Journal articles on the topic 'Arterial grafts'
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SAITOH, S., and Y. NAKATSUCHI. "Arterial Grafting with the Telescoping Anastomotic Technique for Arterial Defects." Journal of Hand Surgery 19, no. 4 (August 1994): 461–65. http://dx.doi.org/10.1016/0266-7681(94)90211-9.
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An arterial graft was taken from the left femoral artery of the rat and grafted into the right femoral artery using the telescoping anastomotic technique at both the proximal and distal anastomoses to compare the patency rate with that of the vein grafts interposed into the arterial defect with the same telescoping technique. The time required for each anastomosis was about 10 minutes and all of the 31 grafts remained patent without application of xylocaine, yielding a higher patency rate than the vein grafts interposed in an arterial defect. The telescoping technique proved to be so dependable that it could be used at least twice in an artery. Inserting one vessel stump into another using the telescoping technique may not itself be responsible for the failure of vein grafts interposed in an arterial defect, but distortion of the slack venous wall of the graft by high arterial blood pressure is.
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Toia, Francesca, Giovanni Zabbia, Tiziana Roggio, Roberto Pirrello, Adriana Cordova, and Salvatore D'Arpa. "Vascular Grafts and Flow-through Flaps for Microsurgical Lower Extremity Reconstruction." Journal of Reconstructive Microsurgery 33, S 01 (October 2017): S14—S19. http://dx.doi.org/10.1055/s-0037-1606560.
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Background The use of vascular grafts is indicated in case of insufficient pedicle length or for complex defects involving both soft tissues and vessels. Venous grafts (for both venous and arterial reconstructions) and arterial grafts (arterial reconstruction) can be used. This study retrospectively evaluated the needs for vascular reconstruction and its results in a clinical series of lower limb reconstructions with microsurgical free flaps. Materials and Methods From 2010 to 2015, a total of 16 vascular grafts or flow-through flaps were used in 12 patients out of a total of 150 patients undergoing microsurgical reconstruction (8%). Arterial reconstruction was performed in seven cases (six flow-through flaps, one arterial graft), combined arterial and venous reconstruction in four cases (three vein grafts, one combined venous/arterial graft), and venous reconstruction in one case (one venous graft). The rate of complications and donor-site morbidity related to vascular graft harvest were evaluated. Results Reconstruction was successful in all cases, despite an overall complication rate of 17 and 8% of surgical revision. Donor-site morbidity, subjectively evaluated, was minimal with respect to functional deficits and aesthetic outcome. Indications for the different types of grafts are discussed. Conclusion The use of vascular grafts is needed in a relevant percentage of microsurgical reconstruction cases. Venous and arterial vascular grafts, transient arteriovenous fistulas, and “flow-through” microsurgical flaps showed a safe reconstruction comparable to microsurgical reconstructions without the use of grafts. Donor-site morbidity secondary to vascular graft harvest is minimal, and in almost 70% of cases no additional scars are needed.
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Haverich, A., and H. G. Borst. "Arterial grafts." Current Opinion in Cardiology 5, no. 6 (December 1990): 737–41. http://dx.doi.org/10.1097/00001573-199012000-00003.
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Amin, Sanaz, Per Lav Madsen, Raphael S. Werner, George Krasopoulos, and David P. Taggart. "Intraoperative flow profiles of arterial and venous bypass grafts to the left coronary territory." European Journal of Cardio-Thoracic Surgery 56, no. 1 (January 31, 2019): 64–71. http://dx.doi.org/10.1093/ejcts/ezy473.
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Abstract OBJECTIVES The different mechanical and vasodilatory properties of arteries and veins may influence their flow profiles when used for coronary artery bypass grafting (CABG). This may be of significance when assessing the cut-off values for adequate flow. However, conduit-related flow differences are less examined. METHODS In a study of 268 patients, transit time flowmetry parameters of 336 arterial and 170 venous conduits all grafted to the left coronary territory were compared. With transit time flowmetry, the mean graft flow (MGF), pulsatility index, percentage of diastolic filling and percentage of backwards flow were measured. Conduit-related differences were further compared according to on- or off-pump CABG (ONCABG versus OPCABG) surgery. RESULTS Overall MGF and pulsatility index were comparable between arterial and venous grafts, but in arterial grafts, MGF was higher during ONCABG than during OPCABG (49.1 ± 35.3 ml/min vs 38.8 ± 26.6 ml/min; P = 0.003). Percentage of diastolic filling was higher in arterial grafts than in venous grafts (overall 71.0 ± 7.9% vs 63.7 ± 11.1%; ONCABG 69.9 ± 7.1% vs 63.9 ± 10.4%; OPCABG 71.9 ± 8.3% vs 63.4 ± 12.2%; all P < 0.001). Furthermore, percentage of backwards flow was higher in arterial grafts than in venous grafts in the overall (2.3 ± 3.2% vs 1.7 ± 3.2%, P = 0.002) and in the ONCABG (2.3 ± 3.2% vs 1.3 ± 2.5%, P < 0.001) cohorts. In venous grafts, percentage of backwards flow was lower during ONCABG versus OPCABG (1.3 ± 2.5% vs 2.6 ± 3.9%, P = 0.016). CONCLUSIONS No statistically significant difference was observed for MGF and pulsatility index between arterial and venous conduits. However, arterial grafts have significantly higher diastolic filling and backwards flow than venous grafts. Furthermore, arterial grafts have a significantly higher MGF in ONCABG versus OPCABG.
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Csébi, Péter, Csaba Jakab, Attila Patonai, Attila Arany-Tóth, László Kóbori, and Tibor Németh. "Morphological evaluation of experimental autologous rectus fascia sheath vascular grafts used for arterial replacement in a dog model." Acta Veterinaria Hungarica 62, no. 4 (December 1, 2014): 429–38. http://dx.doi.org/10.1556/avet.2014.025.
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Although experimental autologous patch or tubular conduit vascular grafts made from the internal rectus fascia sheath (IRFS) have been reported in the literature, thorough morphological evaluation and verification of the histological arterialisation of such grafts are lacking. Four purpose-bred Beagle dogs were utilised to create eight arterial internal rectus fascia sheath (ARFS) grafts implanted between bisected ends of the external iliac arteries. Four out of the eight ARFS grafts were patent after three months. Haematoxylin-eosin and Azan staining verified that the grafts gained a vessel-like layered structure with the presence of large amounts of collagen fibres. Although the inner surface of the intact IRFS was originally covered with claudin-5-negative and pancytokeratin-positive mesothelial cells in control samples, the internal cells of the ARFS grafts became claudin-5 positive and pancytokeratin negative like in intact arteries. Spindle-shaped cells of the wall of ARFS grafts were α-smooth muscle actin (α-SMA) positive just like the smooth muscle cells of intact arteries, but α-SMA immunoreactivity was negative in the intact IRFS. According to these findings, the fibroblast cells of the ARFS graft have changed into myofibroblast cells. The study has proved that ARFS grafts may be used as an alternative in arterial replacement, since the graft becomes morphologically and functionally similar to the host vessel via arterialisation.
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Watanabe, Go, Tamotsu Yasuda, and Shigeyuki Tomita. "A Multipurpose Arterial Graft Holder for Coronary Artery Bypass Grafting." Heart Surgery Forum 8, no. 2 (March 9, 2005): 98. http://dx.doi.org/10.1532/hsf98.2005-1001.
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A multipurpose arterial graft holder designed for use during coronary artery bypass grafting is described. This new holder is atraumatic and holds the arterial grafts and saphenous vein graft securely during anastomosis. The use of this instrument facilitates the use of multiple arterial grafts for coronary artery bypass grafting.
