Vein interposition cuffs decrease the intimal hyperplastic response of polytetrafluoroethylene bypass grafts

Abstract

PTFE bypass grafts with VCs had less IH develop than did grafts with ES and PC anastomoses. IH regression in VCs at 4 weeks suggests compensatory vessel wall remodeling mediated by the presence of the VC. Furthermore, VCs caused a redistribution of hyperplasia to the vein-PTFE interface, delaying IH-induced outflow obstruction in the recipient artery. The marked increase in IH with PCs, despite a similar geometric configuration to VCs, suggests that the biologic properties of autogenous tissue dissipate IH development. Similarly, the flow patterns in PCs and VCs should be identical, which suggests a less important role of hemodynamic forces in VC-mediated protection.

Experimental comparison of four methods of end-to-side anastomosis with expanded polytetrafluoroethylene

“…Significantly less intimal hyperplasia was found in all transitions between the venous patch and the artery. These findings confirm previous clinical 26 and experimental 24 observations. In a histological and radiological study of failed and failing PTFE grafts with a venous cuff (Miller cuff and St Mary's boot) in humans, Tyrrell and Wolfe 26 described intimal hyperplasia at the junction between the ePTFE graft and the venous cuff, whereas the recipient artery was relatively spared.…”

“…In a histological and radiological study of failed and failing PTFE grafts with a venous cuff (Miller cuff and St Mary's boot) in humans, Tyrrell and Wolfe 26 described intimal hyperplasia at the junction between the ePTFE graft and the venous cuff, whereas the recipient artery was relatively spared. A similar distribution of intimal hyperplasia was described for venous Miller cuff anastomoses in an experiment by Kissin et al 24 . These observations support the concept of Baird and Abbott 27 that mismatch in the elastic properties of graft and artery plays a role in distal anastomotic intimal hyperplasia.…”

“…Suggs et al 23 found a reduction in intimal hyperplasia in the arterial outflow with venous cuff interposition between ePTFE and the carotid artery in dogs. Kissin et al 24 observed reduced anastomotic intimal hyperplasia in pigs with Miller cuffs created from vein. An increase in intimal hyperplasia in patched anastomoses was reported by Sottiurai et al 25 only for thin-walled PTFE grafts and Linton patches in a canine model.…”

Numerical Study of the Influence of Anastomotic Configuration on Hemodynamics in Miller Cuff Models

“…Such area is particularly prominent in the cuff model of LHR = 3.2, but greatly reduced in size in the cuff model of LHR = 2.2 and is the smallest in the cuff model of LHR = 1.4. The prevalence of IH along the graft-cuff interface reported in literature 13,31,34 suggests the possibly dominant role of flow separation and recirculation seen here. The fact that the extent of this area of flow separation and recirculation is dependent on the cuff LHR supports the suggestion that clinical outcome of cuffed anastomoses could be influenced by the cuff configuration.…”

“…2 Examination of failed and failing prosthetic bypasses with and without a vein cuff revealed that the extent of intimal hyperplasia (IH), the main cause of failure, is not reduced in cuffsupplemented anastomoses compared with direct anastomoses, but the greatest IH is shifted away from the cuff-artery interface to the more capacious upstream area around the graft-cuff interface, prolonging its patency before restenosis. 13,31,34 Various hypotheses have been proposed to interpret the mechanisms associated with the favorable redistribution of IH in the cuffed anastomoses. Some studies suggested that vein cuff reduces mismatch of elastic properties between the PTFE graft and host artery creating a natural ''buffer zone.''…”