Polytetrafluoroethylene Grafts Research Articles

Internal Jugular to Atrial Bypass with Spiral Vein Graft for Superior Vena Cava Syndrome

The patient was a 41-year-old woman with a history of postpartum class New York Heart Association class II cardiomyopathy. She had undergone biventricular implanTable cardiac defibrillator lead extraction. The procedure was complicated by laceration of the superior vena cava, innominate artery, and confluence of the left subclavian artery. Emergent repair with full cardiopulmonary bypass with bovine pericardial patch angioplasty was performed. During the course of 2 years, the patient had developed superior vena cava syndrome. She described worsening symptoms of severe headaches, blurred vision, near syncope with bending over, and a choking sensation despite sleeping at a 45° head-up angle. Additionally, the patient had developed moderate tricuspid valve regurgitation, which required repair. We elected to repair this patient with a spiral vein graft, in addition to tricuspid valve annuloplasty. Bilateral great saphenous veins were harvested and wrapped around a 36F chest tube such that a 9-mm × 12-cm spiral vein graft was created (Fig 1). After repair of the tricuspid valve, the right internal jugular vein was exposed, and the graft was tunneled through the thoracic inlet and inside a 12-mm ringed polytetrafluoroethylene graft to provide external support. The graft was then anastomosed from the right internal jugular vein to the right atrium. The patient did well and was discharged 6 days postoperatively. During follow-up, the patient has done very well (Fig 2). Five months after surgery, a venogram demonstrated a patent graft, with no pressure gradient across the graft.Fig 2Preoperative (Left) and postoperative (Right) three-dimensional computed tomography reconstructions of the patient demonstrating remarkably decreased venous collaterals. (Bottom) A postoperative venogram demonstrating the widely patent jugular–atrial venous bypass.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Impact of chronic kidney disease on the outcomes of infrapopliteal venous, and heparin-bonded expanded polytetrafluoroethylene bypass surgeries: A retrospective cohort study.

The aim of this study was to analyze the results of infrapopliteal venous and prosthetic bypass surgeries for patients with chronic limb-threatening ischemia (CLTI) and moderate to severe chronic kidney disease (CKD). All consecutive patients undergoing infrapopliteal bypass surgeries at two academic vascular centers between March 2002 and November 2018 were included in this retrospective study. During this timeframe, infrapopliteal grafts were performed for 487 patients. Of these patients, 160 (32.9%; group 1) had normal renal function, 248 (50.9%; group 2) had moderate CKD, and 79 (16.2%; group 3) had severe CKD according to the Kidney Disease Improving Global Outcomes guidelines. After 5 years' follow-up, the primary patency rate was 46.0% and the secondary patency rate was 54.9% without statistical significance noted between the CKD groups. Limb salvage (65.3%, p = 0.024) and long-term survival (19.6%, p < 0.001) were considerably lower in patients with severe CKD. In subgroup analysis, vein grafts had significantly better long-term patency rates compared to prosthetic grafts, regardless of CKD group. However, in patients with severe CKD, patency rates of vein and heparin-bonded expanded polytetrafluoroethylene (HePTFE) grafts were comparable at the 1-year mark. Our study shows that autologous vein grafts remain the first choice for infrapopliteal bypass surgeries in patients with CKD. HePTFE grafts showed good short-term results in patients with severe CKD. Given the short life expectancy of these high-risk patients, prosthetic HePTFE grafts may be reasonable in this population if a suitable vein is absent.

Can concomitant above-knee femoropopliteal bypass with artificial graft affect the outcome of femorofemoral bypass with artificial graft?

Few have studied the effect of concomitant femoropopliteal (FEM-POP) bypass surgery on the outcome of femorofemoral (FEM-FEM) bypass in patients with peripheral arterial disease (PAD). This study was aimed to analyze the risk relationship of concomitant FEM-POP bypass on the patency of FEM-FEM bypass. From March 2009 to April 2020, a total of 27 patients who underwent FEM-FEM bypass surgery using polytetrafluoroethylene grafts were retrospectively analyzed according to concomitant FEM-POP bypass surgery. The mean follow-up duration was 38.20 ± 34.56months. The overall primary patency of the FEM-FEM bypass grafts in all 27 patients was 83.7, 78.5, and 72.0 at one, two, and 3years, respectively. The overall limb salvage rate was 100, 94.1, and 86.9 at one, two, 3years, respectively. Among them, ten patients underwent FEM-FEM bypass only (group 1). The other 17 patients needed a concomitant FEM-POP bypass and these patients were classified into three groups (group 2, ipsilateral FEM-POP, n = 5; group 3, crossover FEM-POP, n = 6; and group 4, bilateral FEM-POP, n = 6) The comparison of the primary patency of group 1 with the concomitant FEM-POP groups (sum of groups 2, 3, and 4, that is, group 5, n = 17) revealed a statistically significant improved patency for FEM-FEM bypasses not requiring concomitant infra-inguinal bypass (p = .036). Among the concomitant FEM-POP groups, group 2 had the lowest primary patency of the FEM-FEM bypass significantly (p = 0.07). The limb salvage rate of group 4 was significantly low. A concomitant FEM-POP bypass influenced the outcome of FEM-FEM bypass surgery. In conclusion, compromised infra-inguinal runoff at either extremity requiring concomitant FEM-POP bypass significantly worsens long-term FEM-FEM bypass patency. In addition, a concomitant bilateral FEM-POP bypass is a risk factor affecting the limb salvage rate in FEM-FEM bypass.