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Rashid, Harun Or, AKM Anwarul Islam, AKM Khursidul Alam, Md Sajid Hasan, and Md Habibur Rahman Dulal. "Comparative Study of Short-Term Outcome of Live Related Renal Transplantation From Grafts Having Single vs Multiple Arteries." Bangladesh Journal of Urology 17, no. 1 (September 14, 2020): 9–16. http://dx.doi.org/10.3329/bju.v17i1.49108.
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Objective: To compare the outcome of live related renal transplantation between the Grafts having single vs multiple arteries.
Materials and Methods: The data of 94 renal transplants with single and multiple arteries performed between January 2011 and December 2012 were collected from Bangabandhu Sheikh Mujib Medical University and National Kidney Foundation. Sixty three renal transplants with single renal artery were compared to 31 transplants with multiple arteries. The aspects analyzed were number of arteries of the graft, donor type, ischemia time, time spent for arterial anastomosis, time spent for total vascular anastomosis and time for whole operation, vascular reconstruction technique, the occurrence of surgical complications, the incidence of delayed graft function, graft function 6 month after transplantation, graft loss and mortality.
Results: The incidence of surgical complications in grafts with single artery and multiple renal artery was respectively: vascular 6.4% and 3.2%; urological 13.2% and 9.6%, other surgical complications was 3,2% and 3.2%, and the difference were not significant among the two groups. Symptomatic lymphocele was 3.2% observed in single artery group but the incidence of lymphoceles was 6.4% in grafts with multiple arteries (p < 0.005). The incidence of delayed graft function in grafts with a single artery and multiple arteries was respectively 6.4% and 6.4% (p =<0.005). Mean serum creatinine at the end of 6th months of postoperative period was 1.33mg/dl and 1.67 mg/dl in grafts with single and multiple arteries respectively (p<0.005). Cold ischemia time, preparation time duration of in vivo arterial anastomosis and the total length of operation time was significantly longer in the multiple artery group(p<0.005). Six months grafts survival in single and multiple artery was 88.9% and 87.1% respectively.
Conclusions: Kidney transplantation using grafts having single and multiple arteries present similar indeces of surgical complications and short-term outcome. Though, lymphoceles was more frequent among grafts with multiple arteries but the difference were not significant among the two groups. In other words. Live related renal transplantation from grafts having multiple arteries is safe and has a good outcome.
Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.9-16
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Patel, Dinesh L., Yashpal R. Rana, Megha M. Sheth, Samir G. Patel, and Milin N. Garachh. "MSCT coronary angiography in non-invasive assessment of coronary artery bypass grafts patency." International Journal of Research in Medical Sciences 7, no. 5 (April 26, 2019): 1413. http://dx.doi.org/10.18203/2320-6012.ijrms20191626.
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Background: Coronary artery disease (CAD) is one of the leading cause of the morbidity and mortality in India and worldwide and last decade has seen a steep rise in incidence of CAD in India and its treatment as bypass surgery. Direct visualization of the grafts and native coronary arteries by invasive catheterization is now being replaced by non-invasive CT coronary angiography with higher slice machines and newer technology as it has good temporal resolution, high scanning speed as well as low radiation dose. We share our experience of graft imaging on 128 slice CT machine.Methods: This is a retrospective, single-center, observational study. We included 500 symptomatic patients who have undergone CT study between the year 2014 to 2018 post bypass surgery.Results: Arterial grafts have a better patency rate than venous grafts. (88% vs. 64.1%). Amongst the individual arterial grafts RIMA had the best patency rate (100%) followed by LIMA (90.8%), RA (68.7%). LAD was the most commonly involved artery (91%).Conclusions: Significant absolute concordance between CT and catheter angiographic findings have been documented for all arterial and venous grafts patency in the literature. The MSCT with retrospective gating permits an accurate and non-invasive evaluation of patent and diseased arterial and vein grafts and could replace conventional angiography for the follow-up of symptomatic, stable patients. Moreover, an optimal diagnostic accuracy was also documented in the appraisal of native vessels distal to the graft anastomoses.
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Tribble, Curtis G. "The Skeleton in the Closet: Harvesting a Skeletonized IMA." Heart Surgery Forum 20, no. 4 (August 28, 2017): 178. http://dx.doi.org/10.1532/hsf.1867.
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There is a considerable amount of data that using more than one arterial graft provides a survival advantage for patients undergoing coronary bypass operations. The Society of Thoracic Surgeons has a set of official guidelines for the use of arterial grafts which include the following recommendations:Internal mammary arteries (IMA’s) should be used to bypass the left anterior descending (LAD) artery when bypass of the LAD is indicated.As an adjunct to left internal mammary artery (LIMA), a second arterial graft (right IMA or radial artery [RA]) should be considered in appropriate patients.Use of bilateral IMA’s (BIMA’s) should be considered in patients who do not have an excessive risk of sternal complications.To reduce the risk of sternal infection with bilateral IMA’s, skeletonized grafts should be considered, smoking cessation is recommended, glycemic control should be considered, and enhanced sternal stabilization may be considered.Use of arterial grafts should be a part of the discussion of the heart team in determining the optimal approach for each patient. [Ann Thorac Surg 2016; 101: 801–9]
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Kawashima, Masatou, Albert L. Rhoton, Necmettin Tanriover, Arthur J. Ulm, Alexandre Yasuda, and Kiyotaka Fujii. "Microsurgical anatomy of cerebral revascularization. Part I: Anterior circulation." Journal of Neurosurgery 102, no. 1 (January 2005): 116–31. http://dx.doi.org/10.3171/jns.2005.102.1.0116.
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Object. Revascularization is an important component of treatment for complex aneurysms that require parent vessel occlusion, skull base tumors that involve major vessels, and certain ischemic diseases. In this study, the authors examined the microsurgical anatomy of cerebral revascularization in the anterior circulation by demonstrating various procedures for bypass surgery. Methods. Twenty-five adult cadaveric specimens were studied, using 3 to 40 magnification, after the arteries and veins had been perfused with colored silicone. The microsurgical anatomy of cerebral revascularization in the anterior circulation was examined with the focus on the donor, recipient, and graft vessels. The techniques discussed in this paper include the superficial temporal artery (STA)—middle cerebral artery (MCA), middle meningeal artery (MMA)—MCA, and side-to-side anastomoses; short arterial and venous interposition grafting; and external carotid artery/internal carotid artery (ICA)—M2 and ICA—ICA bypasses. Bypass procedures for cerebral revascularization are divided into two categories depending on their flow volume: low-flow and high-flow bypasses. A low-flow bypass, such as the STA—MCA anastomosis, is used to cover a relatively small area, whereas a high-flow bypass, such as the ICA—ICA anastomosis, is used for larger areas. Cerebral revascularization techniques are also divided into two types depending on the graft materials: pedicled arterial grafts, such as STA and occipital artery grafts, and free venous or arterial grafts, which are usually saphenous vein and radial artery grafts. Pedicled arterial grafts are mainly used for low-flow bypasses, whereas venous or arterial grafts are used for high-flow bypasses. Conclusions. It is important to understand the methods of bypass procedures and to consider indications in which cerebral revascularization is needed.
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Hofstra, L., D. C. Bergmans, A. P. Hoeks, P. J. Kitslaar, K. M. Leunissen, and J. H. Tordoir. "Mismatch in elastic properties around anastomoses of interposition grafts for hemodialysis access." Journal of the American Society of Nephrology 5, no. 5 (November 1994): 1243–50. http://dx.doi.org/10.1681/asn.v551243.
