Mesh Tube—Constricted Varicose Veins Used as Bypass Grafts for Infrainguinal Arterial Reconstruction

Abstract

Varicose veins are generally deemed inappropriate graft material for arterial reconstructions despite their physiologic flow surface because of their large and irregular caliber. Size reduction by threading such veins in constricting tubes may create bypass grafts of suitable caliber as long as redundant wall material does not cause stenoses. Sixteen human varicose veins (mean +/- SD, 13 +/- 3 mm diameter) obtained after stripping operations were inserted into Dacron mesh tubes of 6 mm internal diameter. Paraffin casts of the distended veins showed a size reduction of 6.9 +/- 2.6 mm. Wall material formed folds in only two veins. In both cases, diameter reduction was more than 10 mm. However, the folds did not result in significant stenoses. Mesh-constricted varicose veins were used as bypass material in 11 infrainguinal arterial reconstructions. All externally supported segments showed satisfactory size reduction without stenoses or folds. One graft occluded 2 months after surgery. Two patients had to undergo reoperation after 2 and 16 months, respectively. None of the complications could be attributed to the constriction of veins. The remaining grafts are patent and functional after a mean of 17 months (range, 6 to 42 months). Considerable size reduction by external wrapping of varicose veins is possible without adverse side effects. Such constricted veins were used successfully as bypass grafts for infrainguinal arterial reconstructions.

Prosthetic Reinforcement of Varicose Saphenous Vein Grafts for Infrainguinal Bypass

“…Berkowitz and O'Neill 6 described good results using reinforced vein grafts for renovascular reconstruction in children. Moritz et al 7 reported successful infrainguinal arterial reconstruction after external reinforcement of both cephalic veins and varicose veins obtained by stripping. Follow-up in our patients confirmed excellent long-term outcome using reinforced varicose saphenous vein grafts for femoropopliteal bypass.…”

“…This improvement has been attributed to a decrease in shear stress on the vascular wall. 7,9 Prosthetic reinforcement may be applied to all or part of the vein graft depending on the extent of varicose dilatation. Anastomosis should not be covered to avoid a compliance mismatch between the vein graft and artery.…”

“…11 In this study, PTFE prostheses were always used, but any type of prosthetic material would probably be compatible. Some groups recommend mesh grafts 7,8 to avoid ischemia of the vein wall by enhancing contact between vein graft and wellvascularized surrounding tissue. Another advantage of using mesh tubes is to avoid entrapment of perivenous effusion which can lead to graft stenosis.…”

Femoro-Distal Bypass with Varicose Veins Covered by Prosthetic Mesh

“…An external support has been proposed to increase the use of large diameter veins that are otherwise considered unacceptable for arterial replacement. Clinical studies have shown acceptable results utilizing varicose vein grafts with prosthetic reinforcement [15].…”

Autologous repair of an internal carotid artery aneurysm by resection, caliber reduction, and external mesh tube reinforcement in a 9-year-old boy

“…External synthetic stents or sheaths have been used to taper vein grafts clinically or to reduce intimal hyperplasia caused by the arterialization process. 17 Jeremy et al 18 showed that external synthetic stents inhibit neointima formation and promote angiogenesis in vein grafts. They also prevent thickening of vein grafts and by this possibly prevent late failure.…”