Journal articles on the topic 'Distal Graft'
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Rodriguez, Santiago, Michael R. Mancini, Rafael Kakazu, Matthew R. LeVasseur, Maxwell T. Trudeau, Mark P. Cote, Robert A. Arciero, Patrick J. Denard, and Augustus D. Mazzocca. "Comparison of the Coracoid, Distal Clavicle, and Scapular Spine for Autograft Augmentation of Glenoid Bone Loss: A Radiologic and Cadaveric Assessment." American Journal of Sports Medicine 50, no. 3 (January 20, 2022): 717–24. http://dx.doi.org/10.1177/03635465211065446.
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Background: Glenohumeral instability caused by bone loss requires adequate bony restoration for successful surgical stabilization. Coracoid transfer has been the gold standard bone graft; however, it has high complication rates. Alternative autologous free bone grafts, which include the distal clavicle and scapular spine, have been suggested. Study Design: Controlled laboratory study. Purpose: The purpose of this study was to determine the percentage of glenoid bone loss (GBL) restored via coracoid, distal clavicle, and scapular spine bone grafts using a patient cohort and a cadaveric evaluation. Methods: Autologous bone graft dimensions from a traditional Latarjet, congruent arc Latarjet, distal clavicle, and scapular spine were measured in a 2-part study using 52 computed tomography (CT) scans and 10 unmatched cadaveric specimens. The amount of GBL restored using each graft was calculated by comparing the graft thickness with the glenoid diameter. Results: Using CT measurements, we found the mean percentage of glenoid restoration for each graft was 49.5% ± 6.7% (traditional Latarjet), 45.1% ± 4.9% (congruent arc Latarjet), 42.2% ± 7.7% (distal clavicle), and 26.2% ± 8.1% (scapular spine). Using cadaveric measurements, we found the mean percentage of glenoid restoration for each graft was 40.2% ± 5.0% (traditional Latarjet), 53.4% ± 4.7% (congruent arc Latarjet), 45.6% ± 8.4% (distal clavicle), and 28.2% ± 7.7% (scapular spine). With 10% GBL, 100% of the coracoid and distal clavicle grafts, as well as 88% of scapular spine grafts, could restore the defect ( P < .001). With 20% GBL, 100% of the coracoid and distal clavicle grafts but only 66% of scapular spine grafts could restore the defect ( P < .001). With 30% GBL, 100% of coracoid grafts, 98% of distal clavicle grafts, and 28% of scapular spine grafts could restore the defect ( P < .001). With 40% GBL, a significant difference was identified ( P = .001), as most coracoid grafts still provided adequate restoration (congruent arc Latarjet, 82.7%; traditional Latarjet, 76.9%), but distal clavicle grafts were markedly reduced, with only 51.9% of grafts maintaining sufficient dimensions. Conclusions: The coracoid and distal clavicle grafts reliably restored up to 30% GBL in nearly all patients. The coracoid was the only graft that could reliably restore up to 40% GBL. Clinical Relevance: With “subcritical” GBL (>13.5%), all autologous bone grafts can be used to adequately restore the bony defect. However, with “critical” GBL (≥20%), only the coracoid and distal clavicle can reliably restore the bony defect.
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Prasertcharoensuk, Supatcha, Sopon Jirasiritham, Wiwat Tirapanich, Surasak Leela-Udomlipi, Piyanut Pootracool, Suthas Horsirimanont, Pannuwat Lertsithichai, Chatree Phasit, and Nantawan Lieungthada. "Comparison of Forearm Swelling After Loop Forearm Arteriovenous Graft between Distal Vein Ligation and No Ligation." Journal of the Association for Vascular Access 22, no. 2 (June 1, 2017): 93–97. http://dx.doi.org/10.1016/j.java.2016.12.003.
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Abstract Purpose: Forearm loop arteriovenous grafts (AVGs) are an effective way to grant permanent vascular access in end-stage renal disease patients undergoing hemodialysis. A common postoperative complication with this procedure is forearm swelling. Distal vein ligation is believed to reduce postoperative venous hypertension and forearm swelling. There have been no previous randomized controlled trials comparing the efficacy of AVGs with and without distal vein ligation. Methods: A pilot study was performed as a randomized controlled trial. End-stage renal disease patients who required AVG construction were recruited and randomly assigned to either the distal vein ligation group or the nondistal vein ligation group. Forearm swelling, graft patency, and graft thrombosis were recorded and compared. Results: The nonligation and ligation groups consisted of 30 and 31 patients, respectively. Forearm swelling at both the proximal and distal areas was nonsignificantly higher in the nonligation group than in the ligation group. The success rate of cannulation of the graft was 77% in both groups. The first cannulation time was somewhat shorter in the ligation group than in the nonligation group (57 vs 63 days; P = .282). There was no difference in graft thrombosis between the 2 groups (8 and 6 patients, respectively, in the nonligation and ligation groups). Conclusions: AVGs can be performed with or without distal vein ligation.
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Kwapisz, Adam, Kelly Fitzpatrick, Jay B. Cook, George S. Athwal, and John M. Tokish. "Distal Clavicular Osteochondral Autograft Augmentation for Glenoid Bone Loss: A Comparison of Radius of Restoration Versus Latarjet Graft." American Journal of Sports Medicine 46, no. 5 (January 30, 2018): 1046–52. http://dx.doi.org/10.1177/0363546517749915.
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Background: Bone loss in shoulder instability is a well-recognized cause of failure after stabilization surgery. Many approaches have been described to address glenoid bone loss, including coracoid transfer. This transfer can be technically difficult and has been associated with high complication rates. An ideal alternative to coracoid transfer would be an autologous source of fresh osteochondral graft with enough surface area to replace significant glenoid bone loss. The distal clavicle potentially provides such a graft source that is readily available and low-cost. Purpose: To evaluate distal clavicular autograft reconstruction for instability-related glenoid bone loss, specifically comparing the width of the clavicular autograft with the width of an ipsilateral coracoid graft as prepared for a Latarjet procedure. Further, we sought to compare the articular cartilage thickness of the distal clavicle graft with that of the native glenoid. Study Design: Controlled laboratory study. Methods: Twenty-seven fresh-frozen cadaver specimens were dissected, and an open distal clavicle excision was performed. The coracoid process in each specimen was prepared as has been described for a classic Latarjet coracoid transfer. In each specimen, the distal clavicle graft was compared with the coracoid graft for size and potential of glenoid articular radius of restoration. The distal clavicle graft was also compared with the native glenoid for cartilage thickness. Results: In all specimens, the distal clavicle grafts provided a greater radius of glenoid restoration than the coracoid grafts ( P < .0001). On average, the clavicular graft was able to reconstruct 44% of the glenoid diameter, compared with 33% for the coracoid graft ( P < .0001). The articular cartilage of the glenoid was significantly thicker (1.4 mm thicker, P < .0001) than that of the distal clavicular autograft (average ± SD, 3.5 ± 0.6 mm vs 2.1 ± 0.8 mm, respectively). When specimens with osteoarthritis were excluded, this difference decreased to 0.97 mm when compared with the clavicular cartilage ( P = .0026). Conclusion: The distal clavicle autograft can restore a significantly greater glenoid bone deficit than the Latarjet procedure and has the additional benefit of restoring articular cartilage to the glenoid. The articular cartilage thickness of the distal clavicle is within 1.4 mm of that of the native glenoid. Clinical Relevance: The distal clavicular autograft may be a suitable option for reconstruction of instability-related glenoid bone loss. This graft provides a structural osteochondral autograft with a broader radius of reconstruction than that of a coracoid graft, is locally available, has minimal donor site morbidity, is anatomic, and provides articular cartilage.
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Chuang, David. "Distal Nerve Transfers: A Perspective on the Future of Reconstructive Microsurgery." Journal of Reconstructive Microsurgery 34, no. 09 (May 16, 2018): 669–71. http://dx.doi.org/10.1055/s-0038-1656719.
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Abstract Background Nerve transfer can be broadly separated into two categories: proximal nerve graft and/or transfer and distal nerve transfer. The superiority of proximal nerve graft/transfer over distal nerve transfer strategy has been debated extensively, but which strategy is the best has not yet been defined. Each technique has its own advantages and disadvantages. However, proximal nerve graft/transfer is still the main reconstructive procedure based on the principle of “no diagnosis, then no treatment.” Proximal nerve transfer can avoid iatrogenic injury where the lesion is still in continuity and neurolysis is the only procedure without further cutting the nerve. Results Our clinical and experimental study show that proximal nerve grafts/transfers yield at least equal or better results compared to distal nerve transfers. Proximal nerve grafts/transfers remain the mainstay of my reconstructive strategy. Proximal nerve graft/transfer offers more accurate diagnosis and proper treatment to restore shoulder and elbow functions simultaneously. Distal nerve transfers can offer more efficient elbow flexion. Conclusion Combined, both strategies in primary nerve reconstruction are especially recommended when there is no healthy or not enough donor nerve available Distal nerve transfers should be considered as a complementary option for proximal nerve grafts/ transfers.
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Mohan, Irwin V., Peter L. Harris, Corine J. van Marrewijk, Robert J. Laheij, and Thien V. How. "Factors and Forces Influencing Stent-Graft Migration after Endovascular Aortic Aneurysm Repair." Journal of Endovascular Therapy 9, no. 6 (December 2002): 748–55. http://dx.doi.org/10.1177/152660280200900606.
