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A Method for Constricting Large Veins for Use in Arterial Vascular Reconstruction
Author(s) -
Moritz Anton,
Grabenwoger Florian,
Windisch Alfred,
Horvath Reinhard,
Windberger Ursula,
Losert Udo,
Wolner Ernst
Publication year - 1990
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.1990.tb02989.x
Subject(s) - medicine , anatomy
Abstract: A satisfactory biologic graft can be created if dilated, but otherwise unusable veins are wrapped with a constrictive mesh tube. The purpose of this study was to determine whether a resorbable constrictive tube creates an appropriately sized vascular graft by induction of neoarterial wall growth. In 8 sheep a 5 cm segment of the carotid artery was resected and the external jugular vein inserted as a tubular graft. The vein was either wrapped with a polydioxanon (PDS) reinforced polyglactin (Vicryl) mesh (n = 4), a Vicryl mesh (n = 4), or a Dacron mesh tube (n = 3) to achieve a diameter reduction to 7 mm. Or the vein was used without reinforcement (n = 3). At angiography after 6 months the unreinforced veins had a diameter of 19 mm (range 15–22). The Vicryl reinforced veins measured 9.4 (8.5–10) mm, but 3 of 4 developed aneurysmatic dilatations at sites of valve sinuses with a mean diameter of 19 (15–21) mm. PDS reinforced veins measured 7.4 mm (7.1–7.9). Two of 4 had minor aneurysms of 13 and 16 mm. The two remaining PDS reinforced grafts were indistinguishable from the native artery. Dacron tubes reduced the vein size reliably to 7.6 (7.5–7.9) mm, but showed narrowing at the proximal anastomoses (PDS 7.2 ± 0.4, Dacron 6.1 ± 0.4, p = 0.016). PDS wrapping reduced maximal graft diameter to 10.9± 4 mm as compared to that of the native vein, 18.7±pL 3.5 (p < 0.05). Resorbable meshes can reduce the diameter of a venous graft by strenghtening the vessel wall. PDS reinforcement needs further technical refinement to prevent local dilatation at the sites of venous valves. Dacron seems to be a safe alternative in this respect but tends to create anastomotic narrowing.