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Arteriovenous (AV) fistulas for hemodialysis access, constructed with the use of interposition grafts, are often complicated by intimal hyperplastic stenosis, mainly occurring at the venous anastomosis. In this study, mismatch in elastic properties around the arterial and venous anastomoses of graft AV fistulas in humans was quantified in order to find clues for the predisposition of intimal hyperplasia to develop at the venous anastomosis. The elastic properties of graft AV fistulas in 31 hemodialysis patients were investigated by the use of vessel wall Doppler tracking, 2 wk after construction. Nine saphenous vein grafts, 8 expanded polytetrafluoroethylene (ePTFE) grafts, and 14 stretch-PTFE (sPTFE) grafts were measured at the arterial inflow segment, the proximal graft segment, the distal graft segment, and the venous outflow segment. Area increase (AI), representing the capacity of the vessel wall to store blood volume, and relative distension, representing the intrinsic elastic properties, were calculated from diameter and distension. A decrease in AI was observed in the arterial anastomoses of all graft types. An increase in AI was found in the venous anastomosis of ePTFE and sPTFE grafts. Higher values for AI and relative distension were found at the proximal and distal graft segments of the saphenous vein grafts when compared with the prosthetic grafts. In the sPTFE grafts, the level of AI was maintained along the graft, whereas in the ePTFE grafts, a decrease in AI was found. In the arterial anastomoses of AV fistulas, a decline in the capacity to store blood volume was observed. By contrast, an increase in the capacity to store blood volume was found in the venous anastomoses.(ABSTRACT TRUNCATED AT 250 WORDS)
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Gaudino, Mario, Faisal G. Bakaeen, Umberto Benedetto, Antonino Di Franco, Stephen Fremes, David Glineur, Leonard N. Girardi, et al. "Arterial Grafts for Coronary Bypass." Circulation 140, no. 15 (October 8, 2019): 1273–84. http://dx.doi.org/10.1161/circulationaha.119.041096.
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Observational and randomized evidence shows that arterial grafts have better patency rates than saphenous vein grafts (SVGs) in coronary artery bypass grafting. Observational studies suggest that the use of multiple arterial grafts is associated with longer postoperative survival, but this must be interpreted in the context of treatment allocation bias and hidden confounders intrinsic to the study designs. Recently, a pooled analysis of 6 randomized trials comparing the radial artery with the SVG as the second conduit and the largest randomized trial comparing the use of single and bilateral internal thoracic arteries have provided apparently divergent results about a clinical benefit with the use of >1 arterial conduit. However, both analyses have methodological limitations that may have influenced their results. At present, it is unclear whether the well-documented increased patency rate of arterial grafts translates into clinical benefits in the majority of patients undergoing coronary artery bypass grafting. A large randomized trial testing the arterial grafts hypothesis (ROMA [Randomized Comparison of the Clinical Outcome of Single Versus Multiple Arterial Grafts]) is underway and will report the results in a few years.
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Mills, Noel L., Charles T. Everson, and David R. Hockmuth. "Free arterial grafts." Current Opinion in Cardiology 6, no. 6 (December 1991): 898–903. http://dx.doi.org/10.1097/00001573-199112000-00007.
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Wayangankar, Siddharth, Jigar Patel, and Thomas A. Hennebry. "Isolated pharmaco-mechanical thrombectomy (IPMT) for the endovascular treatment of acute axillofemoral graft occlusion." Vascular Medicine 18, no. 1 (February 2013): 27–31. http://dx.doi.org/10.1177/1358863x13477233.
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Since the long-term patency of axillofemoral (AXF) grafts is inferior to aorto-bifemoral (ABF) grafts, limb salvage procedures are crucial in this group of patients. Emerging endovascular devices have helped in the successful restoration of flow for acute limb ischemia in both native arteries as well as bypass grafts. One such device, the Trellis™ thrombectomy system is being used more frequently in this setting. The device has previously been used in veins, native arteries, and rarely in aortofemoral grafts. We present its first successful use for the treatment of occluded AXF bypass graft. The use of this device helped to isolate the treatment zone in the occluded graft, which allowed the use of a lower dose of thrombolytics, less systemic release of thrombolytics, and less distal embolization. Resolution of extensive clot burden was achieved and, with subsequent stenting of the graft at the distal anastomotic site, arterial flow to the leg through the AXF graft was restored and a revision surgery was avoided.
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Calafiore, Antonio Maria, Gabriele Di Giammarco, Giovanni Teodori, Shree Prakash Mall, Giuseppe Vitolla, and Carlo Fino. "Myocardial Revascularization with Multiple Arterial Grafts." Asian Cardiovascular and Thoracic Annals 3, no. 3-4 (September 1995): 95–102. http://dx.doi.org/10.1177/021849239500300402.
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From October 1991 10 July 1994, 439 patients underwent elective or urgent coronary artery bypass grafting utilizing 2 or more arterial conduits. Age ranged from 28 to 79 years (mean, 62.3 years). Most of the patients had 3-vessel disease (301); the remaining had 2-vessel (120) or 1-vessel (18) disease. A stenosis of the left main trunk greater than or equal to 50% was present in 73 patients; in 16 cases it was a redo operation. The left ventricular ejection fraction ranged from 0.19 to 0.84 (mean, 0.53). We utilized 1110 arterial conduits (430 left internal mammary arteries, 259 right internal mammary arteries, 136 right gastroepiploic arteries, 120 inferior epigastric arteries, 165 radial arteries) together with 113 saphenous veins (2.63 arterial anastomoses per patient, ranging from 2 to 6). In 347 patients (79%) we performed a complete arterial myocardial revascularization with an average of 2.80 anastomoses per patient. Two arterial conduits were used in 245 patients, 3 in 163, 4 in 30, and 5 in 1 patient. The myocardial protection was achieved by means of intermittent antegrade warm blood cardioplegia. The mean cross-clamping time was 47.3 ± 16 minutes (range, 16 to 142 minutes). Five patients (1.1%) died in the postoperative period, none were in the operating theater. The causes of death were cardiac (2), sepsis (1), pneumonia (1) and pancreatic necrosis (1). In 7 patients (1.6%) a perioperative myocardial necrosis occurred without any hemodynamic sequelae. Out of 430 patients alive, 419 (97.4%) are asymptomatic. At the postoperative angiographic control all the arterial grafts explored showed complete patency; the midterm angiography (mean, 14 months) revealed a cumulative patency of 96% (range, 100% for the left internal thoracic artery to 94.1% for the radial artery). We conclude that on the basis of the early results the technique herein described is effective and reproducible, even if long-term follow-up is needed to confirm these data.
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REDWOOD, ALEC JAMES, STEPHEN MOORE, LIDA SAYADELMI, and MARC TENNANT. "Autogenous artery grafts in hypertensive (SHR) rats do not have increased smooth muscle cell hyperplasia in the graft neointima, compared with grafts in normotensive rats." Journal of Anatomy 195, no. 3 (October 1999): 407–12. http://dx.doi.org/10.1017/s002187829900535x.
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Vein-to-artery graft surgery is used widely to by-pass arterial stenoses, but such grafts can fail over a prolonged period as a result of excessive neointimal hyperplasia causing thrombosis and graft occlusion. It has been suggested that neointimal hyperplasia, in vein grafts, is a result of the vessel wall adapting to the higher intraluminal pressure of the arterial circulation, compared with the venous circulation. Autologous artery grafts have been used to bypass arterial stenoses. Initially it was assumed that donor artery segments would not develop neointimal hyperplasia as they are already adapted to the arterial circulation but this is not so. In this study we postulated that surgical or postsurgical trauma was the cause of neointimal hyperplasia in autologous artery-to-artery grafts. In addition, as artery grafts are pre-adapted to the arterial circulation, autologous artery-to-artery grafts in hypertensive rats should develop similar levels of neointimal hyperplasia as seen in normotensive rats. Artery-to-artery grafts were placed in a series of 20 spontaneously hypertensive rats (SHR). In a separate series of sham grafting experiments the effects of anoxia and clamp trauma were assessed in SHR and WKy normotensive control rats. Finally, clamping, anoxia and anastomosis trauma were assessed in a similar series of rats. In the artery-to-artery graft series there was no difference in neointimal thickness between the SHR and that previously reported for normotensive rats. Minimal neointimal hyperplasia was demonstrated in the sham grafted series of rats and only slightly more in the single anastomosis series. It was only in the full grafting procedure that considerable neointimal hyperplasia developed. These data demonstrate that neointimal hyperplasia in artery-to-artery grafts is not exacerbated by the hypertension. In addition, trauma appears to be the initiator of neointimal hyperplasia and the extent of trauma correlates with the degree of neointimal hyperplasia.
