Longitudinal Forces Acting at Side-to-End and End-to-Side Anastomoses when a Knitted Polyester Arterial Prosthesis is Implanted in the Dog

Abstract

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.

False Anastomotic Aneurysms

“…12,[23][24][25][26] These pathogenic mechanisms are more likely to happen on an end-toside than on an end-to-end anastomosis. [22][23][24][25][26][27] All of the FAAs in our study developed on an end-to-side anastomosis.…”

“…9 In his discussion of the Stoney and Albo study, 1 Baker suggested that anastomosis in the femoral region must be covered by a mobilized sartorius muscle to decrease stress. Mechanical stress caused by insufficient graft length 6 or configuration of end-to-side anastomosis 1,11,22 and the mechanical stress caused by an extensive mismatch, occurring if the prosthesis is too rigid, are also described. With every pulse wave, the anastomotic part of the artery is dilated at least 10% more than the prosthesis.…”

Massive hematuria due to an autogenous saphenous vein graft and urinary bladder fistula in an extra-anatomic iliofemoral bypass: a case report

“…There are several theories to explain the development of the pseudoaneurysm [9]. Infection [10–16], degeneration of the artery [10, 12, 17–27], aseptic necrosis at the anastomotic line [28, 29], extensive endarterectomy, [10, 12, 14, 30, 31], large anastomosis or patch [10, 14, 32], the way that the anastomosis was performed [14, 33, 34], the length of the graft [35], adhesion with surrounding structures [34], mismatch between vessels [36–38], and combinations of these situations have been widely discussed. It is not clear which of the aforementioned was responsible for the development of the pseudoaneurysm in our patient, although it is likely that the significantly larger autogenous vein graft may have caused mechanical stress on the proximal anastomosis and contributed to the formation of the pseudoaneurysm.…”

False Aneurysms

“…Given that this difference increases with the size of False Aneurysms 415 mismatch, the least resistant structures (suture material, artery, prosthesis) could be broken [57,[67][68][69][70]. These pathogenic mechanisms are more likely to happen on an end-to-side than on an end-to-end anastomosis [66][67][68][69][70][71]. At first sight, it is normal to expect that FAAs develop more often after the reconstructive procedures performed owing to aneurysmal and not occlusive diseases.…”

“…In his discussion of the Stoney and Albo study [47], Baker suggested that anastomosis in the femoral region must be covered by a mobilized sartorius muscle to decrease stress. Mechanical stress caused by insufficient graft length [50] or configuration of end-to-side anastomosis [47,56,66] and the mechanical stress caused by an extensive mismatch, occurring if the prosthesis is too rigid, are also described. With every pulse wave, the anastomotic part of the artery is dilated at least 10% more than the prosthesis.…”