Knitted Dacron Grafts Research Articles

Giant pseudoaneurysm due to Dacron graft degeneration: A case report

Knitted Dacron grafts are often preferred as they are easy to process, soft, and flexible; they also tend to expand due to their high porosity. Bleeding and pseudoaneurysm formation at the anastomotic site are common complications of vascular surgery, but nonanastomotic bleeding due to degeneration of Dacron graft's textile structure is rare. Here, we present a 70-year-old male diagnosed with a giant pseudoaneurysm that continues from the femoral artery to the popliteal artery formed due to the degeneration of the previous seven-year-old prosthetic graft. The pseudoaneurysm continued to be the source of arterial flow with its capsule, and the arterial flow into it was able to provide blood supply to the lower extremity without causing ischemia. The patient underwent surgery to excise the giant pseudoaneurysm and create a new bypass between the femoral and popliteal arteries. Today, the durability of prostheses is becoming increasingly important, and modifications in the manufacturing process have made Dacron grafts more resistant to cyclic pulsatile stretching and facilitated the adaptation of the prosthetic material to the host tissue. Despite all the remarkable innovations over the last 50 years, complications of prosthetic grafts can result in fatal bleeding. This situation emphasizes the importance of close follow-up and detailed clinical and radiological evaluation of patients.

A Case of Anastomotic Pseudoaneurysm due to Late Dysruption of Knitted Dacron Graft Treated by Hybrid Operation

A Case of Anastomotic Pseudoaneurysm due to Late Dysruption of Knitted Dacron Graft Treated by Hybrid Operation

Clampless aortic punch system for making a large-diameter access route without side-biting clamp: a preliminary study.

Although thoracic endovascular aneurysm repair (TEVAR) has been getting popularity as a less-invasive procedure, the treatment of thoracic aortic aneurysm with atherosclerotic aortic disease is still challenging. In hybrid TEVAR through the median sternotomy approach, side-biting clamp of the ascending aorta is often necessary for making an access route; however, it could cause embolic complication and aortic dissection. This study aimed to present the results of our preliminary study on the clampless aortic punch system (APS). The swine aorta was used as experimental specimen (diameter 16-20mm). A 10-mm collagen-impregnated knitted Dacron graft was anastomosed to the aorta, and the APS was inserted into it. After piercing the aorta with the inner fish hook of the APS, the aortic wall was scooped out by an outer round cutter. Three different-angled cutters (0°, 15°, and 30°) were tested three times. The diameter of the punched-out lesion ranged from 6 to 9mm (median 8mm). Macroscopically, no major vessel injuries were seen 15° series, whereas minor or major vessel injuries were seen 30° and 0° series, respectively. Histological findings of 15° series confirmed the sharp edge of the stump and abrupt interruption of the elastic fiber without destruction of the normal three-layer structure of the aortic wall. This study suggests that our clampless APS could reduce the risk of stroke and aortic injury in hybrid TEVAR, and an animal study confirming its utility is now under consideration.

Infected Iliac Artery Aneurysm Concomitant with Liver Abscess Caused by <i>Fusobacterium nucleatum</i>

We report a case of infected iliac artery aneurysm concomitant with liver abscesses caused by Fusobacterium nucleatum. A 58-year-old man developed an aneurysm of the right common iliac artery and liver abscesses. The aneurysm was resected and a femoro-femoral crossover bypass with a knitted Dacron graft was performed for impending rupture. Anaerobic cultures obtained from blood and intramural thrombus were positive for Fusobacterium nucleatum. With antibiotics, the liver abscesses disappeared without drainage. Iliopsoas abscesses developed after surgery, but it was controlled with antibiotics. The patient was free of infection 1 year after the surgery. The causative bacterium was suspected to originate in the oral cavity, because the patient had a notable history of poor chronic periodontal conditions. Clinically, infected aortoiliac aneurysm complicated by Fusobacterium is extremely rare relative to the prevalence of the pathogenic bacterium. However, it is noteworthy that Fusobacterium can cause this condition.

