Knitted Dacron Research Articles

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.

The Influence of Collagen Impregnation of a Knitted Dacron Patch Used in Carotid Endarterectomy

In selected populations, carotid endarterectomy (CEA) reduces long-term stroke risk. Studies have shown increased risk of restenosis with use of a collagen-impregnated Dacron patch compared to a polytetrafluorethylene patch. There is concern that collagen impregnation may initiate thrombosis or promote restenosis due to platelet activation. We performed a retrospective analysis of our CEA experience with routine patching using knitted Dacron patches with (Hemashield) and without (Sauvage) collagen impregnation. Our database was queried for all CEAs between January 2006 and December 2010. Seven surgeons performed 655 CEAs. Patients were excluded if no patch was used (n=1), a primary CEA was performed before study period or by other surgeons (n=11), or the patch type was indeterminable (n=38). Demographics, clinical data, and outcomes were compared between the collagen-impregnated (C, Hemashield) group and non-collagen-impregnated (NC, Sauvage) group. A total of 605 CEAs were analyzed (395 C and 210 NC). Demographics were similar except for coronary artery disease (C 54.3% vs. NC 41.6%, P=0.003). There was no statistically significant difference in 30-day (C 99.7% vs. NC 99.5%, P>0.99) or 5-year survival (C 80.0% vs. NC 83.7%, P=0.26) or 30-day stroke rate (C 0.3% vs. NC 1.0%, P=0.28). No late ipsilateral strokes occurred during 5-year follow-up. The 5-year freedom from restenosis >30% (C 85.3% vs. NC 86.4%, P=0.33), restenosis >50% (C 94.5% vs. NC 95.5%, P=0.44), and restenosis >70% (C 98.6% vs. NC 98.9%, P=0.73) were similar. Two patients underwent carotid stenting for restenosis >70%. Two patients (both in the C group) developed occlusion of the carotid artery. The thrombosis and restenosis rates in the 2 groups were similar. This suggests that collagen-impregnated patches do not initiate thrombosis or increase restenosis rates after CEA.

Morpho-Pathological Review on the Healing of Synthetic Vascular Grafts

Abstract Objective: Tissue integration of vascular grafts partially depends on the host response to injury, which immediately begins after implantation and restoration of the circulation. In an infected environment, the inflammation changes the incorporation patterns. The aim of the study was to observe the tissue incorporation process, in a normal and an infected environment. Methods: We have created an experimental model by performing subfascial implantation of four types of vascular grafts, in rats (woven Dacron®, knitted Dacron®, silver coated Dacron® and expanded Polytetrafloroethylene - ePTFE) and by infecting some of them with three different bacterial strains. We have retrieved the noninfected grafts at two and four weeks after implantation, whilst the infected ones at one, two and three weeks. Results: Detailed microscopic appearences were analysed. The control and infected groups were compared. Statistical significance was calculated for various corelations. Conclusions: The morphopathological findings showed that the ePTFE graft’s structure was best preserved. Statistical significance existed between the bacterial strain and the degree of inflammation. The silver coated Dacron® was not shown to be superior to the knitted Dacron®. The poorest incorporation was the one of the woven Dacron®.

