Abstract
Background. Autovein is considered as the best prosthesis in the infrainguinal bypass surgery. However, in 30 % of individuals great saphenous vein is inappropriate for grafting because it is too small or due to phlebitis, varicosity and prior surgery. From this point of view, decellularized vascular grafts, which retain most of the properties of living tissues, seem quite interesting. Due to the high frequency of development of prosthetic aneurysm in the postoperative period xenografts does not gain high popularity. This complication occurs in an average of 6 % of cases, but modern technological advances in manufacture of xenografts have reduced the percentage of aneurysms to 4.1 %, which is still high. To solve this problem, we decided to use external support of nitinol mesh. Aim: assessment of efficiency of bioprosthesis with external support by knitted nitinol mesh as a conduit in infrainguinal bypass surgery. Materials and methods. It was a single-center randomized controlled trial in two groups, 36 patients in each group. There were no statistically significant differences between the groups. Patients of the control group underwent a standard femoropopliteal bypass surgery. In experimental group we used bioprosthesis with external support by knitted nitinol mesh. Results. Aneurysms development was observed in 6 patients (16.67 %) of the control group (4 patients - anastomotic aneurysms; 2 patients - true shunt aneurysms). There were no aneurysms in the experimental group (p < 0.05). Conclusion. The use of a nitinol-based mesh effectively prevents the development of an aneurysm of the xenograft in the postoperative period.
Highlights
Autovein is considered as the best prosthesis in the infrainguinal bypass surgery
Due to the high frequency of development of prosthetic aneurysm in the postoperative period xenografts does not gain high popularity. This complication occurs in an average of 6 % of cases, but modern technological advances in manufacture of xenografts have reduced the percentage of aneurysms to 4.1 %, which is still high
Aneurysms development was observed in 6 patients (16.67 %) of the control group (4 patients – anastomotic aneurysms; 2 patients – true shunt aneurysms)
Summary
Autovein is considered as the best prosthesis in the infrainguinal bypass surgery. in 30 % of individuals great saphenous vein is inappropriate for grafting because it is too small or due to phlebitis, varicosity and prior surgery. Многочисленные исследования доказали, что аутовена считается протезом выбора при операции бедренно-подколенного шунтирования (БПШ) и является наиболее часто используемым кондуитом при артериальных реконструкциях [7, 8]. В то же время примерно в 30 % случаев аутовена недоступна для использования по причине её недостаточной длины, диаметра или варикозной трансформации, что заставляет хирургов выбирать синтетические либо биологические протезы [2]. В связи с этим разработка способа профилактики развития аневризм ксенопротезов кровеносных сосудов с целью их дальнейшего использования в качестве полноценной альтернативы аутовене является весьма актуальной. Нами предложен способ укрепления шунта устройством из никелида титана марки ТН-10 машинного плетения с толщиной нити 40 мкм и внутренним диаметром 1,0 см. Пациентам группы контроля выполнялась классическая операция БПШ ксенопротезом «КемАнгиопротез» (ЗАО «НеоКор», Россия), в экспериментальной группе выполнялась операция БПШ с использованием ксенопротеза, армированным экстравазально установленной цилиндрической конструкцией из никелида титана (рис. 1) марки ТН-10 машинного плетения, с толщиной нити 40 мкм и внутренним диаметром 1,0 см (НИИ Медицинских материалов и имплантатов с памятью формы, Томск, Россия)
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