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Diaz-Abele, Julian, Emily Saganski, and Avinash Islur. "Use of Arterial Grafts in Hypothenar Hammer Syndrome: Application of Perforator Flap Anatomy." Plastic Surgery 28, no. 4 (June 17, 2020): 204–9. http://dx.doi.org/10.1177/2292550320933684.
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Background: Hypothenar hammer syndrome (HHS) is traditionally treated with venous bypass grafting, but controversy has arisen as arterial grafts have become more available. Methods: A retrospective review of all patients undergoing ulnar artery bypass grafting for HHS with an arterial graft from 2008 to 2017 was performed. We also review the literature for patency rates and discuss the scenarios that favor different graft choices. Results: Six patients were included in our series. Five had primary surgery and 1 had revision surgery for HHS. Five arterial grafts were from the deep inferior epigastric artery and 1 was from the lateral circumflex femoral artery. The proximal anastomotic site was the ulnar artery for all: n = 6. The distal anastomosis site was the palmar arch and common digital artery (CDA) of the ring/small finger and CDA of the middle/ring finger: n = 3; the palmar arch and the CDA of the ring/small finger: n = 3. All patients were symptom-free at follow-up and had a patent ulnar artery on Allen’s testing or angiogram. Conclusion: Patency rates of arterial grafts for HHS appear to be excellent and this small series and may offer an alternative to traditional venous grafts and end-to-end arterial anastomoses. We suggest using arterial perforator grafts from free flap donor sites. These have well-described anatomy, are easily harvested, and carry minimal donor site morbidity. Lateral circumflex femoral artery graft is favored in patients requiring a single distal anastomosis, who have a ventral hernia, or who are obese. Deep inferior epigastric artery graft is preferred when multiple distal targets or versatile configurations are needed, in thin patients, or in female patients.
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Veres, Gábor, Kálmán Benke, Roland Stengl, Yang Bai, Klára Aliz Stark, Alex Ali Sayour, Tamás Radovits, et al. "Aspirin Reduces Ischemia-Reperfusion Injury Induced Endothelial Cell Damage of Arterial Grafts in a Rodent Model." Antioxidants 11, no. 2 (January 18, 2022): 177. http://dx.doi.org/10.3390/antiox11020177.
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Long-term graft patency determines the prognosis of revascularization after coronary artery bypass grafting (CABG). Ischemia-reperfusion (I/R) injury of the graft suffered during harvesting and after implantation might influence graft patency. Aspirin, a nonsteroidal anti-inflammatory drug improves the long-term patency of vein grafts. Whether aspirin has the same effect on arterial grafts is questionable. We aimed to characterize the beneficial effects of aspirin on arterial bypass grafts in a rodent revascularization model. We gave Lewis rats oral pretreatment of either aspirin (n = 8) or saline (n = 8) for 5 days, then aortic arches were explanted and stored in cold preservation solution. The third group (n = 8) was a non-ischemia-reperfusion control. Afterwards the aortic arches were implanted into the abdominal aorta of recipient rats followed by 2 h of reperfusion. Endothelium-dependent vasorelaxation was examined with organ bath experiments. Immunohistochemical staining were carried out. Endothelium-dependent maximal vasorelaxation improved, nitro-oxidative stress and cell apoptosis decreased, and significant endothelial protection was shown in the aspirin preconditioned group, compared to the transplanted control group. Significantly improved endothelial function and reduced I/R injury induced structural damage were observed in free arterial grafts after oral administration of aspirin. Aspirin preconditioning before elective CABG might be beneficial on free arterial graft patency.
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Pfeiffer, Thomas, Kever, Grabitz, Reiher, Müller, Hildebrand, and Sandmann. "Das Einheilungsverhalten schmalkalibriger Gefäßprothesen aus Polyester mit plasminbehandelter Fibrinbeschichtung – eine experimentelle Untersuchung." Vasa 29, no. 2 (May 1, 2000): 117–24. http://dx.doi.org/10.1024/0301-1526.29.2.117.
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Background: The autogenous vein represents the graft material of choice in crural and pedal bypass surgery. Because of the numerous problems concerning the graft harvesting and the quality of autogenous vein material an equally good allogenous graft is urgently needed. Up to the present times no such graft material has been able to achieve the success of vein grafts. Methods: We investigated the knitted polyester prosthesis Terumo PF-V (Terumo Comp., Japan), diameter 5 mm with outer reinforce, which is characterized by a new coating of plasmin-treated fibrin. Grafts were implanted as bypass into the ligated carotid (n=10) and femoral arteries (n=10) of 10 dogs (beagles). As a control 5 mm-ePTFE-prostheses (Impra Carboflo) were implanted simultaneously on the contralateral side. Results: After 6 months, seven of 20 PF-V-grafts and 8 of 20 PTFE-grafts were patent. All prostheses presented with good macroscopic healing characteristics. In the patent grafts, angiography showed no substantial stenoses. The histological examination of the material was performed using light microscopy, transmission polarising microscopy, scanning electron microscopy, and transmission electron microscopy. Both types of prostheses showed the typical pattern of graft healing by migration of mesenchymal cells through the prosthesis, formation of capillaries, and growing of a neointima with endothelium-like cells. All failed bypass grafts presented with an occluding proliferation from the arterial wall into the anastomotic region. Conclusions: Using clinically or histologically evaluation, neither graft demonstrated superiority over the other. The results indicate that the coating plays only a minor role for graft healing if any. For proper graft function, the arterial wall proliferation at the anastomotic region, which is not dependent on the type of prosthesis, appears to be most important. The overall results concerning both types of prostheses were disappointing
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Genoni, Michele, Dragan Odavic, Helen Loblein, and Omer Dzemali. "Use of the eSVS Mesh: External Vein Support Does Not Negatively Impact Early Graft Patency." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 8, no. 3 (May 2013): 211–14. http://dx.doi.org/10.1097/imi.0b013e3182a326ed.
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Objective The aim of this study was to assess early graft patency in eSVS Mesh–covered saphenous vein grafts (SVGs) in patients undergoing coronary artery bypass grafting. Methods In 20 patients meeting criteria for double arterial grafting to the left-sided coronary system and eSVS Mesh–covered SVG to the right-sided coronary system, patency was evaluated intraoperatively by transit time flow measurement and at 5 days postoperatively by computed tomographic angiography. Results Twenty patients underwent 49 arterial and 22 venous grafts (mean, 3.55/patient) using off-pump techniques. All grafts were determined to be patent intraoperatively. On computed tomographic angiography, arterial graft patency was 100%. In one venous anastomosis, the distal limb of a sequential graft was occluded, for an overall patency rate of 95%. Conclusions The eSVS Mesh does not compromise early SVG patency.
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Stukov, Yu Yu. "OPERATIVE TECHNIQUES AND APPROACHES IN COMPLETE ARTERIAL REVASCULARIZATION IN MULTIVESSEL CORONARY ARTERY DISEASE. Review." Medical Science of Ukraine (MSU) 16, no. 3 (September 30, 2020): 44–50. http://dx.doi.org/10.32345/2664-4738.3.2020.8.