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

Gigantic 25-cm abdominal aortic aneurysm

A 69-year-old man presented to the hospital in June 1993 with a prominent, visibly pulsatile abdominal mass (A). The patient had a history of smoking, hypertension, hepatitis C, and tuberculosis and had noted a pulsation in his abdomen for several years but had never sought medical attention. Physical examination demonstrated a very large, nontender, pulsatile mass with a soft bruit. Translumbar aortography revealed a gigantic infrarenal abdominal aortic aneurysm (AAA) measuring 25 cm in diameter with a large mural thrombus extending to the aortic bifurcation and both common iliac arteries (B). The patient was prepared for urgent open surgical aneurysm repair under general anesthesia and gave informed consent for photographic documentation and publication of his case. At operation (C), the aneurysm was readily exposed; the transverse diameter was measured with a centimeter scale and recorded as 25 cm by the surgeon. After infrarenal cross-clamping, the aneurysm was opened, a massive mural thrombus was removed, and a bifurcated 22 10-cm knitted Dacron aortoiliac graft was sewn in place (D). Excess aneurysm wall was trimmed, and the remaining aneurysm wall was closed over the graft. The patient received one unit of Cell Saver blood transfusion, was extubated immediately after the operation, and had an uneventful recovery. He was discharged from the hospital on day 12 and had no subsequent events related to the aneurysm or surgical repair. He survived for 7 years, dying of heart failure at the age of 76 years. The majority of AAAs are discovered when they are 6 cm, with an annual rupture risk of 30% to 50% for aneurysms >8 cm. Thus, it is unlikely that patients with very large aneurysms survive for a long time. Indeed, aneurysms >10 cm are rare, with only a few reports of successful repair of giant aneurysms larger than 12 cm. The largest reported diameter in published cases of giant unruptured AAA is 15 cm. This report of a 25-cm gigantic AAA may represent the largest successfully repaired infrarenal AAA in the world’s literature.

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.

人工血管瘤の1治験例

人工血管瘤の1治験例

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.

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.

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.

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.

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.

Researches and observations concerning biointegration of vascular prosthesis in animals.

In our study we tried to observe and appreciate the quality of anastomosis in case of vascular prosthesis, its tolerance and biointegration degrees. Observations were made on a number of fifteen dogs, different age and rase, and also on a number of five pigs weighing between 50-60 kg. For anastomosis it was used knitted Dacron prosthetic graft with low porosity. Dacron graft was used for iliac arteries and for aorta. The anastomosis was effectuated both in interrupted simple suture and simple continuous patterns. Dacron prosthesis were well tolerated by dogs, species which was monitored during thirty days, but also by pigs which were monitored during sixty days. We did not observe any complications or adverse reactions

Extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis: report of five patients

Squamous cell carcinoma (SCC) of the penis with inguinal lymph node involvement aggravates prognosis and can cause femoral artery bleeding, hemorrhagic shock and even death. The objective of this study is to describe the use of extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis. Five patients with SCC and inguinal lymphatic metastasis involving the femoral vessels, who underwent extra-anatomical arterial bypass through obturator foramen between 1999 and 2007, were reviewed. The surgical technique and the postoperative outcome were described. After extra-anatomical transobturator bypass, all patients presented distal pulses. The mean time of surgery was 6 h. In four patients, a knitted Dacron tube was used; and in one, the contralateral devalvulated greater saphenous vein was used. Concomitantly, two patients underwent mass resection and one patient underwent node dissection 2 weeks after bypass. Two patients chose not to undergo inguinal resection, opting for palliative chemotherapy after the vascular procedure. The average follow-up period was 12 months and four patients have died-three due to pulmonary metastasis, and one due to acute myocardial infarct. No prosthetic complication was identified and no patient presented femoral bleeding. The use of the transobturator bypass can benefit patients presenting with penile SCC and inguinal lymph nodes metastasis involving the femoral vessels, allowing resection of extensive tumor lesions, as well as avoidance of local complications.

Novel thromboresistant materials

The development of a clinically durable small-diameter vascular graft as well as permanently implantable biosensors and artificial organ systems that interface with blood, including the artificial heart, kidney, liver, and lung, remain limited by surface-induced thrombotic responses. Recent breakthroughs in materials science, along with a growing understanding of the molecular events that underlay thrombosis, has led to the design and clinical evaluation of a variety of biologically active coatings that inhibit components of the coagulation pathway and platelet responses by surface immobilization or controlled release of bioactive agents. This report reviews recent progress in generating synthetic thromboresistant surfaces that inhibit (1) protein and cell adsorption, (2) thrombin and fibrin formation, and (3) platelet activation and aggregation.

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.