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Purpose: To assess and validate the clinical features predisposing to stent-graft migration and to calculate the distal displacement forces exerted at the proximal fixation site following endovascular aortic aneurysm repair (EVAR). Methods: Demographic, anatomical, and graft-related features from 2862 patients were analyzed in a regression model to identify variables associated with stent-graft migration, which was defined as device movement >5 mm or considered significant by the investigator. Using the principles of continuity and momentum, a mathematical model of blood flow was created. The pulse pressure, proximal aortic and distal iliac diameters, and the degree of iliac angulation were varied in the calculations, and the distal displacement force exerted at the proximal fixation site was calculated. Results: Ninety-nine patients developed stent-graft migration, which was clinically relevant in 85 (3.0%). Hypertension (p=0.015), smoking (p=0.009), maximal aortic diameter (p=0.004), and distal transverse aortic diameter (p=0.03) correlated with migration in the univariate analysis, but iliac angulation did not quite achieve significance (p=0.06). On multivariate analysis, current smoking, hypertension, distal transverse aortic diameter, maximum common iliac diameter, and increasing proximal graft size were significantly associated with stent-graft migration. The mathematical model calculated the distal displacement force exerted on the proximal fixation site of the stent-graft and validated the clinical findings. The ratio of graft-diameter change from proximal aorta to distal iliac influenced the greatest increase in the displacement force. Conclusions: The mathematical model validated hypertension, aneurysm morphology, and endograft size as clinical factors significantly associated with stent-graft migration. These findings may have important implications for the choice and design of future stent-grafts.
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Onohara, Toshihiro, Kaoru Kitamura, Thomas E. Arnold, Teruo Matsumoto, and Morris D. Kerstein. "Management of Failed or Failing Infrainguinal Bypasses with Distal Correctable Lesions." American Surgeon 67, no. 10 (October 2001): 935–38. http://dx.doi.org/10.1177/000313480106701005.
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The goal of this study was to assess the management of failed or failing infrainguinal bypasses with distal correctable lesions. A retrospective analysis of 94 procedures was performed for 72 (77%) failed and 22 (23%) failing infrainguinal bypasses with distal correctable lesions in 94 patients. The 94 procedures included 50 (53%) balloon angioplasties and 44 (47%) distal vein graft extensions from the previous graft to the distal artery. Preprocedural thrombolytic therapy was performed in 62 of 94 limbs with a failed graft, and complete thrombolysis was achieved in 30 of 94. The results of thrombolytic therapy (complete or incomplete thrombolysis) or the means of revision procedure (balloon angioplasty or distal vein graft extension) did not affect the patency. Lower patency was observed for women, patients with a secondary bypass, and grafts with multiple episodes of revision. We conclude that the patency of failing infrainguinal bypasses after revision of distal lesions was affected not by means of therapy but by previous vascular procedures, the usual risk factors, and female gender.
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Parada, Stephen A., K. Aaron Shaw, Colleen Moreland, Douglas R. Adams, Mickey S. Chabak, and Matthew T. Provencher. "Variations in the Anatomic Morphology of the Lateral Distal Tibia: Surgical Implications for Distal Tibial Allograft Glenoid Reconstruction." American Journal of Sports Medicine 46, no. 12 (August 31, 2018): 2990–95. http://dx.doi.org/10.1177/0363546518793880.
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Background: Distal tibial allograft glenoid augmentation has been introduced as a viable treatment approach for glenoid bone loss in conjunction with shoulder instability. No previous study, however, has assessed the morphologic variation of the distal tibia at the incisura as it relates to graft dimensions for glenoid augmentation. Increased concavity at the lateral distal tibia necessitates removal of the lateral cortex to obtain a flat surface, which may have implications for the strength of surgical fixation. Purpose: To assess the morphologic variation of the distal tibia at the incisura as it relates to graft dimensions for glenoid augmentation. Study Design: Descriptive laboratory study. Methods: Magnetic resonance images of the ankle were reviewed for morphology assessment of the appearance and depth of the distal tibia. A classification system was created reflecting the suitability for glenoid augmentation. Type A tibias contained a flat contour of the lateral tibia at the articular surface, indicative of an ideal graft. Type B tibias had slight concavity with a central depth <5 mm and were deemed acceptable grafts. Type C tibias had deep concavity with a central depth >5 mm and were deemed unacceptable. Statistical analysis was performed via univariate analyses to compare patient demographics against acceptable morphology for glenoid augmentation. Results: Eighty-five study patients met inclusion criteria (53 male, 32 female; mean age ± SD, 35.1 ± 10.3 years). Overall, 12 patients (14.1%) demonstrated type A morphology, with 61 patients (71.8%) having type B morphology for a total of 85.9% of acceptable grafts for glenoid augmentation. The interrater reliability was moderate to strong between observers (kappa value = 0.841). On univariate analysis, sex was the only variable significantly associated with an acceptable graft, with 100% of female patients having acceptable morphology, as compared with 77% of male patients ( P = .004). Conclusion: Variable morphology of the distal tibia at the incisura was found: 14.1% of patients demonstrated an ideal morphology for glenoid augmentation; an additional 71.8% were deemed suitable for graft usage; and 14.1% of tibias had unacceptable morphology. Sex was a significant factor for predicting acceptable grafts. Clinical Relevance: This information will assist surgeons in accepting or rejecting grafts based on the epidemiology of the distal tibial morphology as it relates to glenoid augmentation.
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Dhupa, S., and J. E. Harris. "Treatment of degloving injuries with autogenous full thickness mesh scrotal free grafts." Veterinary and Comparative Orthopaedics and Traumatology 21, no. 04 (2008): 378–81. http://dx.doi.org/10.3415/vcot-07-04-0029.
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SummaryIn this report, we evaluated the effectiveness of scrotal tissue as an autogenous free skin graft to treat cutaneous degloving injuries of the distal limb in dogs. Surgery was performed on two male intact dogs with distal extremity degloving wounds. Dog #1 had a tarsal degloving wound with exposure of the distal tibial and tarsal bones. Dog #2 had a degloving injury over the metacarpals. Wounds were treated with daily wetto- dry bandages in order to develop a healthy bed of granulation tissue at the graft recipient site. Scrotal ablation castration was performed once the recipient site had been prepared. Subcutaneous and adipose tissue were excised from the scrotal graft and mesh slits were created. The graft was applied to the recipient site with monofilament absorbable simple interrupted sutures. Bandaging was performed postoperatively, and bandage changes occurred four, seven, nine and 11 days postoperatively. Follow-up was performed at 30 days. In dog #1, the tarsal degloving injury graft had first intention healing with 100% graft take on day 11. In dog #2, the metacarpal degloving injury graft had 90% graft take on day nine, with second intention healing adjacent to the fifth digit pad. The scrotum is often discarded at the time of scrotal ablation castration. Distal extremity wounds can be successfully treated with free skin grafts. In male dogs, the scrotum is a viable option as a full thickness mesh free graft for distal extremity reconstructive surgery.
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Kaisar, Jeremy, Aaron Chen, Mathew Cheung, Elias Kfoury, Carlos F. Bechara, and Peter H. Lin. "Comparison of propaten heparin-bonded vascular graft with distal anastomotic patch versus autogenous saphenous vein graft in tibial artery bypass." Vascular 26, no. 2 (August 23, 2017): 117–25. http://dx.doi.org/10.1177/1708538117717141.
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Introduction Heparin-bonded expanded polytetrafluoroethylene grafts (Propaten, WL Gore, Flagstaff, AZ, USA) have been shown to have superior patency compared to standard prosthetic grafts in leg bypass. This study analyzed the outcomes of Propaten grafts with distal anastomotic patch versus autogenous saphenous vein grafts in tibial artery bypass. Methods A retrospective analysis of prospective collected data was performed during a recent 15-year period. Sixty-two Propaten bypass grafts with distal anastomotic patch (Propaten group) were compared with 46 saphenous vein graft (vein group). Pertinent clinical variables including graft patency and limb salvage were analyzed. Results Both groups had similar clinical risk factors, bypass indications, and target vessel for tibial artery anastomoses. Decreased trends of operative time (196 ± 34 min vs. 287 ± 65 min, p = 0.07) and length of hospital stay (5.2 ± 2.3 days vs. 7.5 ± 3.6, p = 0.08) were noted in the Propaten group compared to the vein group. Similar primary patency rates were noted at four years between the Propaten and vein groups (85%, 71%, 64%, and 57%, vs. 87%, 78%, 67%, and 61% respectively; p = 0.97). Both groups had comparable secondary patency rates yearly in four years (the Propaten group: 84%, 76%, 74%, and 67%, respectively; the vein group: 88%, 79%, 76%, and 72%, respectively; p = 0.94). The limb salvage rates were equivalent between the Propaten and vein group at four years (84% vs. 92%, p = 0.89). Multivariate analysis showed active tobacco usage and poor run-off score as predictors for graft occlusion. Conclusions Propaten grafts with distal anastomotic patch have similar clinical outcomes compared to the saphenous vein graft in tibial artery bypass. Our data support the use of Propaten graft with distal anastomotic patch as a viable conduit of choice in patients undergoing tibial artery bypass.
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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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Norman, P. E., and A. K. House. "Influence of Dexamethasone on Intimal Thickening in Experimental Vein Graft." Cardiovascular Surgery 1, no. 6 (December 1993): 724–28. http://dx.doi.org/10.1177/096721099300100626.