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Relevance. Multi arterial bypass surgery comprises nearly 10% of the overall operations for ischemic heart disease. Multiple studies proved the superiority of arterial grafts for multivessel coronary artery disease. Nevertheless, the vast majority of conduits utilized for multiple bypasses are saphenous vein grafts. With the increasing popularity of radial artery utilization, the gastroepiploic artery remains a faded option. So more studies should be conducted for evaluation of the benefits from the gastroepiploic artery in the setting of multi-arterial revascularization.
Objective. Presentation of approaches and operative techniques for complete arterial revascularization in patients with multivessel coronary artery disease.
Methods. Analytical review of literature on keywords in international scientometric databases Pub Med, Scopus, Web of Science. Search depth 12 years: from 2007 to 2018.
Results. The current paper presents operative techniques and approaches to complete arterial revascularization in patients with multivessel coronary artery disease. The internal mammary artery remains the “gold standard” for the left anterior descending artery anastomosis site. Multiple arterial grafting is superior in terms of overall and cardiac survival. Emerging evidence of radial artery high term patency suggests the use of this arterial graft. Bilateral internal artery utilization provides long-term survival. Supplemental radial artery grafting to bilateral internal mammary provides complete arterial revascularization and can be safely used in routine cardiac surgery practice. Gastroepiploic artery proved superior patency rates, compared to saphenous vein grafts. Right coronary artery territory is an ideal anastomotic site for gastroepiploic artery grafting. The inferior epigastric artery may be used in addition to other arterial grafts as free graft or as y- or t-graft in the setting of multivessel coronary atherosclerotic lesions.
Conclusion. Complete arterial revascularization provides symptomatic relief from coronary artery disease provides superior patency rates and lowers the incidence of major adverse cardiac events.
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de Niet, A., and J. H. Van Uchelen. "Hypothenar hammer syndrome: long-term follow-up after ulnar artery reconstruction with the lateral circumflex femoral artery." Journal of Hand Surgery (European Volume) 42, no. 5 (December 19, 2015): 507–10. http://dx.doi.org/10.1177/1753193415622592.
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In symptomatic patients with hypothenar hammer syndrome, the occluded part of the ulnar artery can be reconstructed with an autologous graft. Venous grafts are used frequently, but they are known for their low patency rate. Arterial grafts show better patency rates than venous grafts in coronary bypass surgery. We performed 11 ulnar artery reconstructions with the descending branch of the lateral circumflex femoral artery and compared these with previously performed venous reconstructions. All patients with an arterial graft reconstruction had a patent graft at a mean follow-up of 63 months. In addition, nine out of 11 patients reported improvement in their symptoms. The patency rate of venous reconstructions in hypothenar hammer syndrome is significantly lower. Arterial grafting for hypothenar hammer syndrome has superior patency compared with venous grafting; we recommend it as the surgical treatment of choice for symptomatic hypothenar hammer syndrome. Level of evidence: 4.
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Saha, Kamales Kumar. "Graft Spasm—The Achilles Heel of Arterial Grafts." Indian Heart Journal 69, no. 5 (September 2017): 571–72. http://dx.doi.org/10.1016/j.ihj.2017.07.003.
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Gabriele, S., M. Mutin, J. Margonari, J. L. Faure, A. Naouri, A. Gelet, and J. M. Dubernard. "Cryopreservation of arterial grafts." Cryobiology 25, no. 6 (December 1988): 560. http://dx.doi.org/10.1016/0011-2240(88)90445-2.
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Sladen, J. G., R. P. Thompson, D. T. Brosseuk, P. G. Kalman, P. F. Petrasek, and R. D. Martin. "Sartorius Myoplasty in the Treatment of Exposed Arterial Grafts." Cardiovascular Surgery 1, no. 2 (April 1993): 113–17. http://dx.doi.org/10.1177/096721099300100205.
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The long-term success of sartorius myoplasty in 14 of 16 patients who presented with an exposed vascular graft in an infected groin is described. The presenting complications were wound dehiscence (ten patients), hemorrhage (two), skin erosion (two), late bilateral fistulas (one) and false aneurysm (one). Ten grafts were prosthetic and six autogenous. Positive cultures were obtained from 15 wounds; four grew Staphylococcus epldermidis, the remainder mixed or Gram-negative bacteria. Each groin was radically debrided, including the surface of the arterial graft, and, if possible, closed immediately with a sartorius myoplasty applied directly to the graft. Twist, fan and loop myoplasties were equally effective. Grossly infected wounds were debrided initially and obviously infected grafts were replaced in situ before myoplasty. Sartorius myoplasty is recommended as an elegant solution for the infected groin in which there is an exposed arterial graft.
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Moritz, A., F. Grabenwöger, F. Raderer, H. Ptakovsky, H. Magometschnigg, R. Ullrich, and M. Staudacher. "Use of Varicose Veins as Arterial Bypass Grafts." Cardiovascular Surgery 1, no. 5 (October 1993): 508–12. http://dx.doi.org/10.1177/096721099300100508.
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Varicose veins are not generally used as arterial bypass grafts despite their physiological endothelial flow surface. The large, irregular diameter and the thin wall renders these veins inadequate. Experimental studies have shown that a considerable reduction in the diameter of veins can be achieved by external wrapping without the generation of obstructing folds of the vein wall. A Dacron mesh tube surrounding varicose veins was used as a bypass graft in 13 infrainguinal arterial reconstructions. Ligated larger side branches and connections of the mesh segments caused irregularities of the otherwise smooth flow surfaces. Ten grafts were patent after a mean follow-up of 17 months. Two grafts have remained patent despite severe outflow obstruction in one and proximal occlusion in the other; both underwent successful interventions. The antithrombogenic properties of these grafts were partly due to a marked increase of the vasa vasorum. Externally constricted varicose veins may be used as arterial bypass conduits with good intermediate-term patency.
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Black, R. A., and T. V. How. "Attenuation of Flow Disturbances in Tapered Arterial Grafts." Journal of Biomechanical Engineering 111, no. 4 (November 1, 1989): 303–10. http://dx.doi.org/10.1115/1.3168383.
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Flow disturbances in tapered arterial grafts of angles of taper between 0.5 and 1.0 deg were measured in vitro using a pulsed ultrasound Doppler velocimeter. The increase in transition Reynolds numbers with angle of taper and axial distance was determined for steady flow. The instantaneous centerline velocities were measured distal to a 50 percent area stenosis (as a model of a proximal anastomosis), in steady and pulsatile flow, from which the disturbance intensities were calculated. A significant reduction in post-stenotic disturbance intensity was recorded in the tapered grafts, relative to a conventional cylindrical graft. In pulsatile flow with a large backflow component, however, there was an increase in disturbance intensity due to diverging flow during flow reversal. This was observed only in the 1.0 deg tapered graft. These findings indicate that taper is an important consideration in the design of vascular prostheses.
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Elliott, Morgan B., Brian Ginn, Takuma Fukunishi, Djahida Bedja, Abhilash Suresh, Theresa Chen, Takahiro Inoue, et al. "Regenerative and durable small-diameter graft as an arterial conduit." Proceedings of the National Academy of Sciences 116, no. 26 (June 10, 2019): 12710–19. http://dx.doi.org/10.1073/pnas.1905966116.