Inferior Vena Cava Reconstruction Using a Ringed Polytetrafluoroethylene Interposition Graft and Inferior Vena Cava Filter Placement Following Resection of Renal Cell Carcinoma With a Tumor Thrombus Directly Infiltrating the Inferior Vena Cava.

BackgroundRenal cell carcinoma (RCC) with tumor thrombus (TT) may extend into and, in rare cases, actually invade the inferior vena cava (IVC). Techniques of IVC reconstruction after removal of the RCC, TT, and infiltrated portion of the IVC have not been well documented. Methods A ringed polytetrafluoroethylene (PTFE) interposition graft along with an IVC filter placed within the graft (to prevent the development of pulmonary emboli) was used for patients who underwent surgical resection of RCC with TT extending into and directly invading the wall of the IVC. Demographic information about these patients along with their pathology reports, surgical procedures, and patency of the PTFE graft was obtained and described. Results Four male patients were identified as having RCC and TT with histologic invasion of the IVC requiring IVC dissection and replacement with a PTFE graft (as described above); their TT levels were II, IIIa, IIIc, and IV, respectively. Patient ages were 58, 65, 58, and 51years and tumor sizes were 7.5, 7.5, 15.0, and 6.5cm, respectively. These patients were followed for 36, 24, 32, and 48months, respectively. At last follow-up, each patient had a patent IVC graft, and none of them developed any pulmonary emboli post-operatively. Conclusions Ringed PTFE interposition graft along with an IVC filter deployed inside the graft appears to be a safe vascular conduit for IVC reconstruction after surgical resection of RCC with TT directly invading the IVC.

Development of artificial blood vessels made of new materials, used for vascular access in renal dialysis

It can take many years to find a matched kidney donor and, in some cases, a matched donor is never found. Dialysis machines and methods of accessing a patient's cardiovascular system mean patients can live well whilst waiting for a transplant. Patients must undergo one of two surgical procedures before their first haemodialysis; receiving either an arteriovenous fistula or an arteriovenous graft, which join the artery to the vein and facilitate the transfer of blood from body to machine. If a graft is needed, an operation to insert a polytetrafluoroethylene (PTFE) based device is required but complications can arise in the form of blockages. Denan Jin, Department of Innovative Medicine, Osaka Medical and Pharmaceutical University, Japan, has spent years conducting research on the issues related to PTFE device blockage. He worked with his mentor Professor Mizuo Myazaki before his retirement and his colleague Professor Shinji Takai, and these collaborations led to understanding of the major causes of these blockages. Jin and his team are working to develop means to increase the longevity of PTFE grafts. The researchers have discovered two key mechanisms through which the grafts become blocked, which has led to the identification of two possible routes for preventing blockages. These relate to fibroblasts and the researchers have also identified the enzyme chymase as a key intermediate in the process of fibroblast recruitment. Jin and the team are proposing the use of an alternative to PTFE and the development of an effective chymase inhibitor to reduce the recruitment of fibroblasts to the graft site.

Use of Transcarotid IMPELLA 2.5 Axial-Flow Pump Device for Left Ventricle Unloading During VA-ECMO Support in Pediatric Acute Heart Failure.

An alternative strategy for left ventricular (LV) venting during short-term mechanical circulatory support is use of Impella axial-flow pump. We present our transcarotid Impella 2.5 implantation technique using a polytetrafluoroethylene graft, in two children with acute heart failure treated primarily with venoarterial ECMO. The venoarterial extracorporeal membrane oxygenator and Impella support were maintained for 5 and 17 days, respectively. Transcarotid Impella implantation might be an alternative and feasible option in pediatrics patients affected by severe LV failure, as a bridge to decision or bridge to candidacy. Potentially, the Impella 2.5 device provides less invasive support for children with heart failure.

Prevalence and risk factors for vascular access infection among chronic hemodialysis patients in Al-Gharbia Governerate, Egypt

Background Chronic hemodialysis patients are at considerably high risk for vascular access-related blood stream infections that may be associated with serious complications. Infections are more frequent with central venous catheters and polytetrafluoroethylene grafts than with arteriovenous fistula. Aim We aim to evaluate the prevalence of vascular access infection among hemodialysis patients, risk factors, common causative microorganisms and their antibiotics sensitivity. Patients and method This cross-sectional study included 720 end-stage renal disease patients on hemodialysis recruited from six hemodialysis centers in Al-Gharbia Governorate from June 2019 to June 2020. Results The prevalence of vascular access infection was 27.77%. Sex, old age, and diabetes mellitus had a significant statistical association. Temporary catheters recorded the highest infection rate. Gram-positive bacteria were the most common organisms in 57.5% of cases, Gram negative in 39.5% while candida albicans in only 3% of the cases. The antibiotic sensitivity was higher to amikacin and imipenem. Conclusion Creation of native arteriovenous fistula is highly recommended to avoid catheter-related blood stream infections and their complications. Strict adherence to antiseptic measures and use of a rational antibiotic policy for the early diagnosis and better management of hemodialysis vascular access site infection is important.