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The influence of dexamethasone on vein graft intimal hyperplasia was studied in a rat model. The iliolumbar vein was grafted to the common iliac artery in 42 rats. Twenty animals were treated with dexamethasone 0.1 mg/kg per day by injection for 3 weeks; 22 control animals received saline injections. Grafts were harvested at 3 weeks and longitudinal sections prepared. Five deaths and considerable morbidity was seen in the dexamethasone-treated animals. All grafts in the surviving animals in both groups were patent at 3 weeks. Intimal thickening, measured in the proximal, mid and distal graft, was found to be maximal in the proximal graft and least in the mid-portion of the graft. Dexamethasone reduced intimal thickening throughout the graft; the median thickness of the proximal graft was 30 μm (control 50 μm), in the mid-graft 10 μm (control 30 μm) and in the distal graft 20 μm (control 30 μm). This reduction was statistically significant in the mid-graft only ( P <0.05; Mann—Whitney U test). The small effect on anastomotic intimal thickening suggests that dexamethasone is of limited use in the prevention of vein graft intimal hyperplasia in clinical practice.
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Davidovic, Lazar, Dragan Vasic, Ruzica Maksimovic, Dusan Kostic, Dragan Markovic, and Miroslav Markovic. "Aortobifemoral Grafting: Factors Influencing Long-Term Results." Vascular 12, no. 3 (May 2004): 171–78. http://dx.doi.org/10.1258/rsmvasc.12.3.171.
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We present the results and respective determinant factors of 283 consecutive aortobifemoral bypasses. This prospective study included 283 patients with aortoiliac atherosclerotic occlusive disease treated by aortobifemoral reconstructions. Polytetrafluoroethylene (PTFE) grafts were used in 136 patients and Dacron® grafts in 147 patients. The 30-day mortality rate was 11 patients (3.9%). Perioperative (< 30 days) graft failure occurred in 6 patients (2.1%), whereas in 14 (5.25%) patients, it occurred during the follow-up period. There were 3 (1.05%) distal anastomotic pseudoaneurysms and 5 (1.7%) graft infections, with no statistical difference between the two types of grafts. The type of prosthesis did not influence cumulative graft patency. The end-to-end configuration of proximal anastomosis and a simultaneously performed femoropopliteal bypass significantly increased the graft patency ( p < .05). The associated occlusion of the superficial femoral and popliteal arteries decreased the cumulative graft patency in comparison with that of the patients without artery disease ( p < .05). Our results showed that in the aortobifemoral position, there was no significant difference in the patency, anastomotic pseudoaneurysms, and graft infection between PTFE and Dacron grafts. However, the PTFE grafts had a significantly higher rate ( p < .05) of distal anastomotic stenosis, which was mostly caused by neointimal hyperplasia.
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Kallakuri, S., E. Ascher, A. Hingorani, T. Jacob, and S. Salles-Cunha. "Hemodynamics of Infrapopliteal PTFE Bypasses and Adjunctive Arteriovenous Fistulas." Cardiovascular Surgery 11, no. 2 (April 2003): 125–29. http://dx.doi.org/10.1177/096721090301100204.
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Purpose Blood flow, pressure and peripheral resistance in patients with established polytetrafluoroethylene (PTFE) grafts and adjunctive arteriovenous fistulas (AVF) have rarely been investigated. To better elucidate the effects of this AVF, we obtained noninvasive measurements of hemodynamic variables in patients with infrapopliteal PTFE grafts and an AVF. Methods Systolic, mean and diastolic arm and toe pressures were measured with an oscillometric technique employed in automatic blood pressure monitors. Peak-systolic velocity, end-diastolic velocity and flow rates at the graft and recipient distal artery were measured with duplex ultrasound. Resistance for the leg and foot in peripheral resistance units (PRU) was estimated as mean arm pressure divided by graft flow rate and as mean toe pressure divided by distal artery flow rate respectively. We analyzed data from 21 patients. Toe pressures were measurable in 13 patients. Bypass graft inflow was at the external iliac artery in 11 patients, common femoral in six, common iliac in two and superficial femoral in two. The distal anastomosis was at the anterior tibial artery in 10 patients, peroneal in seven and posterior tibial in four patients. Results Graft systolic and diastolic velocities were 91 ± 46 (mean±sd) and 38 ± 31 (mean±sd) cm/s respectively. Toe systolic pressure averaged 81 ± 28 (mean±SD) mmHg with a corresponding toe/brachial index (TBI) of 0.53 ±0.18 (mean±SD). The ratio between arm mean pressure, 104 ± 20 (mean±SD) mmHg, and graft flow rate, 413 ± 290 (mean±sd) ml/min, yielded an estimated leg resistance of 0.32 ± 0.20 peripheral resistance units (PRU) (mean±sd). The ratio between mean toe pressure, 51 ± 21 (mean ± SD) mmHg, and distal artery flow rate, 37 ± 26 (mean±SD) ml/min, produced an estimated foot resistance averaging 1.66 ± 1.18 PRU (mean±sd). Conclusions Average graft flow rate was five times greater than flow reported for standard tibial bypasses. Although distal artery flow rate and graft peak systolic velocity were within reported normal ranges, mean toe pressure and toe-brachial index were below normal. Leg and foot resistances were decreased. These data suggest that bypasses with arteriovenous fistulas have increased flow, desirable for graft patency, but may affect distal perfusion pressure.
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TAMBE, A. D., L. CUTLER, S. R. MURALI, I. A. TRAIL, and J. K. STANLEY. "In Scaphoid Non-Union, Does the Source of Graft Affect Outcome? Iliac Crest Versus Distal End of Radius Bone Graft." Journal of Hand Surgery 31, no. 1 (February 2006): 47–51. http://dx.doi.org/10.1016/j.jhsb.2005.07.008.
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Iliac crest bone grafts are sometimes preferred to other bone grafts for the treatment of non-unions of fractures of the scaphoid as they are claimed to have better osteogenic potential and biomechanical properties. We retrospectively studied a consecutive cohort of 68 symptomatic established scaphoid non-unions treated by bone grafting. An iliac crest graft was used in 44 cases and a distal radius graft in the other 24. The two treatment groups were comparable in terms of location of the fracture, duration of the non-union and the fixation implants used. Overall union was achieved in 45 of the 68 patients (66%) and the union rate was not influenced by the type of bone graft used. Twenty-nine of the 44 treated with iliac crest bone graft (66%) and 16 of the 24 (67%) treated with distal radial graft united. Donor site pain over the iliac crest was present in nine of the 44 patients in this group.
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Hudson, Parke W., Martim C. Pinto, Eugene W. Brabston, Matthew C. Hess, Brent M. Cone, Johnathan F. Williams, William S. Brooks, Amit M. Momaya, and Brent A. Ponce. "Distal clavicle autograft for anterior-inferior glenoid augmentation: A comparative cadaveric anatomic study." Shoulder & Elbow 12, no. 6 (September 3, 2019): 404–13. http://dx.doi.org/10.1177/1758573219869335.
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Introduction The aim of this study was to anatomically compare distal clavicle and coracoid autografts and their potential to augment anterior-inferior glenoid bone loss. Methods Ten millimeters of distal clavicle and 20 mm of coracoid were harvested bilaterally from 32 cadavers. Length, weight, and height were measured and surface area and density were calculated. For each graft, ipsilateral measurements were compared and the ability to restore corresponding glenoid bone loss was calculated. Results Distal clavicle grafts were larger than coracoid grafts with respect to length (22.3 mm versus 17.7 mm; p < 0.001), height (12.49 mm versus 9.65 mm; p < 0.001), mass (2.72 g versus 2.45 g; p = 0.0437), and volume (2.36 cm3 versus 1.96 cm3; p = 0.002). Coracoid grafts had larger widths (14.56 mm versus 10.52 mm; p < 0.001) and greater density (1.24 g/cm3 versus 1.18 g/cm3; p < 0.001). Distal clavicle surface area was greater on both the articular (2.93 cm2 versus 1.5 cm2; p < 0.001) and superior surfaces (2.76 cm2 versus 1.5 cm2; p < 0.001) when compared to lateral coracoid surface area. Discussion Distal clavicle grafts were larger and restored larger bony defects but had greater variability and lower density than coracoid grafts. Clinical studies are needed to compare these graft options.
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Wolfe, J. H. N., and G. A. D. McPherson. "The failing femoro distal graft." European Journal of Vascular Surgery 1, no. 5 (October 1987): 295–96. http://dx.doi.org/10.1016/s0950-821x(87)80054-3.
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Scott, Julian, Jonathan Beard, and Michael Horrocks. "Flow in femoro-distal graft." European Journal of Vascular Surgery 3, no. 2 (April 1989): 185. http://dx.doi.org/10.1016/s0950-821x(89)80017-9.
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Mohammadi, Siamak, Jean-Pierre Normand, Pierre Voisine, and François Dagenais. "Thoracic Aortic Stent Grafting in Patients with Connective Tissue Disorders: A Word of Caution." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 2, no. 4 (July 2007): 184–87. http://dx.doi.org/10.1097/imi.0b013e31815887e0.