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Despite significant research efforts, clinical practice for arterial bypass surgery has been stagnant, and engineered grafts continue to face postimplantation challenges. Here, we describe the development and application of a durable small-diameter vascular graft with tailored regenerative capacity. We fabricated small-diameter vascular grafts by electrospinning fibrin tubes and poly(ε-caprolactone) fibrous sheaths, which improved suture retention strength and enabled long-term survival. Using surface topography in a hollow fibrin microfiber tube, we enable immediate, controlled perfusion and formation of a confluent endothelium within 3–4 days in vitro with human endothelial colony-forming cells, but a stable endothelium is noticeable at 4 weeks in vivo. Implantation of acellular or endothelialized fibrin grafts with an external ultrathin poly(ε-caprolactone) sheath as an interposition graft in the abdominal aorta of a severe combined immunodeficient Beige mouse model supports normal blood flow and vessel patency for 24 weeks. Mechanical properties of the implanted grafts closely approximate the native abdominal aorta properties after just 1 week in vivo. Fibrin mediated cellular remodeling, stable tunica intima and media formation, and abundant matrix deposition with organized collagen layers and wavy elastin lamellae. Endothelialized grafts evidenced controlled healthy remodeling with delayed and reduced macrophage infiltration alongside neo vasa vasorum-like structure formation, reduced calcification, and accelerated tunica media formation. Our studies establish a small-diameter graft that is fabricated in less than 1 week, mediates neotissue formation and incorporation into the native tissue, and matches the native vessel size and mechanical properties, overcoming main challenges in arterial bypass surgery.
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Sakurai, T., Y. Iwatsuka, N. Nishikimi, T. Yano, and Y. Nimura. "Below-Elbow Joint Arterial Reconstruction for Chronic Ischaemia." Cardiovascular Surgery 1, no. 6 (December 1993): 709–11. http://dx.doi.org/10.1177/096721099300100622.
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Ten below-elbow joint arterial bypass grafts performed in nine patients for chronic upper extremity ischaemia are reviewed. The cause of the ischaemia was thromboangiitis obliterans in four patients, iatrogenic trauma in four and unknown aetiology in one. Graft revision was required in two patients with thromboangiitis obliterans who underwent axillary-brachial bypass. Eight grafts, including one reoperation, have remained patent from 1 to 10 years (mean 54.3 months). Graft failure after 5 months did not occur, at which time the primary patency rate was 80%. In general, the long-term patency rates of autogenous vein bypass graft to the forearm were satisfactory. Aggressive arterial reconstruction is especially indicated in significant chronic upper extremity ischaemia resulting from iatrogenic trauma, as chances of success are excellent. Clinical and technical problems of in situ vein bypass in the upper extremity are discussed.
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Anli, Selcuk, Afsaneh Karimian-Tabrizi, Anton Moritz, and Nadejda Monsefi. "Mid-Term Clinical Outcome of Patients Undergoing Coronary Artery Bypass Grafting with Valvulotomized Vein Grafts." Heart Surgery Forum 21, no. 4 (June 18, 2018): E269—E274. http://dx.doi.org/10.1532/hsf.1960.
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Background: The lower patency rate of vein grafts (VG) in comparison to arterial grafts may be related to vein valves, which favor turbulences and thrombosis that lead to graft failure. The aim of this study was to determine the outcome of patients with valvulotomized VG after coronary artery bypass grafting (CABG) procedure. Methods: From 2007 to 2014, 233 patients with a mean age of 67 ± 9 years had CABG or combined CABG and valve procedures. Valvulotomized saphenous VG and arterial grafts were used. Clinical follow-up and outcome were evaluated after 6.3 ± 2 years. The graft patency was rated with multislice computed tomography in 57 patients and coronary angiography in 29 patients 3.1 ± 2 years postoperatively.Results: Overall, 168 patients had segregated CABG surgery, and 65 patients received additional procedures, with mean 2.7 ± 1 arterial and 1.5 ± 0.7 venous anastomoses. The 30-day-mortality in isolated CABG patients was 2%. Survival at five years was 80%. Major adverse cardiac and cerebrovascular events (MACCE) free rate at five years was 80%. At the last follow up (mean 6.3 years), 94% of the patients were in Canadian Cardiovascular Society (CCS) class 0. The quote of patent valvulotomized VG was 96.1% compared to a patency rate of 96.7% for the arterial grafts in the subgroup undergoing angiography or computed tomography of the heart. Conclusion: Our data demonstrate good mid-term results of graft patency, and comparable clinical results in patients undergoing CABG with valvulotomized VG. A longer follow-up period and a higher number of bypass graft imaging examinations are necessary to affirm our results.
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D’Souza, Rovan Evan, Girish Girish, Preethy D’Souza, Melissa Glenda Lewis, and Vishnu Renjith. "Outcomes of Visceral Arterial Reconstruction: A Systematic Review." Vascular and Endovascular Surgery 56, no. 3 (February 7, 2022): 290–97. http://dx.doi.org/10.1177/15385744211029112.
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Aims: The study aimed to review the use of synthetic grafts (SGs) and autologous vein grafts (AVGs) in visceral arterial reconstruction (VAR) in chronic visceral ischaemia. Methods: Systematic review methodology was employed. Results: Six studies were included (218 patients and 281 vessels). Two studies had data about AVG only, 3 had data about SG only and 1 had both AVG and SG data. Three studies reported outcomes for AVG (117 patients and 132 vessels revascularized). One-year primary patency was 87% (95% CI 71%, 97%). Graft thrombosis rate was 6% (95% CI 0%, 16%). Pooled stenosis rate at one-year was 11% (95% CI 1%, 28%). The 30-day (n = 96), one-year (n = 72) and 5-year mortality (n = 30) were 0%, 0% and 12%, respectively. Four studies reported outcomes for SGs (106 patients and 147 vessels). The pooled primary patency at one year was 100% (95% CI 99%, 100%). Pooled primary 5-year patency rate was 88% (95% CI 69%, 100%). There was no graft infection in 2 of the 3 studies. Overall pooled percentage of graft thrombosis and stenosis at one year was 0%. Jimenez et al. (2002) reported one graft thrombosis at 20 months and graft stenosis in 2 patients at 46 and 49 months. Illuminati et al (2017) reported graft thrombosis in 2/24 patients at 22 and 52 months. Thirty days, one-year and 5-year mortality was 1% (95% CI 0%, 6), 7% (95% CI 0%, 20%) and 39% (95% CI 11%), respectively. Conclusion: Patency was better with SG compared with AVG. Mortality was higher in the SG group. Graft dilatation does occur with vein grafts, but in this review no intervention was found necessary. Poorly designed studies, incomplete reporting and absence of morbidity and mortality indices preclude emphatic conclusions.
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Shrestha, Malakh, Nawid Khaladj, Hiroyuki Kamiya, Michael Maringka, Axel Haverich, and Christian Hagl. "Total Arterial Revascularization and Concomitant Aortic Valve Replacement." Asian Cardiovascular and Thoracic Annals 15, no. 5 (October 2007): 381–85. http://dx.doi.org/10.1177/021849230701500505.
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The safety of total arterial revascularization with a left internal thoracic artery-radial artery T-graft was evaluated in patients with at least two-vessel coronary artery disease and aortic valve stenosis requiring concomitant aortic valve replacement. From June 2001 to January 2005, 18 patients underwent aortic valve replacement and total arterial revascularization, while 101 had aortic valve replacement and conventional grafting. By matching age, sex, left ventricular ejection fraction, and number of distal anastomoses, 1:2 matched groups were generated: 15 patients with a left internal thoracic-radial artery T-graft, and 30 with left internal thoracic artery and additional vein grafts. Aortic cross clamp and cardiopulmonary bypass times were similar in both groups. There were no significant differences in postoperative data between the groups. Early mortality was 0% in the T-graft group and 2% in those with conventional grafts. Follow-up ranged from 2 to 50 months. Event-free survival was 100% in the T-graft group and 90% in the conventional graft group. Total arterial grafting with a left internal thoracic-radial artery T-graft can be performed in selected patients with aortic valve stenosis requiring simultaneous aortic valve replacement.