腹部大動脈瘤人工血管置換術後遠隔期に生じた非吻合部仮性動脈瘤に対してEVAR を施行した1 例

腹部大動脈瘤人工血管置換術後遠隔期に生じた非吻合部仮性動脈瘤に対してEVAR を施行した1 例

Y 型人工血管置換術後9 年で分岐部に発症したシールドグラフト破綻による非吻合部瘤の1 例

Y 型人工血管置換術後9 年で分岐部に発症したシールドグラフト破綻による非吻合部瘤の1 例

Clinical analysis of non-anastomotic aneurysms of implanted prosthetic grafts

To investigate the features of non-anastomotic aneurysms (NAAs) of implanted prosthetic grafts through our case series and present a general review of NAAs. We studied retrospectively, a series of NAAs of seven grafts in six patients treated between 2001 and 2010, and reviewed the data on NAAs reported between 1962 and 2009. The grafts in our series were implanted between 1986 and 2006. The primary surgical procedures were bypass between the axillary and femoral artery (n = 1), bypass between the subclavian artery and abdominal aorta (n = 1), bypass between the aorta and femoral artery (n = 1), bypass between the femoral and popliteal artery (n = 1), bypass between the femoral and femoral artery (n = 2), and bypass between the aorta and iliac artery (n = 1). The graft material was knitted Dacron in all cases and the implantation period ranged from 2.7 to 24 years (median 13.8 years). All NAAs originated from a hole in the graft. Reports of NAA have decreased dramatically, although according to the data, knitted Dacron accounted for 80 % of these implanted grafts. Graft deterioration and the subsequent development of an NAA can occur even with the latest knitted Dacron grafts, even though the incidence is very low.

Longitudinal rupturing of a knitted Dacron graft 30 years after its implantation

A 79-year old man with a pulsatile mass in his left groin was admitted to our institution in 2012. He had undergone an aortobifemoral bypass using a bifurcated Cooley double velour knitted Dacron graft for aortoiliac occlusive disease in 1982. Computed tomography detected a 34 mm para-anastomotic pseudoaneurysm in the left limb of the graft. Graft replacement was performed to prevent the aneurysm from rupturing, and we found that the old Dacron graft had ruptured longitudinally along its guideline. The disrupted portion of the old Dacron graft was excised and examined by scanning electron microscopy, which revealed the deterioration of the polyester filaments around the guideline.

Nonanastomotic rupture of thoracic aortic Dacron graft treated by endovascular stent graft placement

A 61-year-old man had a Stanford type A acute aortic dissection, and the total aortic arch was replaced with 22-mm knitted Dacron graft in 1996. In 2006, he underwent mitral valve replacement and tricuspid valve repair due to severe mitral and tricuspid valve regurgitation. Although preoperative computed tomography (CT) scan suggested pseudoaneurysm around the Dacron graft replaced with aortic arch, it could not be repaired concomitantly. Four months later, in view of the technical difficulties of an open surgical procedure, the prosthetic graft failure was repaired by endovascular stent graft consisting of a Gianturco Z stent covered with an UBE woven Dacron graft. However, during a follow-up, aneurysm sac diameter increased without any sings of endoleak in follow-up CT scans. Redo endovascular stent graft placement using a Gore-TAG device was performed. Subsequently, shrinkage of the pseudoaneurysmal sac could be observed.

A pilot study of a triple antimicrobial-bonded Dacron graft for the prevention of aortic graft infection

Perioperative infection of an aortic graft is one of the most devastating complications of vascular surgery, with a mortality rate of 10% to 30%. The rate of amputation of the lower limbs is generally >25%, depending on the graft material, the location of the graft and infection, and the bacterial virulence. In vitro studies suggest that an antibiotic-impregnated graft may help prevent perioperative graft infection. In a pilot animal study, we tested a locally developed technique of bonding Dacron aortic grafts with three antimicrobial agents to evaluate the ensuing synergistic preventive effect on direct perioperative bacterial contamination. We surgically implanted a 6-mm vascular knitted Dacron graft in the infrarenal abdominal aorta of six Sinclair miniature pigs. Two pigs received unbonded, uninoculated grafts; two received unbonded, inoculated grafts; and two received inoculated grafts that were bonded with chlorhexidine, rifampin, and minocycline. Before implantation, the two bonded grafts and the two unbonded grafts were immersed for 15 minutes in a 2-mL bacterial solution containing 1 to 2 × 10(7) colony-forming units (CFU)/mL of Staphylococcus aureus (ATCC 29213). Two weeks after graft implantation, the pigs were euthanized, and the grafts were surgically excised for clinical, microbiologic, and histopathologic study. The two bonded grafts treated with S aureus showed no bacterial growth upon explant, whereas the two unbonded grafts treated with S aureus had high bacterial counts (6.25 × 10(6) and 1.38 × 10(7) CFU/graft). The two control grafts (unbonded and untreated) showed bacterial growth (1.8 × 10(3) and 7.27 × 10(3) CFU/graft) that presumably reflected direct, accidental perioperative bacterial contamination; S cohnii ssp urealyticus and S chromogenes, but not S aureus, were isolated. The histopathologic and clinical data confirmed the microbiologic findings. Only pigs that received unbonded grafts showed histopathologic evidence of a perigraft abscess. Our results suggest that bonding aortic grafts with this triple antimicrobial combination is a promising method of reducing graft infection resulting from direct postoperative bacterial contamination for at least 2 weeks. Further studies are needed to explore the ability of this novel graft to combat one of the most feared complications in vascular surgery.