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Objective Use of thoracic Stent-graft in patients with connective tissue disorders (CTD) remains limited. We herein report 3 patients with CTD who underwent stent grafting. Methods and Results Case 1; A male Marfan patient was operated for thoraco-abdominal aneurysm. On computed tomography (CT), large false aneurysm at the proximal anastomosis was documented which was excluded with a 30 mm Talent stent-graft with 10–15% oversize. Case 2; A female with Ehlers-Danlos syndrome had undergone resection of descending aortic thoracic aneurysm presented with an enlarging aneurysm distal to the graft. Three Talent stent-grafts (15% oversize) were deployed with balloon dilatation to exclude the aneurysm. The immediate postoperative period was complicated by an extensive intramural hematoma of the descending aorta with hemothorax, managed conservatively. Case 3; A female Marfan patient had undergone Bentall procedure and mitral repair followed with resection of the proximal descending aorta. Three months later a false aneurysm at the distal anastomosis was treated with a 24 mm Valiant stent-graft (30% oversize). Aortic dissection distal to stent was documented on the early postoperative CT. The dissected aneurysm enlarged significantly with a type I distal endoleak during follow-up. Concomitantly, the patient presented a class III dyspnea owing to a severe mitral regurgitation. The patient underwent a successful MVR and stent-graft explantation with replacement of the descending aorta. Conclusion Significant complications supervened when stent-grafts were deployed in native aorta. We thus recommend that deploying a stent-graft in a CTD diseased aorta should be considered a relative contraindication. In cases with prohibitive or high risk surgery, use of a stent-graft with minimal radial force and minimal oversizing without balloon dilatation should be considered.
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Redzek, Aleksandar, Bogoljub Mihajlovic, Pavle Kovacevic, Nada Cemerlic-Adjic, Katica Pavlovic, and Lazar Velicki. "Patency of internal thoracic artery and vein grafts according to revascularized coronary artery properties." Medical review 64, no. 3-4 (2011): 137–42. http://dx.doi.org/10.2298/mpns1104137r.
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Long-term results of surgical myocardial revascularization are determined by the quality of grafts and the progression of atherosclerosis in coronary arteries. The aim of the study was to evaluate the patency rate of internal thoracic artery and great saphenous vein grafts in relation to the hemodynamic properties of revascularized coronary artery. The patency of internal thoracic artery and great saphenous vein grafts was analyzed in relation to the degree of coronary stenosis estimated by angiography and the diameter of distal portion of coronary artery assessed intra-operatively. The long-term patency of great saphenous grafts depends on the distal coronary artery diameter but not on the degree of coronary artery stenosis. The patency of internal thoracic artery graft depends on the degree of co?ronary artery stenosis but not on the distal coronary artery diameter. The internal thoracic artery is the superior graft in coronary surgery, but the low patency rate in case of moderate coronary artery stenosis emphasizes the importance of selective approach.
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O'Brien, Thomas, Liam Morris, Michael Walsh, and Tim McGloughlin. "That Hemodynamics and Not Material Mismatch is of Primary Concern in Bypass Graft Failure: An Experimental Argument." Journal of Biomechanical Engineering 127, no. 5 (April 28, 2005): 881–86. http://dx.doi.org/10.1115/1.1992532.
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The long term patency of end-to-side peripheral artery bypasses are low due to failure of the graft generally at the distal end of the bypass. Both material mismatch between the graft and the host artery and junction hemodynamics are cited as being major factors in disease formation at the junction. This study uses experimental methods to investigate the major differences in fluid dynamics and wall mechanics at the proximal and distal ends for rigid and compliant bypass grafts. Injection moulding was used to produce idealized transparent and compliant models of the graft/artery junction configuration. An ePTFE graft was then used to stiffen one of the models. These models were then investigated using two-dimensional video extensometry and one-dimensional laser Doppler anemometry to determine the junction deformations and fluid velocity profiles for the rigid and complaint graft anastomotic junctions. Junction strains were evaluated and generally found to be under 5% with a peak stain measured in the stiff graft model junction of 8.3% at 100mmHg applied pressure. Hemodynamic results were found to yield up to 40% difference in fluid velocities for the stiff/compliant comparison but up to 80% for the proximal/distal end comparisons. Similar strain conditions were assumed for the proximal and distal models while significant differences were noted in their associated hemodynamic changes. In contrasting the fluid dynamics and wall mechanics for the proximal and distal anastomoses, it is evident from the results of this study, that junction hemodynamics are the more variable factor.
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Shaw, Kenneth Aaron, Colleen M. Moreland, Mickey S. Chabak, Matthew T. Provencher, and Stephen Parada. "Surgical Implications of the Distal Tibia Morphology at the Incisura for Glenoid Augmentation." Orthopaedic Journal of Sports Medicine 6, no. 7_suppl4 (July 1, 2018): 2325967118S0016. http://dx.doi.org/10.1177/2325967118s00161.
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Objectives: Distal tibia allograft (DTA) glenoid augmentation has been introduced as a viable treatment approach for glenoid bone loss in conjunction with shoulder instability. An ideal graft has a flat or nearly flat lateral border of the tibia, allowing the surgeon to retain the lateral cortical bone for increased screw fixation (Figure 1A). DTA grafts with a deep concavity are difficult to prepare for fixation, as it is necessary to remove most of the cortical bone to create a flat contour of the graft (Figure 1B). Previous anatomic studies have sought to evaluate the morphology at the incisura as it pertains to syndesmosis fixation. No previous study has assessed the morphologic variation of the distal tibia at the incisura as it relates to graft dimensions for glenoid augmentation. Methods: Magnetic resonance images (MRI) of the ankle were reviewed over a 3 month period. Studies that met inclusionary criteria underwent morphology assessment to characterize the appearance and depth of the distal tibia at the incisura, both at the articular surface and the physeal scar, representing the typical depth of a DTA graft. Measurements were performed by two independent observers and inter-rater reliability was assessed. A three-part classification system was created reflecting the suitability of the distal tibial for glenoid augmentation. Type A grafts contained a flat contour of the lateral tibia, indicative of an ideal graft. Type B grafts had a slight concavity, with a central depth < 5 mm and were deemed acceptable grafts. Type C grafts had a deep concavity, with a central depth > 5 mm and were deemed unacceptable for glenoid augmentation. Statistical analysis was performed using univariate analyses to compare recorded patient demographics against acceptable morphology for glenoid augmentation. Results: 101 patients were identified with 16 excluded, leaving 85 patients for study inclusion (53 male, 32 female, average 35.1 years ±10.3 years). Overall, 12 patients (14.1%) demonstrated a type A morphology, with an additional 61 patients (71.8%) having a type B morphology for a total of 85.9% with an acceptable specimens for glenoid augmentation. The inter-rater reliability was moderate to strong between measuring observers (0.793). Only gender has found to effect the likelihood of an acceptable graft with 100% of female patients having an acceptable morphology, compared to 77% of male patients (p=0.004). Conclusion: The morphology of the distal tibia at the incisura, as it relates to glenoid augmentation was variable in this patient cohort. 14.1% of patients demonstrated an ideal morphology for glenoid augmentation, with an additional 71.8% were deemed suitable for graft usage with only minor contouring necessary. 14.1% of patients were found to have an unacceptable morphology. Gender was a significant factor for predicting acceptable grafts, with 100% of female patients having an acceptable morphology. This information will help surgeons accept or reject grafts based on the knowledge of the epidemiology of the distal tibia morphology as it relates to glenoid augmentation.
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Neufang, Achim, Carolina Vargas-Gomez, Patrick Ewald, Nicolaos Vitolianos, Tolga Coskun, Nael Abu-Salim, Rainer Schmiedel, Peter von Flotow, and Savvas Savvidis. "Very distal vein bypass in patients with thromboangiitis obliterans." Vasa 46, no. 4 (June 1, 2017): 304–9. http://dx.doi.org/10.1024/0301-1526/a000624.
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Abstract. Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex findings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin configuration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superficial femoral artery was used for inflow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identified graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after definitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.
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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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WILSON, S., and D. SAMMUT. "Flexor Tendon Graft Attachment: A Review of Methods and A Newly Modified Tendon Graft Attachment." Journal of Hand Surgery 28, no. 2 (April 2003): 116–20. http://dx.doi.org/10.1016/s0266-7681(02)00362-5.
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A review of the described methods of attachment of flexor tendon grafts to the distal phalanx is presented. The authors advocate the previously described method of attachment consisting of passage of the tendon graft through the pulp with anchorage to the nail. A new modification of this technique is presented, facilitating accurate dissection and placement of the graft with minimal trauma.
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Kumar, Narinder. "Limb Preservation in Recurrent Giant Cell Tumour of Distal End of Radius with Fibular Graft Fracture: Role of Ulnocarpal Arthrodesis." Hand Surgery 20, no. 02 (June 2015): 307–9. http://dx.doi.org/10.1142/s0218810415720107.
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Giant cell tumors of distal radius are locally aggressive tumors with a high rate of recurrence. Though surgery remains the mainstay of treatment, reconstruction remains a challenge in cases of recurrence. Recurrences of GCT in autogenous fibular grafts have been rarely reported and pathological fractures through such grafts are even rarer. Ulnocarpal arthrodesis has never been described as a limb preservation procedure in such a recurrent lesion in distal radius with pathological fracture through a well incorporated fibular graft. A case of pathological fracture in a well incorporated autogenous non-vascularized fibular bone graft in recurrent GCT of distal radius and its successful management with ulnocarpal arthrodesis is reported. In such a scenario where other reconstructive options like allograft or prosthetic reconstructions are not likely to succeed, ulnocarpal arthrodesis may be considered as a salvage procedure.
