Compliance and Formation of Distal Anastomotic Intimal Hyperplasia in Dacron Mesh Tube Constricted Veins Used as Arterial Bypass Grafts

Abstract

Dilated and varicose veins constricted with a Dacron mesh tube were successfully used as arterial bypass grafts to avoid nonautogenous vascular prostheses. Mesh constriction has also been used to adapt the venous graft lumen to the diameters of grafted arteries. The influence of the external mesh on the wall elasticity of such venous grafts and the reactions of the host artery were not investigated. Elastic properties of mesh constricted autologous veins used as arterial grafts in femoropopliteal reconstructions, as well as consecutive formation of distal anastomotic intimal hyperplasia (DAIH), were investigated in this experiment. Twenty-four autologous venous grafts were implanted in 12 sheep. Grafts were left natural (Groups 1 and 3) or were constricted with an external Dacron mesh (Groups 2 and 4); their diameters were left unchanged (Groups 1 and 2) or were matched to the diameter of the host artery (Groups 3 and 4). Wall elasticity of the graft, distal anastomosis, and distal artery were measured by locally applied crystal transducers during surgery and follow-up. Formation and localization of DAIH was evaluated histomorphologically after a median of 8.3 months. Graft wall elasticity was found to be lower (54.6 vs. 147.9, P = 0.006) and overall DAIH was found to be higher in mesh tube grafts (49.42 vs. 20.8 microns, P = 0.001, Mann-Whitney U-test). No differences in elasticity and DAIH formation were observed between grafts with adapted and large diameters. Constriction of venous grafts by a Dacron mesh tube reduces graft wall elasticity and promotes formation of DAIH. To avoid such an increased mismatch in compliance while making use of the advantages of this method, the external mesh tube must not be brought close to the distal anastomotic area itself.