Abstract
In an experience with 56 small arterial reconstructions using Biograft, we consider that the pannus hyperplasia at the anastomotic site is the main cause of graft failure occurring in the intermediate period (6 months to 2 years) and likely due to compliance mismatch and abnormality of the anastomotic geometry. We previously reported that host artery at the anastomotic site is most seriously affected by compliance mismatch and the influence of compliance mismatch is amplified by abnormality of anastotic geometry. This report describes an effectiveness of fixation of the anastomotic host artery using Teflon ring and or AronAlpha in order to prevent intimal hyperplasia. Twenty two grafts of EPTFE with a diameter of 4mm, were plased in the carotid arteries of 11 dogs. Follow up ranges from 4 to 16 weeks. Twenty-two grafts were devided into 3 groups. Group 1; control, 11 grafts. Group 2; 6 grafts. Host arteries at the anastomotic sites were fixed with Teflon rings. Group 3; 5 grafts. Host artery were stabilized with AronAlpha. Group 1 patency at 4 weeks were 70%, Group 2 50%, Group 3 80%. Of 11 grafts of control gourp, 2 patent grafts were demonstrated obvious intimal hyperplasia of host artery at the proximal anastomotic site at 4 and 12 weeks after implantation, respectively. Of the total 22 grafts, 12 grafts showed good anastomotic geometry and remainder showed poor. The anastomotic geometry were graded as good to poor by our angiographic criteria. The good geometry group patency at 4 weeks was 83.3%, poor geometry group 44.4%. We have concluded that anastomotic geometry is the most important factor influencing the early results and, when anastomotic geometry is satisfactory, failures occurring in the intermediate period are mainly caused by intimal hyperplasia due to compliance mismatch, and which is minimized by the fixation of the host artery at the anastomotic site.