Long-term size follow-up of knitted Dacron grafts (Gelseal ) used in the ascending aorta

There is limited information about the size change of a knitted Dacron graft (Gelseal™) used in the thoracic aorta. We evaluated the diameters of the Gelseal™ grafts at a long-term follow-up for 3.7 ± 1.3 years (1-5.9 years; median, 4.0 years), which were used for replacement of the ascending aorta in 59 patients with acute aortic dissection. The early and late dilatation rates (LDRs) of the prosthetic grafts were calculated retrospectively based on the graft diameter at the level equivalent to the ascending aorta on the pre-discharge computed tomography (CT) scans and follow-up CT scans performed every year after surgery. Immediately after surgery (15 ± 7 days), the early dilatation of the Gelseal™ grafts was 26.0 ± 6.0% with significant correlations with the number of post-operative days (R = 0.500, P = 0.003). At the follow-up for 3.7 ± 1.3 years, the LDR was 10.5 ± 6.6%, which was also significantly correlated with the number of the post-operative years (R = 0.608, P = 0.001). Linear regression analysis indicated that the annual dilatation rate was ≈ 3.23%. During the follow-up, we have experienced no redo surgery due to graft fracture or false aneurysm formation at the anastomosis sites associated with the graft dilatation. In conclusion, the Gelseal™ graft used in the ascending aorta demonstrates a small but continuous increase in the diameter, up to 5 years after implantation, without any adverse events.

Abdominal Aortic Disease Caused by Penetrating Atherosclerotic Ulcers

Penetrating atherosclerotic ulcer (PAU) of the aorta is defined as an atherosclerotic lesion with ulceration of the aortic intima and media and rupture of the internal elastic lamina. PAU induced aortic dissection, aortic rupture, and secular aortic aneurysm and typically occurs in elderly hypertensive patients with severe atherosclerosis. Although it has been reported that atherosclerosis similarly occurs in the abdominal aorta, its natural history and treatment are still unclear. This study investigated the clinical features, natural history, and treatment of PAU of the abdominal aorta. Between April 2006 and March 2009, 4 diagnoses of PAU in the abdominal aorta were made by computed tomography (CT) and magnetic resonance imaging (MRI). These 4 cases were analyzed along with 61 previously reported cases from the literature with diagnoses of PAU in the abdominal aorta, aortic rupture, and isolated abdominal aortic dissection over the past 15 years, giving a total of 65 cases. The patients were men with an average age of 63.5 years. All 4 had hypertension, and 2 had concomitant coronary artery disease. Two patients were asymptomatic, and the other 2 were symptomatic and transmural rupture had occurred. All diagnoses were made by CT and MRI. All 4 patients underwent open surgery with a knitted Dacron graft, with no postoperative deaths. In the literature, 53% of cases were symptomatic, including pain (40%, n = 26), shock (4.6%, n = 3), and lower limb embolism (9.2%, n = 6). The remaining 40% of cases were asymptomatic (n = 26). Six patients were treated medically, while 58 patients underwent surgery, with 2 postoperative deaths. We suggest that surgical treatment (open surgery or endovascular stent grafting) should be performed to prevent an aortic catastrophe such as intramural hematoma, dissection, or rupture. (English translation of Jpn J Vasc Surg 2010; 19: 723-730.).

Externally Supported, Noncoated, Knitted Dacron Graft and Gelatin-Coated Knitted Dacron Graft with Rings for Peripheral Arterial Reconstruction.