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Harb, Amro, Maxwell Levi, Akio Kozato, Yelena Akelina, and Robert Strauch. "Torsion Does Not Affect Early Vein Graft Patency in the Rat Femoral Artery Model." Journal of Reconstructive Microsurgery 35, no. 04 (October 30, 2018): 299–305. http://dx.doi.org/10.1055/s-0038-1675224.
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Background Torsion of vein grafts is a commonly cited reason for graft failure in clinical setting. Many microsurgery training courses have incorporated vein graft procedures in their curricula, and vein graft torsion is a common technical error made by the surgeons in these courses. To improve our understanding of the clinical reproducibility of practicing vein graft procedures in microsurgery training courses, this study aims to determine if torsion can lead to early vein graft failure in nonsurvival surgery rat models. Methods Sprague-Dawley rats were divided into five cohorts with five rats per cohort for a total of 25 rats. Cohorts were labeled based on degree of vein graft torsion (0, 45, 90, 135, and 180 degrees). Torsion was created in the vein grafts at the distal arterial end by mismatching sutures placed between the proximal end of the vein graft and the distal arterial end. Vein graft patency was then verified 2 and 24 hours postoperation. Results All vein grafts were patent 2 and 24 hours postoperation. At 2 hours, the average blood flow rate measurements for 0, 45, 90, 135, and 180 degrees of torsion were 0.37 ± 0.02, 0.38 ± 0.04, 0.34 ± 0.01, 0.33 ± 0.01, and 0.29 ± 0.02 mL/min, respectively. At 24 hours, they were 0.94 ± 0.07, 1.03 ± 0.15, 1.26 ± 0.22, 1.41 ± 0.11, and 0.89 ± 0.15 mL/min, respectively. Conclusion Torsion of up to 180 degrees does not affect early vein graft patency in rat models. To improve the clinical reproducibility of practicing vein graft procedures in rat models, we suggest that microsurgery instructors assess vein graft torsion prior to clamp release, as vessel torsion does not seem to affect graft patency once the clamps are removed.
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Venouziou, Aaron I., and Dean G. Sotereanos. "Supplemental Graft Fixation for Distal Radius Vascularized Bone Graft." Journal of Hand Surgery 37, no. 7 (July 2012): 1475–79. http://dx.doi.org/10.1016/j.jhsa.2012.04.024.
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Hofer, Matthias D., Lauren Folgosa Cooley, Ayman Elmasri, and Francisco E. Martins. "Revisiting One-Stage Urethroplasties for Distal Urethral Strictures." Journal of Clinical Medicine 10, no. 24 (December 16, 2021): 5905. http://dx.doi.org/10.3390/jcm10245905.
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Background: Reconstructive approaches for distal urethral strictures range from simple meatotomy to utilizing grafts or flaps depending on the etiology, length and location. We describe a contemporary cohort of distal urethral strictures and report a surgical technique termed distal one-stage urethroplasty developed to address the majority of distal urethral strictures encountered. Methods: Thirty-four patients were included. The mean age was 56.7 years (range 15.7–84.9 years), the mean stricture length was 1.1 cm (0.5–1.5) and the mean follow-up was 42.5 months (28–61.3). Results: The vast majority of distal strictures (27/34 (79.4%)) were treated with our hybrid one-stage approach combining a distal urethral reconstruction with excision of the scar tissue without the need to use grafts or flaps. The average stricture length was 0.68 cm and average operative time was 24.43 min. Post-operative spraying was reported in a minority of patients (4/27 (14.8%)). The length of stricture and surgery were significantly longer in those 7/34 (20.6%) patients in whom grafts or flaps were used (2.88 cm and 154.8 min, respectively, p < 0.001 for both when compared to the hybrid one-stage approach). We noted 6/34 (17.6%) recurrences of distal urethral strictures, all of which were treated successfully with graft and flap repairs. Conclusions: The vast majority of distal urethral strictures are amenable to a distal one-stage urethroplasty, avoiding the use of grafts and/or flaps while achieving reasonable outcomes. This limited approach, at least initially, is associated with shorter operative time and time of catheter placement and avoids morbidity associated with graft or flap harvesting. Spraying of urine is seldomly encountered and comparable to other approaches addressing distal urethral strictures.
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Wong, Ivan H., JP King, Gordon Boyd, Michael Mitchell, and Catherine M. Coady. "Radiographic Analysis of Glenoid Morphology after Arthroscopic Latarjet vs Distal Tibial Allograft in the Treatment of Anterior Shoulder Instability." Orthopaedic Journal of Sports Medicine 6, no. 7_suppl4 (July 1, 2018): 2325967118S0009. http://dx.doi.org/10.1177/2325967118s00094.
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Objectives: The Latarjet procedure for autograft transposition of coracoid to the anterior rim of the glenoid remains the most common procedure for reconstruction of the glenoid after shoulder instability. The anatomic glenoid reconstruction using distal tibial allograft has gained popularity and is suggested to better match the normal glenoid size and shape. However, there is concern for decreased healing and increased resorption using an allograft bone. The purpose of this study was to evaluate the arthroscopic reconstruction of the glenoid with respect to the size, shape, healing, and resorption of autograft coracoid vs allograft distal tibia. Methods: A retrospective review of 50 consecutive patients who had an arthroscopic boney reconstruction of the glenoid (13 coracoid; 37 distal tibial), diagnosed with anterior shoulder instability, and CT confirmed glenoid bone loss >20%. Pre-and post-operative CT scans were reviewed by two fellowship trained musculoskeletal radiologists for: graft position, glenoid concavity, cross sectional area, width, version, total area, osseous union, and graft resorption. Results: Graft nonunion was seen in 3 (23.07%) of the coracoid patients, and in 2 (5.4%) of the tibial allograft patients (OR 5.25; 95% CI: 0.768-35.89). Odds ratios comparing allograft to coracoid for overall resorption was 5.00 (CI: 1.276-19.597). Graft resorption greater than 50% was seen in 3 (8.11%) of the allografts and was absent within the coracoid patients. Graft resorption lesser than 50% was greater in both groups with 27 (72.97%) allograft and 6 (46.15%) coracoid patients. However, no statistically significant difference was found between the two procedures regarding AP diameter of graft (p=0.818) or graft cross sectional area (p=0.797). Conclusion: Arthroscopic anatomic glenoid reconstruction using distal tibial allograft showed greater boney union but higher resorption compared to coracoid autograft. Even so, there was no statistically significant difference between the two procedures regarding final graft surface area and size of grafts. These short-term results suggest distal tibial allograft as an alternative to coracoid autograft in the recreation of glenoid boney morphology.
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Attia, Ahmed K., Karim Mahmoud Khamis, Kareem Ahmed H. M. A. Elsweify, Jason T. Bariteau, and Sameh A. Labib. "Donor Site Morbidity of Calcaneal, Distal and Proximal Tibial Cancellous Autografts in Foot and Ankle Surgery: A Systematic Review and Meta-Analysis of 2296 Grafts." Foot & Ankle Orthopaedics 7, no. 1 (January 2022): 2473011421S0009. http://dx.doi.org/10.1177/2473011421s00094.
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Category: Other Introduction/Purpose: Non-union of foot and ankle arthrodesis sites has been associated with revision surgery, morbidity and increased healthcare costs, so many surgeons elect to augment the fusion site with autologous bone grafts to improve union. While iliac crest autografts are considered the historical gold standard, other donor sites distal in the lower extremity such as calcaneus, proximal and distal tibia have been successfully used in foot and ankle surgery. This study aims to report on the safety and donor site morbidity of distal lower extremity (calcaneal, proximal and distal tibial) bone autografts. We summarized the findings in a comprehensive infographic illustration. We are unaware of any similar meta-analyses to date. Methods: Following the PRISMA guidelines, 2 independent investigators searched several databases in December 2020 using the following keywords and their synonyms: ('Bone graft', 'donor site morbidity', 'calcaneal graft', 'Proximal tibia graft', and 'distal tibia graft'). Besides, the reference lists from previous review articles were searched manually for eligible studies. The primary outcomes of interest were (1) Chronic pain, (2) Fracture and (3) infection whereas the secondary outcomes were (1) neurological complications, (2) sensory disturbance and hypertrophic scars, (3) other complications such as shoe-wear difficulties and gait disturbance. Inclusion criteria were: studies on complications and adverse events of lower extremity bone autografts (calcaneal, proximal tibial, and distal tibial bone autografts) reporting at least one desired outcome. Studies not reporting any of the outcomes of interest or if the full text is not available in English were excluded. Studies reporting on bone marrow aspirate or autografts for non-orthopedic indications were also excluded. Results: After removal of duplicates, 5981 studies were identified. After screening, 85 studies remained for full-text assessment, and 15 studies qualified for the meta-analysis with a total of 2296 bone grafts.1557(67.8%) were calcaneal grafts, 625 (27.2%) were proximal tibial grafts, and 114 (5%) were distal tibial grafts. The mean age of all patients was 52.43+-16 [CI=51.77-53.08] years. The mean follow-up duration was 1.86+-1.70[CI=1.79-1.93] years. The primary surgery was reported for 2129 grafts(92.7%).Out of those, foot and ankle procedure represented 97.4% of the procedures. In calcaneal bone grafts, there were 28 cases of chronic pain [1.97%,CI:1.10-2.50%, I2=66%], 5 fractures [0.32%,CI:0.10-0.60%, I2=0%], 20 sural neuritis [1.28%,CI:0.70-1.80%, I2=0%), and no wound infections. In proximal tibial grafts there were 13 cases of chronic pain [2.08%,CI:1.01-3.2%, I2=34.5%], 1 fracture [0.16%,CI:0.10-0.50%, I2= 0%], and 3 superficial wound infections [0.48%,CI:0.10-1.01, I2=0%]. In the distal tibial grafts there were no cases of chronic pain or wound infections, 1 fracture [0.90%,CI:0.80-2.6%,I2=0%], and 5 saphenous neuritis [4.5%,CI: 0.70- 8.40%,I2=65%]. Conclusion: Calcaneal, distal tibial, and proximal tibial bone autografts are safe with a low rate of overall and major complications. We report an overall complication rate of 6.8%, which is less than half of that previously reported for iliac crest grafts. The authors recommend using distal lower extremity grafts for foot and ankle primary surgeries instead of iliac crest grafts when indicated. Clinical trials with large sample sizes are required.
