). − In patients presenting with peripheral artery disease, synthetic femoropopliteal above-knee grafts show similar patency rates compared to vein grafts over two to five-year periods, , due to the high flow rate and low resistance present in these large diameter vessels . However, these are not currently viable in small-diameter (<6 mm) vascular applications, such as for coronary arteries and below-knee grafts, including those that pass through the knee. , Small diameter grafts experience low blood flow and induce turbulent blood flow due to the mismatch in compliance between the inelastic synthetic graft and native vessel at the sites of anastomosis .…”

Section: Introductionmentioning

confidence: 99%

“…Currently, synthetic grafts composed of polymers such as polyethylene terephthalate (PET, Dacron) and expanded polytetrafluoroethylene (ePTFE, Gore-Tex) exhibit lower patency than autologous grafts but are still suitable and widely used for large diameter applications (>6 mm). − In patients presenting with peripheral artery disease, synthetic femoropopliteal above-knee grafts show similar patency rates compared to vein grafts over two to five-year periods, , due to the high flow rate and low resistance present in these large diameter vessels . However, these are not currently viable in small-diameter (<6 mm) vascular applications, such as for coronary arteries and below-knee grafts, including those that pass through the knee. , Small diameter grafts experience low blood flow and induce turbulent blood flow due to the mismatch in compliance between the inelastic synthetic graft and native vessel at the sites of anastomosis . These poor mechanics are combined with a lack of endothelialization and the thrombogenic nature of the foreign surface, leading to thrombosis and luminal narrowing due to intimal hyperplasia that are reflected in their poor long-term patency. , Reduced circulation in peripheral grafts presents additional challenges in maintaining hemocompatibility especially given the graft length required in these locations typically being over 20 cm.…”

Section: Introductionmentioning

confidence: 99%

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Biomaterials and Modifications in the Development of Small-Diameter Vascular Grafts

Hiob

¹

,

She

²

,

Muiznieks

³

et al. 2016

ACS Biomater. Sci. Eng.

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There remains a significant clinical need for an alternative to autologous vein grafts in small-diameter applications such as coronary bypass, but no clinically viable, synthetic small-diameter vascular grafts have been developed. While ePTFE and Dacron have long been used for large diameter grafts, it is likely that in small-diameter, low flow conditions, alternative materials and techniques are required, which have shown promising experimental results through enhancing compliance, biocompatibility, and endothelialization of vascular grafts. It is likely that the integration of synthetic materials that possess optimized mechanical properties combined with techniques for improved biocompatibility, such as the use of pure extracellular matrix proteins, will be the impetus for the creation of a new generation of clinically viable, smalldiameter vascular substitutes.

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“…About 80% of the small diameter grafts consist of either autologous saphenous vein grafts (SVGs) or synthetic expanded polytetrafluoroethylene grafts (ePTFE) [ 4 ]. However, these grafts encounter 10–15% early thrombosis within 1 month, and 50% occlusion at 1-year due to intimal hyperplasia for CABG-SVGs [ 4 – 8 ] and show similar longevity following PABG for both SVGs and PTFE grafts [ 9 – 11 ]. Hence, there is a critical clinical need for more effective small diameter arterial conduits.…”

Section: Introductionmentioning

confidence: 99%

A novel small diameter nanotextile arterial graft is associated with surgical feasibility and safety and increased transmural endothelial ingrowth in pig

Joseph

¹

,

Bruno

²

,

Sulaiman

³

et al. 2022

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Globally, millions of patients are affected by myocardial infarction or lower limb gangrene/amputation due to atherosclerosis. Available surgical treatment based on vein and synthetic grafts provides sub-optimal benefits. We engineered a highly flexible and mechanically robust nanotextile-based vascular graft (NanoGraft) by interweaving nanofibrous threads of poly-L-lactic acid to address the unmet need. The NanoGrafts were rendered impervious with selective fibrin deposition in the micropores by pre-clotting. The pre-clotted NanoGrafts (4 mm diameter) and ePTFE were implanted in a porcine carotid artery replacement model. The fibrin-laden porous milieu facilitated rapid endothelization by the transmural angiogenesis in the NanoGraft. In-vivo patency of NanoGrafts was 100% at 2- and 4-weeks, with no changes over time in lumen size, flow velocities, and minimal foreign-body inflammatory reaction. However, the patency of ePTFE at 2-week was 66% and showed marked infiltration, neointimal thickening, and poor host tissue integration. The study demonstrates the in-vivo feasibility and safety of a thin-layered vascular prosthesis, viz., NanoGraft, and its potential superiority over the commercial ePTFE. Graphical Abstract

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“…38 Several investigators have mentioned the need to save the saphenous vein for later coronary operations in patients undergoing peripheral outflow reconstruction. [39][40][41] Despite increased use of internal mammary artery (IMA) grafts, the GSV remains a common conduit for coronary artery grafting in most institutions; it is easy to use, and the difference in 5-year patency versus IMA grafts is not significant. [42][43][44] Hartz and associates 45 reported that the use of IMA conduits increased from 7% in 1968 to 65% in 1973, then gradually declined to 25% in 1979 and 1980, before a steep Figure 3ࡗ(A) A competent tributary vein is transected 1.5 cm distal to its insertion point on the GSV, then anastomosed (B) end to side by use of 8-0 nylon suture, under magnification.…”

Section: Discussionmentioning

confidence: 99%