During the last 14 years, externally supported noncoated knitted Dacron grafts (EXS) and gelatin-coated knitted Dacron grafts with rings (GEL) were used in 176 patients for femoropopliteal bypass (F-P), femorofemoral bypass (F-F) and axillofemoral bypass (Ax-F). In the EXS group, 58 F-P above knee (ak), 42 below knee (bk), 25 F-F, and 19 Ax-F surgeries were performed. Twenty-three F-Pak, 5 F-Pbk, 26 F-F, and 8 Ax-F surgeries were performed in the GEL group. In the F-Pak, primary patency at 5 and 9 years was 75.5 and 53% for the EXS and that at 3 and 5 years was 75.0 and 60.0% for the GEL (n.s.). In the F-Pbk, primary patency at 5 and 10 years was 60.5 and 29.5% for the EXS, while patency at 1 year was 11.1% for the GEL (P < 0.05). In both the EXS and the GEL groups, the F-Pak surgery showed better outcomes than the F-Pbk surgery. The outcomes of the F-P grafts implanted into the legs with claudication were better than those performed for the limb salvage cases. Primary patency of the F-F and the Ax-F showed no differences and there were also no differences between the graft types. For F-Pak surgery, the EXS is the graft of choice. The GEL is not suitable for F-Pbk surgery. For F-F and Ax-F reconstruction, both the EXS and the GEL are acceptable.

Development of femoro-femoral and axillo-femoral bypass procedures

Development of femoro-femoral and axillo-femoral bypass procedures

Pseudoaneurysm in the Left Groin due to Ruptured Knitted Dacron Graft

An 82-year-old man was admitted to our institution with a painful pulsating mass in the left groin. He had undergone bypass surgery with a bifurcated Cooley double velour knitted Dacron graft to treat aorto-iliac occlusive disease 21 years previously. Computed tomography demonstrated a 35-mm pseudoaneurysm near the distal anastomosis site of the graft. Opening the aneurysm revealed that the graft was disrupted along the guideline. We resected the aneurysm and interposed an expanded polytetrafluoroethylene (ePTFE) graft. Vascular surgeons should consider that grafts can fail in patients with long-term prosthetic grafts.

Mycotic Abdominal Aneurysm Caused by Campylobacter Fetus: A Case Report for Surgical Management

We report a rare case of mycotic abdominal aortic aneurysm associated with Campylobacter fetus. A 72-year-old male admitted to the hospital because of pain in the right lower quadrant with pyrexia. The enhanced abdominal computed tomography (CT) examination showed abdominal aortic aneurysm (AAA) measuring 50 mm in maximum diameter and a high-density area of soft tissue density from the right lateral wall to the anterior wall of the aorta. However, since the patient showed no significant signs of defervescence after antibiotics administration, so we performed emergency surgery on the patient based on the diagnosis of impending rupture of mycotic AAA. The aneurysm was resected in situ reconstruction using a bifurcated albumin-coated knitted Dacron graft was performed. The cultures of blood and aneurysmal wall grew Campylobacter fetus, allowing early diagnosis and appropriate surgical management in this case, and the patient is making satisfactory progress. This is the fifth report of mycotic AAA characterizing culture positive for Campylobacter fetus in blood and tissue culture of the aortic aneurysm wall.

Bilateral Retroperitoneal Approach to Repairing a Ruptured Right Iliac Artery Aneurysm in a Patient who has Undergone Transperitoneal Abdominal Surgery

An 84-year-old woman with a history of surgery for cholangiocarcinoma presented to Akita University Hospital with severe right lower abdominal pain, respiratory distress, and hypotension. Computed tomography scanning revealed a ruptured right common iliac artery aneurysm with a massive right retroperitoneal hematoma and a right internal iliac artery aneurysm. Under the bilateral retroperitoneal approach, we preformed an in-situ repair of an aneurysm rupture from the aorta to the left common and right external iliac arteries using a bifurcated knitted Dacron graft, and then we ligated the right internal iliac artery. The postoperative course of the patient was uneventful. The patient was discharged from hospital 52 days after surgery. In conclusion, a bilateral retroperitoneal approach may be a safe and useful strategy for in-situ repair of a right iliac artery aneurysm rupture in patients with peritoneal adhesions after transperitoneal abdominal surgery.