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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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Alherbish, Aws, Colleen M. Norris, Jay Shavadia, Mohammad Almutawa, Seraj Abualnaja, Jayan Nagendran, Michelle M. Graham, and Sean Van Diepen. "Clinical and Angiographic Outcomes in Coronary Artery Bypass Surgery with Multiple versus Single Distal Target Grafts." Heart Surgery Forum 20, no. 4 (August 24, 2017): 132. http://dx.doi.org/10.1532/hsf.1793.
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Background: Coronary artery bypass grafting (CABG) with multiple distal target (MDT) grafts requires less graft material and reduces cardiopulmonary bypass time; however, there may be a higher incidence of graft failure. A real-world analysis reporting long-term outcomes associated with MDT grafts is lacking.Material and Methods: In 6262 consecutive patients who underwent an isolated first CABG from 2004-2012, patients with MDTs were propensity matched to those with single distal target (SDT) grafts. Logistic regression adjusted for traditional, anatomical, and functional definitions of complete revascularization (CR). Outcomes included 30-day, 1-year, and long-term mortality (median 6.29 years). Results: A total of 549 (8.8%) CABG patients had a MDT graft. CR defined using traditional (96.1% versus 92.0%, P = .005), anatomical (89.0% versus 80.20%, P < .001), and functional (90.7% versus 82.6, P < .001) definitions was more frequent in MDT patients. No significant differences in mortality were observed at 30 days (2% versus 3.3%, P = .18), 1-year (3.8% versus 4.9%, P = .37), or through end of follow-up (18.0% versus 16.6% P = .52) between the MDT and SDT groups, respectively. Similarly, no differences were observed after adjustment for all definitions of CR. Graft failure in MDT and SDT patients was 37.8% and 27.6%, respectively (P = .18).Conclusion: In a contemporary population-based cohort, no differences in mortality were observed between CABG patients with MDT and SDT grafts. Our findings support the safety of MDT grafts to facilitate CR in patients and when graft material is limited.
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Palumbo, Maria C., Alberto Redaelli, Matthew Wingo, Katherine A. Tak, Jeremy R. Leonard, Jiwon Kim, Lisa Q. Rong, et al. "Impact of ascending aortic prosthetic grafts on early postoperative descending aortic biomechanics on cardiac magnetic resonance imaging." European Journal of Cardio-Thoracic Surgery 61, no. 4 (November 29, 2021): 860–68. http://dx.doi.org/10.1093/ejcts/ezab501.
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Abstract OBJECTIVES Among patients with ascending thoracic aortic aneurysms, prosthetic graft replacement yields major benefits but risk for recurrent aortic events persists for which mechanism is poorly understood. This pilot study employed cardiac magnetic resonance to test the impact of proximal prosthetic grafts on downstream aortic flow and vascular biomechanics. METHODS Cardiac magnetic resonance imaging was prospectively performed in patients with thoracic aortic aneurysms undergoing surgical (Dacron) prosthetic graft implantation. Imaging included time resolved (4-dimensional) phase velocity encoded cardiac magnetic resonance for flow quantification and cine-cardiac magnetic resonance for aortic wall distensibility/strain. RESULTS Twenty-nine patients with thoracic aortic aneurysms undergoing proximal aortic graft replacement were studied; cardiac magnetic resonance was performed pre- [12 (4, 21) days] and postoperatively [6.4 (6.2, 7.2) months]. Postoperatively, flow velocity and wall shear stress increased in the arch and descending aorta (P < 0.05); increases were greatest in hereditary aneurysm patients. Global circumferential strain correlated with wall shear stress (r = 0.60–0.72, P < 0.001); strain increased postoperatively in the native descending and thoraco-abdominal aorta (P < 0.001). Graft-induced changes in biomechanical properties of the distal native ascending aorta were associated with post-surgical changes in descending aortic wall shear stress, as evidenced by correlations (r = −0.39–0.52; P ≤ 0.05) between graft-induced reduction of ascending aortic distensibility and increased distal native aortic wall shear stress following grafting. CONCLUSIONS Prosthetic graft replacement of the ascending aorta increases downstream aortic wall shear stress and strain. Postoperative increments in descending aortic wall shear stress correlate with reduced ascending aortic distensibility, suggesting that grafts provide a nidus for high energy flow and adverse distal aortic remodelling.
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Park, Jinha, and Si Young Roh. "Immediate Nail Bed Graft on Exposed Distal Phalanx in Fingertip Injury." Journal of Wound Management and Research 16, no. 3 (October 31, 2020): 207–10. http://dx.doi.org/10.22467/jwmr.2020.01298.
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Fingertip injuries with nail bed defects have traditionally been covered with full- or split-thickness nail bed grafts. However, it was widely understood, without sufficient evidence, that graft take is difficult if the nail bed is grafted directly on the distal phalanx. This study reports two successful cases of nail bed graft on sterile matrix defects with exposed bare cortical bone. Two patients suffered a crush injury on their fingers. While there was no fracture, the distal phalanx was exposed with a nailbed defect. As the defect was too large for primary closure and too small for flap coverage, a sterile matrix nailbed graft was performed using the ipsilateral big toe. In both cases, damaged nails have grown fully, identical to the contralateral finger with smooth and flat regrowth of the nail and adherence of the growing nail. Both outcomes were graded as excellent according to Zook’s criteria. No major complication was found except for a minor ingrown nail on donor site in both cases. Even if there is a nail bed defect with exposure of cortical bone, successful nail reconstruction could be obtained through immediate nailbed graft on the exposed distal phalanx.
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Shirasu, Takuro, Atsushi Akai, Manabu Motoki, and Masaaki Kato. "Clampless In-Situ Immobilized Branching (CLIMB) to Reconstruct the Internal Iliac Artery." Life 12, no. 11 (November 18, 2022): 1928. http://dx.doi.org/10.3390/life12111928.
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Background: Surgical reconstruction of the internal iliac artery (IIA) or its branches is sometimes demanding because of difficulty in distal clamping and suturing in the narrow pelvic space. Here we present a hybrid technique of ClampLess In-situ imMobilized Branching (CLIMB) to reconstruct IIA. Methods: in the CLIMB technique, an 8 mm artificial graft is sutured onto the surface of the common iliac artery (CIA) without clamping. Following puncture of the CIA wall, stent grafts are bridged from IIA to the graft. Finally, the graft is sutured to the ipsilateral external iliac artery (EIA). Concomitant endovascular aneurysm repair or IIA branch embolization can also be performed. We applied this technique to the patients unsuited for other IIA reconstruction. Results: eleven patients underwent the current technique. All but one patient underwent contralateral IIA interruption. Seven patients had a history of aorto-iliac repair before the index surgery. Iliac extender, internal iliac component, Viabahn VBX or Fluency covered stent were used for bridging the graft. Simultaneous IIA branch embolization was performed in 2 patients. Distal landing zones were IIA in 7 grafts, superior gluteal artery in 4 grafts and inferior gluteal artery (IGA) in 1 graft. Technical success was achieved in all cases. No patient complained of buttock claudication or other ischemic symptoms on the treatment side. During a mean follow-up period of 38 months, 11 out of 12 grafts were patent without any related endoleak. One IGA graft occluded at 56 months after surgery. Conclusions: the CLIMB technique is a viable alternative to preserve IIA with an acceptable mid-term durability.
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Jaff, Michael R., Gerald Dorros, Krishna Kumar, Gerardo Caballero, and Alfred Tector. "Endovascular Repair of an Ascending Aorta-to-Left Common Femoral Artery Graft with Aneurysmal Degeneration." Journal of Endovascular Therapy 2, no. 2 (May 1995): 189–95. http://dx.doi.org/10.1177/152660289500200213.
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Purpose: To report the use of endovascular grafting to repair degenerative aneurysmal changes in an extra-anatomic bypass graft. Methods: A 14-year-old extra-anatomic ascending aorta-to-left common femoral bypass graft (“ventral aorta”) had undergone aneurysmal degeneration, producing symptoms of progressive claudication and local abdominal swelling. The aneurysmal graft dilatation began within the thoracic cavity and extended through the entire extraperitoneal abdominal segment. The option for minimally invasive repair using a customized stent-graft device was offered to the patient as an alternative to standard reoperation. Results: An 8-mm × 42-cm endovascular graft was constructed of polytetrafluoroethylene with 30-mm Palmaz stents sutured to each end. With balloon occlusion of antegrade and retrograde blood flow, the stent-graft was delivered retrograde through an incision in the distal end of the existing bypass graft. The device was successfully positioned and deployed with complete exclusion of the aneurysm. No complications occurred, and the patient's symptoms abated. Follow-up arteriography at 1 month showed a pseudoaneurysm at the distal graft incision site; surgical repair was necessary. At 6 months, angiography demonstrated continued patency of the extra-anatomic bypass graft. Conclusions: Intraluminal aneurysm exclusion techniques in degenerated extra-anatomic bypass grafts may evolve into a viable therapeutic alternative to complex reoperative surgery.