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Baradi, A., N. Andrianopoulos, L. Roberts, D. Jackson, S. Duffy, D. Clark, A. Ajani, et al. "PCI Outcomes in Native Arteries Versus Saphenous Vein Grafts (SVG) Versus Arterial Grafts." Heart, Lung and Circulation 22 (January 2013): S147. http://dx.doi.org/10.1016/j.hlc.2013.05.351.
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Bosanquet, DC, CN Jones, N. Gill, P. Jarvis, and MH Lewis. "Laminar flow reduces cases of surgical site infections in vascular patients." Annals of The Royal College of Surgeons of England 95, no. 1 (January 2013): 15–19. http://dx.doi.org/10.1308/003588413x13511609956011.
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Introduction Numerous strategies are employed routinely in an effort to lower rates of surgical site infections (SSIs). A laminar flow theatre environment is generally used during orthopaedic surgery to reduce rates of SSIs. Its role in vascular surgery, especially when arterial bypass grafts are used, is unknown. Methods A retrospective review of a prospectively maintained database was undertaken for all vascular procedures performed by a single consultant over a one-year period. Cases were performed, via random allocation, in either a laminar or non-laminar flow theatre environment. Demographic data, operative data and evidence of postoperative SSIs were noted. A separate subgroup analysis was undertaken for patients requiring an arterial bypass graft. Univariate and multivariate logistical regression was undertaken to identify significant factors associated with SSIs. Results Overall, 170 procedures were analysed. Presence of a groin incision, insertion of an arterial graft and a non-laminar flow theatre were shown to be predictive of SSIs in this cohort. In the subgroup receiving arterial grafts, only a non-laminar flow theatre environment was shown to be predictive of an SSI. Conclusions This study suggests that laminar flow may reduce incidences of SSI, especially in the subgroup of patients receiving arterial grafts.
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Pomposelli, FB, P. Basile, DR Campbell, and FW LoGerfo. "Salvaging the ischemic transmetatarsal amputation through distal arterial reconstruction." Journal of the American Podiatric Medical Association 83, no. 2 (February 1, 1993): 87–90. http://dx.doi.org/10.7547/87507315-83-2-87.
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From 1982 to 1991, 17 patients underwent a lower extremity arterial bypass to salvage an ischemic transmetatarsal amputation at the New England Deaconess Hospital. Eleven patients were male, and 16 had diabetes for an average of 29 years. The mean age was 71 years. Twelve patients presented with an ischemic ulcer, one had rest pain, and four underwent bypass for failure to heal a transmetatarsal amputation. Twelve patients presented with findings of secondary infection. All 17 patients underwent successful lower extremity bypass procedures to a variety of outflow vessels. Thirteen bypasses were to infrapopliteal arteries, including four to the dorsalis pedis artery. There were no perioperative deaths and all patients were discharged with patent grafts and healing limbs. Actuarial graft patency of the 14 vein grafts was 90% at 2 years. Actuarial limb salvage for the entire group was 93% at 2 years. Thirteen of the 14 patients who maintained patent grafts and healed their transmetatarsal amputations were ambulatory at their last known follow-up examination. Ischemic complications of previously created transmetatarsal amputations are uncommon. However, limb salvage attempts by lower extremity arterial bypass have a high likelihood of success. Major amputation in these patients should not be done without having first undergone a comprehensive vascular evaluation.
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Milas, Zvonimir L., Thomas F. Dodson, and Richard R. Ricketts. "Pediatric Blunt Trauma Resulting in Major Arterial Injuries." American Surgeon 70, no. 5 (May 2004): 443–47. http://dx.doi.org/10.1177/000313480407000513.
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Ten children, aged 4 to 14 years, sustaining blunt arterial trauma from motor vehicle collisions (6), bicycle accidents (2), and falls (2) were identified over a 10-year period. The arteries injured included the common iliac (3), abdominal aorta (2), carotid (2), brachial (2), and the subclavian, renal, and femoral artery (1 each). One patient had three arterial injuries. Six patients had associated injuries including a pelvic and lumbar spine fracture, Horner's syndrome, liver laceration, skull fracture, open humerus fracture, small bowel serosal tear, and a brachial plexus injury. Definitive diagnosis was made using arteriography (6), computed tomography (CT) scan (2), and physical examination (2). The types of arterial injuries found included incomplete transection, complete transection with pseudo-aneurysm formation, traumatic arteriovenous (AV) fistulas, complete occlusion, and dissection. Repair was accomplished by hypogastric artery interposition or bypass grafting, synthetic grafting with polytetrafluoroethylene (PTFE), reverse saphenous vein grafting, or primary repair, depending on the circumstances. An AV fistula between the carotid artery and cavernous sinus was embolized. All grafts remained patent with exception of the aorto-renal bypass graft at follow-up ranging from 1 month to 3 years. The principles for repairing vascular injuries in children are slightly different than those in adults. Every effort should be made to use autogenous tissue such as the hypogastric artery or saphenous vein for repair if possible. If not, PTFE grafts can be used, although the long-term patency of these grafts in growing children is not known.
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Nabuchi, Akihiro, Goh Kawaguchi, Tetsuya Ichihara, Shin Takuma, Hiroyuki Fujisaki, and Kunikazu Hisamochi. "Total Arterial Revascularization for a Patient with a Single Coronary Artery." Asian Cardiovascular and Thoracic Annals 5, no. 1 (March 1997): 50–52. http://dx.doi.org/10.1177/021849239700500112.
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A 52-year-old male patient with left main trunk disease and absent right coronary artery underwent successful coronary artery bypass grafting with in situ arterial conduits. Bilateral internal mammary arteries and the gastroepiploic artery were employed, with the inferior epigastric artery as a composite graft to the left internal mammary artery. The postoperative angiogram showed excellent patency of all 4 grafts and cardiac performance during exercise monitored by scintigram was found to be satisfactory.
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Uçak, Hacı Ali. "The relationship between epicardial fat tissue thickness and transit time flow measurement values of coronary artery bypass grafts." Journal of Cardiovascular and Thoracic Research 12, no. 4 (November 24, 2020): 307–12. http://dx.doi.org/10.34172/jcvtr.2020.50.
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Introduction: Epicardial fat tissue, the true visceral adipose depot of the heart, has been associated with changes in both cardiac function and morphology. This study aimed to show the relationship between epicardial fat tissue (EFT) thickness and graft flow dynamics in arterial and venous grafts in coronary artery bypass graft surgery (CABG). Methods: Patients underwent transthoracic echocardiography before surgery and epicardial fat thickness were evaluated. The patients were divided into two groups as EFT value <5.5 (group 1) mm and ≥5.5 (group 2) mm. One hundred eighty-one patients with a total of 434 grafts (162 arterial and272 venous) underwent isolated coronary artery bypass grafting surgery. All grafts were examined by transit time flow meter intraoperatively. Results: The mean epicardial fat tissue thickness values were 4.9±0.8 mm and 6.1±1.3 mm, respectively.Mean graft flow values of left internal mammary artery was 44.21±23.2 mL/min in group 1 and39.65 ± 19.2 mL/min in group 2 (P = 0.041). Similarly, mean graft flow values were higher in group1 in all venous grafts regardless of which vessel bypass was performed. There is a significant negative correlation between epicardial fat thickness and mean graft flow. Conclusion: Epicardial fat thickness measurement preoperatively might provide additional data for the faith of the graft.
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Saha, Shiv Shankar, Anurag Pandey, and Chirayu Parwal. "Arterial segments as microvascular interposition grafts in venous anastomosis in digital replantations." Indian Journal of Plastic Surgery 48, no. 02 (May 2015): 166–71. http://dx.doi.org/10.4103/0970-0358.163055.