Acute Aortic Occlusion Due to False-Lumen Expansion After Repair of Abdominal Aortic Rupture in Type B Acute Aortic Dissection

We describe a patient with aortic occlusion due to false-lumen expansion after repair of abdominal aortic rupture in acute type B aortic dissection. A 70-year-old man presented to a nearby hospital with severe lower back pain, and was subsequently referred to our hospital with a diagnosis of abdominal aortic rupture. Computed tomography scanning on admission revealed type B aortic dissection with concomitant false-lumen rupture at the level of pre-existing infrarenal abdominal aortic aneurysm. The patient underwent abdominal aortic replacement with the true lumen reconstructed using a bifurcated knitted Dacron graft. On postoperative day 2, the patient developed severe lower body ischemia. Computed tomography scanning revealed complete true-lumen occlusion at the renal artery level because of false-lumen expansion. The patient underwent open fenestration by opening the bulging flap with a transverse graftotomy distal to the proximal graft anastomosis. After fenestration, the patient developed severe metabolic complications (i.e., myonephropathic-metabolic syndrome) and died a day later of cardiac arrest resulting from hyperkalemia. Abdominal aortic replacement with true-lumen reconstruction in patients with abdominal aortic rupture in type B acute aortic dissection could also lead to acute aortic occlusion due to re-dissection or true-lumen compromise accompanying retrograde propagation of false-lumen thrombosis. This lethal sequela after true-lumen reconstruction might be prevented by an adjuvant procedure such as concomitant fenestration.

Dehiscence of aortic valve commissure complicated by aortic regurgitation

Dehiscence or aortic valve commissural tear is a rare cause of acute aortic regurgitation (AR). We report a case of aortic valve commissural dehiscence with progressive AR and aortic root dilatation that was successfully repaired with aortic root and ascending aortic replacements. Clinical Summary A 67-year-old man was admitted to the Sakakibara Heart Institute with new onset of exertional precordial pain. His electrocardiogram and cardiac enzymes were normal. Contrast-enhanced computed tomography showed a small pericardial effusion but did not reveal aortic dissection. A transthoracic echocardiogram showed mild AR with no dilatation of the cardiac chamber. Furthermore, a flap or intimal tear of the proximal aorta was absent on transthoracic echocardiography. Because the patient had a history of paroxysmal atrial fibrillation, an antiarrhythmic drug was prescribed before discharge. After 1 month, he was readmitted to the Sakakibara Heart Institute because of the progression of dyspnea on exertion. He had a new diastolic murmur and a systolic murmur. Chest x-rays revealed pulmonary congestion. Transthoracic echocardiography demonstrated severe AR and moderate mitral regurgitation with dilatation of the left ventricle. Computed tomography showed aneurysmal enlargement of the ascending aorta with aortic root dilatation (ascending aorta, 47 mm; sinotubular junction, 44 mm; sinus of Valsalva, 44 mm); however, there was no evidence of aortic dissection. Transesophageal echocardiography was performedto assess the cause of AR. Transesophageal echocardiography revealed a prolapse of both the right and left coronary cusps (Figure 1) with no intimal flap in the ascending aorta. Surgery was planned after medical control of the patient’s heart failure. Amediansternotomywasperformed.Whenthepericardiumwas opened,bloodyserouseffusionwas observed.Cardiopulmonary bypass was performed with ascending aortic and bicaval venous cannulations. Bilateral pulmonary vein isolation with radiofrequency ablation was done before cardiac arrest. After aortic clamp and cardiac arrest, mitral annuloplasty with a semi-rigid ring (size, 28 mm) was performed. The body temperature was decreased to 25C, systemic perfusion was temporarily arrested, and retrograde cerebral perfusion was started. The ascending aorta was resected and replaced with a 24-mm knitted Dacron graft (Hemashield Gold, Boston Scientific, Natick, Mass) with 1 branch. After the completion of distal aortic anastomosis, systemic perfusion through the side branch of the graft was resumed. There was no dissection or intramural hematoma in the ascending aorta. There was a dehiscence of the commissure between the right and left coronary cusps of the aortic valve (Figure 2). The valve leaflets were slightly atherosclerotic but almost intact, and the aortic wall was normal. We performed aortic root replacement with a commercially available composite valved conduit (23‐26 mm; Carboseal, CarboMedics, Austin, Tex). Total cardiopulmonary bypass time was 188 minutes. The postoperative course was uneventful, and no neurologic deficit occurred.

Late-stage, nonanastomotic rupture of double-velour Dacron graft after descending aortic replacement

d doi:10.1016/j.jtcvs.2006.06.007 acron arterial prostheses, which have proven to be efficient and durable conduits, have been widely used in cardiovascular surgery. However, late graft failures involving infection, anastomotic pseudoaneurysm, aneurysmal dilatation, or graft upture are known to occur with them. We report an interesting case of rupture of a ouble-velour knitted Dacron graft that had been implanted in the descending aorta over 20 ears previously.