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Conte, Michael S. "Challenges of Distal Bypass Surgery in Patients with Diabetes." Journal of the American Podiatric Medical Association 100, no. 5 (September 1, 2010): 429–38. http://dx.doi.org/10.7547/1000429.
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Surgical revascularization of the lower extremity using bypass grafts to distal target arteries is an established, effective therapy for advanced ischemia. Recent multicenter data confirm the primacy of autogenous vein bypass grafting, yet there remains significant heterogeneity in the utilization, techniques, and outcomes associated with these procedures in current practice. Experienced clinical judgment, creativity, technical precision, and fastidious postoperative care are required to optimize long-term results. The diabetic patient with a critically ischemic limb offers some specific challenges; however, numerous studies demonstrate that the outcomes of vein bypass surgery in this population are excellent and define the standard of care. Technical factors, such as conduit and inflow/outflow artery selection, play a dominant role in determining clinical success. An adequate-caliber, good-quality great saphenous vein is the optimal graft for distal bypass in the leg. Alternative veins perform acceptably in the absence of the great saphenous vein, whereas prosthetic and other nonautogenous conduits have markedly inferior outcomes. Graft configuration (reversed, nonreversed, or in situ) seems to have little effect on outcome. Shorter grafts have improved patency. Inflow can be improved by surgical or endovascular means if necessary, and distal-origin grafts (eg, those arising from the superficial femoral or popliteal arteries) can perform as well as those originating from the common femoral artery. The selected outflow vessel should supply unimpeded runoff to the foot, conserve conduit length, and allow for adequate soft-tissue coverage of the graft and simplified surgical exposure. This review summarizes the available data linking patient selection and technical factors to outcomes and highlights the importance of surgical judgment and operative planning in the current practice of infrainguinal bypass surgery. (J Am Podiatr Med Assoc 100(5): 429–438, 2010)
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Kopp, Franz. "Technique Tip: Distal Bone Graft Harvest." Foot & Ankle International 29, no. 3 (March 2008): 344–46. http://dx.doi.org/10.3113/fai.2008.0344.
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Hader, Maria, Matthias E. Sporer, Aidan D. Roche, Ewald Unger, Konstantin D. Bergmeister, Robert Wakolbinger, and Oskar C. Aszmann. "Fascicular shifting: a novel technique to overcome large nerve defects." Journal of Neurosurgery: Spine 27, no. 6 (December 2017): 723–31. http://dx.doi.org/10.3171/2017.3.spine16276.
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OBJECTIVEOver the last decade, a number of authors have investigated the utility of different biological and synthetic matrices as alternatives to conventional nerve grafts. However, the autologous nerve graft remains the gold standard, even though it often involves using a pure sensory nerve to reconstruct a mixed or even a pure motor nerve. Furthermore, limited donor sites often necessitate a significant mismatch of needed nerve tissue, especially for large proximal nerve defects such as brachial plexus lesions. Here, the authors present a new technique that overcomes these problems: the fascicular shift procedure (FSP). A fascicular group of the nerve distal to the injury is harvested in a sufficient length to bridge the nerve defect.METHODSThe method of fascicular shifting was tested at the sciatic nerve in 45 Lewis rats. In the experimental group, a 15-mm nerve defect was created and reconstructed with a fascicular group that was harvested directly distal to the gap. This group was compared with 1 negative control group (defect without reconstruction) and 3 positive control groups (sensory, motor, and mixed graft). After 12 weeks of nerve regeneration, outcome was evaluated using retrograde labeling, histomorphometric analysis, and muscle force analysis.RESULTSAll reconstructed groups showed successful regeneration with various levels of function. The negative control group showed minimal force measurements that were of no functional value. The fascicular shift provided sufficient guidance to overcome nerve defects, had higher (p < 0.1) motor neuron counts (1958.75 ± 657.21) than the sensory graft (1263.50 ± 538.90), and was equal to motor grafts (1490.43 ± 794.80) and mixed grafts (1720.00 ± 866.421). This tendency of improved motor regeneration was confirmed in all analyses. The mixed graft group was compared with the experimental group to investigate the influence of the potential damage induced by the fascicular shift distal to the repair site. However, none of the analyses revealed an impairment of nerve regeneration for both the tibial and common peroneal index muscles.CONCLUSIONSThis study demonstrates that harvesting a transplant from the nerve segment distal to the injury site offers a mixed graft without causing additional donor-site morbidity. These grafts perform statistically better than a standard sensory graft in terms of motor recovery. The fascicular shift presents a novel method to reconstruct large proximal nerve defects, making it immensely attractive in brachial plexus reconstruction.
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Kim, Yesel, Jeong-Kui Ku, In-Woong Um, Hyun Seok, and Dae Ho Leem. "Impact of Autogenous Demineralized Dentin Matrix on Mandibular Second Molar after Third Molar Extraction: Retrospective Study." Journal of Functional Biomaterials 14, no. 1 (December 20, 2022): 4. http://dx.doi.org/10.3390/jfb14010004.
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The purpose of this retrospective study was to evaluate bone healing after autogenous demineralized dentin matrix (DDM) grafts, focusing on the distal root of the mandibular second molar after the extraction of the third. We included retrospective data from 20 patients who had undergone molar extractions (15 male, 41.9 ± 12.0 years) between January 2020 and September 2022 and had DDM grafts implanted on the extraction socket, immediately (“immediate graft”) or 6 weeks (“delayed graft”) after the first surgery without primary closure. Patients who underwent grafting on only one side were used as the control group (n = 4). Bone defects at the mandibular second molar were measured preoperatively and 4 months after the graft surgery using cone-beam computed tomography (CBCT). Improvement of bone defect (i.e., the change in the bony defect pre- vs. postoperatively) was compared between the control and graft groups using the Wilcoxon Signed Rank test, and the difference between immediate and delayed grafts was analyzed with the Mann-Whitney U test. Complications such as infections or graft failure did not occur. Although pre-operative defects were smaller in the control than in the graft group (2.98 ± 1.77 and 10.02 ± 3.22 mm, p = 0.001), post-operative defects were similar in both (2.12 ± 0.59 and 2.29 ± 1.67 mm, respectively). The improvement ratio was not statistically significant in the control group (22.68 ± 15.36%) but a difference was observed in the graft group (76.70 ± 15.36%, p = 0.001). The amount of improvement of bone defect was not affected by graft timing or patient sex. In conclusion, DDM can improve bone defect at the distal aspect of the mandibular second molar after third molar extraction.
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Tiwari, Alok, Henryk Salacinski, Alexander M. Seifalian, and George Hamilton. "New Prostheses for Use in Bypass Grafts with Special Emphasis on Polyurethanes." Cardiovascular Surgery 10, no. 3 (June 2002): 191–97. http://dx.doi.org/10.1177/096721090201000301.
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Vascular bypass procedures using traditional prosthetic grafts such as polytetrafluoroethylen (PTFE) and polyethylene tetraphthlate (Dacron) are prone to failure when used in low flow states such as in below knee bypass and when the diameter of the graft is less than 6 mm. A major factor in this is compliance mismatch between the graft and the diseased vessel, which may cause intimal hyperplasia at the distal anastomosis. PTFE and Dacron are rigid grafts with poor compliance. By improving the compliance of the prosthetic graft it is hoped that patency will improve. Recent advances in polyurethane chemistry have developed materials that do not degrade and which allow compliance matching of the graft to the patient's vasculature. It is now possible to manufacture biologically and haemodynamically compatible grafts with small diameter from these polyurethane graft materials. This review will focus on the lack of compliance in current vascular bypass grafts and the promise of the new polyurethane polymers in a new generation of small-bore bypass grafts.
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Zhang, H., S. Chen, Z. Wang, Y. Guo, B. Liu, and D. Tong. "Topographic matching of distal radius and proximal fibula articular surface for distal radius osteoarticular reconstruction." Journal of Hand Surgery (European Volume) 41, no. 6 (December 16, 2015): 657–63. http://dx.doi.org/10.1177/1753193415622354.
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During osteoarticular reconstruction of the distal radius with the proximal fibula, congruity between the two articular surfaces is an important factor in determining the quality of the outcome. In this study, a three-dimensional model and a coordinate transformation algorithm were developed on computed tomography scanning. Articular surface matching was performed and parameters for the optimal position were determined quantitatively. The mean radii of best-fit spheres of the articular surfaces of the distal radius and proximal fibula were compared quantitatively. The radial inclination and volar tilt following reconstruction by an ipsilateral fibula graft, rather than the contralateral, best resembles the values of the native distal radius. Additionally, the ipsilateral fibula graft reconstructed a larger proportion of the distal radius articular surface than did the contralateral. The ipsilateral proximal fibula graft provides a better match for the reconstruction of the distal radius articular surface than the contralateral, and the optimal position for graft placement is quantitatively determined.