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ABSTRACT Introduction: Microvascular anastomosis is a crucial procedure in replantation surgeries. Venous insufficiency is one of the most consistent cause of failure or re-exploration in these surgeries necessitating the use of venous grafts. Materials and Methods: We discuss our study of 9 such replantation surgeries executed in calendar year 2013-2014, including a double finger replantation done in the same patient having total amputation of 4 fingers of the same (right) hand, in which an arterial segment was used as a microvascular interposition graft for venous anastomosis. Out of these 9 surgeries, 3 were re-exploration procedures for venous compromise and 6 were successful primary replantations. Results: In all, 8 replants were successful and one failed due to arterial compromise. Discussion: In our experience and extensive review of the previously available literature, we would like to portray the advantages of arterial segments as microvascular grafts in replant surgeries. Specifically, in a crush amputation injury for which the use of a vascular interposition graft is being contemplated. If any other digit is also amputated and is unsuitable for replantation, it can act as a potential donor site to harvest the arterial segment. However, when dealing with single finger amputation, the surgeon must be confident about the single digital arterial anastomosis, before harvesting the second digital artery as a microvascular graft. Conclusion: In our study, we found the use of arterial grafts in microvascular anastomosis of veins advantageous, as arterial segments have better ability to resist spasm due to environmental changes, better pressure tolerance as compared to venous segments, and provide an appropriate calibre match and ease of harvest in the same operative field.
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Taggart, David P. "How I deploy arterial grafts." Annals of Cardiothoracic Surgery 7, no. 5 (September 2018): 690–97. http://dx.doi.org/10.21037/acs.2018.09.06.
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Barner, Hendrick B., and Thoralf M. Sundt. "Multiple arterial grafts and survival." Current Opinion in Cardiology 14, no. 6 (November 1999): 501. http://dx.doi.org/10.1097/00001573-199911000-00009.
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Sawchuk, Alan P. "Management of Infected Arterial Grafts." Critical Care Medicine 23, no. 9 (September 1995): 1615–16. http://dx.doi.org/10.1097/00003246-199509000-00037.
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Lister, Graham D., and Zoran M. Arnez. "Arterial T and Y Grafts." Plastic and Reconstructive Surgery 88, no. 2 (August 1991): 319–22. http://dx.doi.org/10.1097/00006534-199108000-00024.
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Mair, Helmut, Sabine Daebritz, and Bruno Reichart. "Caution with twisted arterial grafts." Journal of Thoracic and Cardiovascular Surgery 129, no. 6 (June 2005): 1461–62. http://dx.doi.org/10.1016/j.jtcvs.2004.11.036.
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Yeager, Richard A. "Management of infected arterial grafts." Journal of Vascular Surgery 20, no. 6 (December 1994): 1010. http://dx.doi.org/10.1016/0741-5214(94)90246-1.
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van Son, Jacques A. M., and Frank Smedts. "Spasm in free arterial grafts." Annals of Thoracic Surgery 52, no. 4 (October 1991): 896–97. http://dx.doi.org/10.1016/0003-4975(91)91242-n.
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Sjövall, A., E. Ekwall, G. Johansson, and U. Markström. "Pets and Arterial Prosthetic Grafts." EJVES Extra 5, no. 5 (May 2003): 67–68. http://dx.doi.org/10.1016/s1533-3167(03)00028-1.
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van Breda, Arina. "Thrombolysis in Arterial Bypass Grafts." Seminars in Thrombosis and Hemostasis 17, no. 01 (January 1991): 7–13. http://dx.doi.org/10.1055/s-2007-1002585.
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Kobayashi, Junjiro, Osamu Tagusari, Ko Bando, Kazuo Niwaya, Hiroyuki Nakajima, Michiko Ishida, Satsuki Fukushima, and Soichiro Kitamura. "Total Arterial Off-Pump Coronary Revascularization with Only Internal Thoracic Artery and Composite Radial Artery Grafts." Heart Surgery Forum 6, no. 1 (February 2, 2005): 30. http://dx.doi.org/10.1532/hsf.969.
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<P>Objective: Total arterial off-pump coronary artery bypass (OPCAB) grafting with only internal thoracic artery (ITA) and composite radial artery (RA) grafts has been applied extensively to avoid cerebral complications and late vein graft failure. We evaluated the initial experience with this method by clinical and angiographic study. </P><P>Methods: Between April 2000 and May 2002, 257 patients underwent OPCAB grafting with this technique. The range of ages at operation was 42 to 86 years (mean, 66.1 � 8.6 years). On average, 3.28 � 0.86 grafts per patient were completed. More than 4 distal anastomoses were performed in 88 patients (34%). For coronary revascularization, 289 ITA and 555 RA grafts were used. The RA was used as a Y graft in 211 patients, as an I graft (for ITA extension) in 52 patients, and as a K graft (the side of the RA attached to the side of the left ITA) in 28 patients. Sequential bypass grafting was performed with 190 RA and 7 ITA grafts. The sites of distal anastomoses were 256 left anterior descending arteries (30%), 236 posterolateral branches (28%), 144 posterior descending arteries (17%), 106 diagonal branches (13%), 82 obtuse marginal branches (10%), and 19 right coronary arteries (2%). </P><P>Results: There were 1 operative death (0.4%) due to cerebral hemorrhage and 2 episodes of stroke (0.8%) during postoperative angiography. There were no clinical underperfusion syndromes or new intra-aortic balloon pump insertions. Perioperative myocardial infarction occurred in 12 patients (4.7%), sternal dehiscence in 5 (1.9%), and early coronary intervention in 4 (1.6%). There was no deep wound infection, reexploration for bleeding, or hand ischemia. The actuarial survival rate and the cardiac event-free rate at 2 years were 98.6% � 2.4% and 94.2% � 0.8%, respectively. Early postoperative angiography revealed a 97.8% (264/270) graft patency of ITAs and 97.9% (512/523) graft patency of RAs in 238 patients. Flow competition of the RA graft was recognized in 22 patients and, as indicated by follow-up angiographic study, did not cause late graft occlusion. </P><P>Conclusions: OPCAB grafting with ITAs and composite RAs provides excellent early and intermediate clinical results and graft patency.</P>
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Vardanian, Andrew J., Anthony Chau, William Quinones-Baldrich, and Peter F. Lawrence. "Arterial Allograft Allows In-line Reconstruction of Prosthetic Graft Infection with Low Recurrence Rate and Mortality." American Surgeon 75, no. 10 (October 2009): 1000–1003. http://dx.doi.org/10.1177/000313480907501030.
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Surgical management of infected prosthetic vascular grafts is associated with a significant risk of recurrent infection, limb loss, and mortality. Treatment options include graft excision with extra-anatomic bypass and in-line repair with prosthetic graft, vein, or artery. We hypothesized that inline reconstruction using cryopreserved arterial allografts would be associated with a lower recurrent infection rate, limb loss, and mortality than other alternatives. We reviewed all cases where adults underwent surgical management of infected prosthetic aortic, iliac, or femoral bypass grafts with cryopreserved arterial allograft at our medical center from 2001 to 2008. Cryopreserved arterial allografts were used in 21 patients. There were nearly equal number of men (n = 11, 52%) and women (n = 10, 48%). The median age was 63 years and median time since cryoartery repair was 4 years. There have been no deaths in the follow-up period. Complications (19%) included colon perforation (n = 1), lower extremity compartment syndrome (n = 1), limb ischemia (n = 1), and reinfection with pseudoaneurysm and subsequent limb amputation (n = 1). These positive findings of low morbidity and absence of mortality in high risk patients have resulted in a shift at our institution to the preferential use of cryopreserved arterial allograft with in-line reconstruction for infected prosthetic grafts.