A method for constricting large veins for use in arterial vascular reconstruction.
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 +/- 3.5 (p less than 0.05). Resorbable meshes can reduce the diameter of a venous graft by strengthening the vessel wall.(ABSTRACT TRUNCATED AT 250 WORDS)
Moritz
A
A
II. Chirurgische Universitätsklinik, University of Vienna, Austria.
Grabenwöger
F
F
Windisch
A
A
Horvath
R
R
Windberger
U
U
Losert
U
U
Wolner
E
E
D000818:Animals; D001672:Biocompatible Materials; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D005260:Female; D007601:Jugular Veins / Q000637:transplantation; D016687:Polydioxanone; D011091:Polyesters; D011093:Polyethylene Terephthalates; D011098:Polyglactin 910; D011474:Prosthesis Design; D012756:Sheep; D013526:Surgical Mesh; D013537:Sutures; D014654:Vascular Patency
D001672:Biocompatible Materials; D011091:Polyesters; D011093:Polyethylene Terephthalates; D016687:Polydioxanone; D011098:Polyglactin 910