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Marymont, John V., Gerald Shute, Hongseng Zhu, Kevin E. Varner, Vibor Paravic, John L. Haddad, and Philip C. Noble. "Computerized Matching of Autologous Femoral Grafts for the Treatment of Medial Talar Osteochondral Defects." Foot & Ankle International 26, no. 9 (September 2005): 708–12. http://dx.doi.org/10.1177/107110070502600908.
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Background: Cored autologous graft from the distal ipsilateral femur has been used to fill osteochondral defects in the talus. There are no studies that compare the articular morphology of potential donor sites on the distal femur with recipient sites on the talus. Methods: Using coronal MRI of the talus and distal femur of five matched cadaver, computer reconstructions of the articular surfaces were prepared. From these, six 10-mm in diameter donor sites from the nonweightbearing surfaces of the medial and lateral aspects of the femoral condyles were matched to three recipient sites on the anterior, middle, and posterior aspects of the corresponding medial talus using customized computer software that minimized differences between the articular surfaces of the graft and the talus. After matching the femoral to the talar graft, the average and maximal distances between the surfaces (surface contour) and the average and maximal distances of the offset at the outer 1 mm of the graft periphery (step-off) were determined. Results: For all graft combinations, the average step-off was 0.24 +/−0.03 mm and the maximum 0.60 mm. The average surface contour was 0.32 +/−0.04 mm and the maximum was 1.16 mm. In all cases, the best donor site was from the superolateral femur for any medial talar lesion. Conclusion: In this study of grafts from the femoral condyles, the superolateral femur was the optimal location for an osteochondral graft for any medial talar lesion.
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Kölbel, Tilo, Nikolaos Tsilimparis, Kevin Mani, Fiona Rohlffs, Sabine Wipper, E. Sebastian Debus, Yskert von Kodolitsch, and Anders Wanhainen. "Physician-Modified Thoracic Stent-Graft With Low Distal Radial Force to Prevent Distal Stent-Graft–Induced New Entry Tears in Patients With Genetic Aortic Syndromes and Aortic Dissection." Journal of Endovascular Therapy 25, no. 4 (May 8, 2018): 456–63. http://dx.doi.org/10.1177/1526602818774795.
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Purpose: To describe a novel modification technique to lower the distal radial force of a thoracic stent-graft so as to avert stent-graft–induced new entry tears (SINE) in the fragile aorta of patients with genetic aortic disease and aortic dissection. Technique: A commercially available thoracic stent-graft is partially deployed on a back table. The most distal Z-stent is removed, the distal fabric is marked by vascular clips, and the modified stent-graft is reloaded and deployed in the true lumen of an aortic dissection. The technique is demonstrated in 3 patients with aortic dissection related to genetic aortic diseases. Conclusion: Creating a low distal radial force stent-graft is easy and can be done in a short time. Endovascular implantation appears feasible and safe.
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Chock, Megan M., Johnathon Aho, Nimesh Naik, Michelle Clarke, Stephanie Heller, and Gustavo S. Oderich. "Endovascular treatment of distal thoracic aortic transection associated with severe thoracolumbar spinal fracture." Vascular 23, no. 5 (November 18, 2014): 550–52. http://dx.doi.org/10.1177/1708538114560458.
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Endovascular repair has become the first line of treatment in most patients with blunt aortic injury. The most common mechanism is deceleration injury affecting the aortic isthmus distal to the origin of the left subclavian artery. Injuries of the distal thoracic aorta are uncommon. We report the case of a 25-year-old male patient who presented with paraplegia and distal thoracic aortic pseudoaneurysm associated with severe thoracolumbar vertebral fracture and displacement after a motocross accident. Endovascular repair was performed using total percutaneous technique and conformable C-TAG thoracic stent-graft (WL Gore, Flagstaff, AZ). Following stent-graft placement and angiographic confirmation of absence of endoleak, thoracolumbar spinal fixation was performed in the same operative procedure. This case illustrates a multispecialty approach to complex aortic and vertebral injury and the high conformability of newer thoracic stent-grafts to adapt to tortuous anatomy.
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SAITOH, S., and Y. NAKATSUCHI. "Long-Term Results of Vein Grafts Interposed in Arterial Defects Using the Telescoping Anastomotic Technique and Fibrin Glue." Journal of Hand Surgery 21, no. 1 (February 1996): 47–52. http://dx.doi.org/10.1016/s0266-7681(96)80011-8.
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Fibrin glue has been applied in the anastomosis of vein grafts placed in rat femoral arteries using the telescoping technique at both ends of the graft. 34 out of 35 grafts which were patent 1 to 3 weeks post-operatively were kept for 3 months to assess the long-term patency, and the effect of the glue on the diameters of the graft and femoral artery. All 34 grafts were patent 3 months post-operatively. Excessive enlargement of the graft diameter was alleviated by the fibrin glue without affecting the diameter of the femoral artery. The diameter at the proximal anastomosis was 66% and that at the distal anastomosis was 87% of the diameter of the femoral artery.
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HAERLE, M., H. E. SCHALLER, and C. MATHOULIN. "Vascular Anatomy of the Palmar Surfaces of the Distal Radius And Ulna: Its Relevance to Pedicled Bone Grafts at the Distal Palmar Forearm." Journal of Hand Surgery 28, no. 2 (April 2003): 131–36. http://dx.doi.org/10.1016/s0266-7681(02)00279-6.
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The potential for harvesting vascularized bone grafts from the palmar surface of the distal radius has been studied in 40 arms of fresh cadavers which had previously been injected with coloured latex solution. It was found that vascularized grafts can be pedicled on the radial part of the palmar carpal arterial arch. If a longer pedicle is required, the bone graft can be pedicled on the anterior branch of the anterior interosseous artery with retrograde flow occurring from the palmar carpal arch.
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Bosaeus, Linus, Kevin Mani, Anders Wanhainen, and Krister Liungman. "Open: Precannulated Fenestrated Endovascular Aneurysm Repair using Guidewire Fixator." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 12, no. 4 (July 2017): 265–68. http://dx.doi.org/10.1097/imi.0000000000000392.
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Objective By using a guidewire fixator, the distal guidewire position can be secured in an artery. This new principle enables a method for fenestrated endovascular aortic repair where the connection between the aortic branches and the stent graft fenestrations is made before inserting and deploying the stent graft. Methods This is conducted using a fenestrated stent graft with preloaded catheters, through which the prepositioned and distally secured guidewires from the branches are inserted. Results This report covers the method when implementing a single fenestration stent graft in pig. Conclusions Successful tests with single and dual fenestrated grafts have been conducted in pigs.
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GLASBY, M. A., S. E. GSCHMEISSNER, C. L.-H. HUANG, and B. A. DE SOUZA. "Degenerated Muscle Grafts used for Peripheral Nerve Repair in Primates." Journal of Hand Surgery 11, no. 3 (June 1986): 347–51. http://dx.doi.org/10.1016/0266-7681_86_90155-5.
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The basement membrane matrix of skeletal muscle has a tubular configuration resembling that of peripheral nerves. Grafts made of autogenous skeletal muscle denatured by freezing and thawing were used to repair the ulnar nerve in marmosets. By six months, normal hand function had returned and the grafts were shown to transmit normal compound extracellular action potentials in both directions. Morphological examination of the grafts and distal nerves revealed normal axon numbers and axon maturity. Myelination in the graft was found to take place more slowly than in the distal nerve segment. It is suggested that such grafts might be of use in the repair of human peripheral nerves.
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Balkhy, Husam H., Nirav C. Patel, Mahesh Ramshandani, Hiroto Kitahara, Valavunar A. Subramanian, Nicholas V. Augelli, Gareth Tobler, and Tung H. Cai. "Multicenter Assessment of Grafts in Coronaries." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 13, no. 4 (July 2018): 273–81. http://dx.doi.org/10.1097/imi.0000000000000533.
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Objective The commercially available C-Port distal anastomotic device (Food and Drug Administration cleared in 2007) is an automated miniature vascular stapler that performs the coronary anastomosis. This prospective multicenter registry sought to evaluate midterm patency using this device compared with hand-sewn grafts. Methods Patients receiving at least one C-Port anastomosis during coronary artery bypass grafting surgery were enrolled at eight sites. Of the 117 patients enrolled, 78 patients (67%) with 104 C-Port vein grafts completed the study to patency assessment via computed tomography angiography. Clinical follow-up and index graft patency (Gated 64-slice computed tomography scan) were performed at least 12 months postoperatively. The primary efficacy endpoint was patency compared with the peer-reviewed results from the PRoject of Ex-vivo Vein graft ENgineering via Transfection IV (PREVENT IV) trial. Results The patient population was consistent with the PREVENT IV placebo cohort. The mortality at 12 months was 0.85% (1/117). The major cardiac morbidity rate was 3.4% (4/117). The C-Port vein graft occlusion rate was 16.3% (17/104) compared with 26.6% (597/2242) in the PREVENT IV trial ( P = 0.011). Within this study, C-Port graft occlusion rates were not significantly different from the hand-sewn grafts ( P = 0.821). Conclusions The C-Port device is safe and effective in creating the distal anastomosis with equivalent patency rates to hand-sewn grafts at 12 months. When compared with hand-sewn anastomoses from a recent large prospective trial, the C-Port device demonstrated a statistically significant reduction in midterm graft occlusion. Further studies are required to evaluate its effect in less invasive coronary surgery.