Omniflow II biosynthetic grafts versus expanded polytetrafluoroethylene grafts for infrainguinal bypass surgery. A single-center retrospective analysis.

The aim of this study is to evaluate the outcome of Omniflow II biosynthetic vascular grafts as compared to synthetic expanded polytetrafluoroethylene (ePTFE) grafts in infrainguinal bypass surgery. A single-center, retrospective, observational study was performed reviewing patients with critical limb ischemia who underwent infrainguinal bypass surgery between 2014 and 2018. Patients characteristics, graft characteristics, and treatment outcomes were collected. Patency rates were compared using Kaplan-Meier estimates. Sixty bypasses were performed in 57 patients. For above-knee surgery, six were Omniflow and 13 were synthetic. For below-knee surgery, 19 were Omniflow and 22 were synthetic. Patient characteristics between groups were similar. However, American Society of Anesthesiologists (ASA) classification scores were higher in the Omniflow group as compared to ePTFE (88% was ASA 3 or higher versus 60%; p = 0.018). Furthermore, wound, ischemia, and foot infection (WIfI) composite scores were higher in the Omniflow group (p = 0.0001). There was a trend toward more active infection at time of surgery in the Omniflow group (40 vs 22.9%, p = 0.15). At 1year, primary patency rates were 60.0% versus 46.9% for above-knee Omniflow versus ePTFE grafts, respectively (p = 0.72). Secondary patency rates were 80.0% versus 82.5% (p = 0.89), and limb salvage rates were 83.3% versus 100% (p = 0.14). For below-knee surgery, 1- and 2-year primary patency rates in Omniflow versus ePTFE grafts were 36.0% versus 41.8% (p = 0.60) and 36.0% versus 31.1% (p = 0.87). Secondary patency rates were 66.8% versus 75.2% at 1year (p = 0.53) and 58.8% versus 48.3% (p = 0.77) at 2years. Below-knee limb salvage rates for Omniflow versus ePTFE after 2years were 88.0% versus 68.3% (p = 0.28), respectively. Aneurysmal degeneration occurred in 2/25 (8%) in the Omniflow group and 0/35 (0%) in the ePTFE group. Bypass infections occurred in 2/25 (8%) in the Omniflow group and 0/35 (0%) in the ePTFE group (p = 0.09). Omniflow bypasses were more commonly implanted in patients with higher limb infection rate as confirmed with a higher adapted WIfI score. A trend toward a higher infection rate of Omniflow grafts was observed but not statistically significant. Graft infection rates were relatively low and treatable with antibiotics. No significant difference in graft performance was observed. The choice between the two studied grafts remains based on surgeon's preference.

Our clinical experiences of vascular injuries due to lumbar disc surgeries.

We aimed to evaluate emergency vascular complications of the lumbar disc reconstructive surgery in this study. Between March 2006 and February 2020, nine patients (six males and three females; mean age: 53.4 ± 9.6 years; range: 38-64 years) who underwent emergent vascular intervention during lumbar spinal disc reconstructive surgery in our clinic were included in this retrospective study. The left common iliac artery injury, the left common iliac artery and left common iliac vein injuries, bilateral common iliac artery and abdominal aortic injuries, and vena cava inferior injury with left common iliac vein and right common iliac vein injuries were detected in two, three, two, and two patients, respectively. In addition, 16 mm Dacron tube graft interposition and graft patch plasty were performed in one and two patients who had an abdominal aortic injury, respectively. Also, 8 mm polytetrafluoroethylene straight graft interposition was performed in two patients with left common iliac artery injury, and lateral wall repair was performed in other patients. Graft patch plasty and 8 mm polytetrafluoroethylene graft interposition were performed in one patient with vena cava inferior injury and left common iliac vein injury, respectively. Also, lateral wall repair was performed in other patients with venous injuries. Deep venous thrombosis had developed in three patients, and one patient of these had a pulmonary embolism. The incidence of vascular injury after the lumbar disc surgery is relatively low; however, the emergency vascular operation should be performed as soon as possible.

Extra Anatomical Bypass for Common Femoral Artery Pseudoaneurysm following Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

Background: Improvements in the instrumentation and guidelines for the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has increased the use of it as an adjunct in managing haemorrhagic shock. REBOA-related complications continue to be assessed and described.&#x0D; Methods: We describe a case of a femoral artery pseudoaneurysm within an infected groin wound after REBOA usage in a 25-year-old male after several bouts of sepsis and complications related to the initial penetrating injury and associated ICU stay.&#x0D; Results: An extra-anatomical external iliac-to-superficial femoral artery bypass was performed using a 6mm polytetrafluoroethylene graft to treat the FAP successfully.&#x0D; Conclusion:&#x0D; REBOA is a well described adjunct in the management of haemorrhagic shock. The immediate and delayed complications should be not overlooked. Deviations from the expected postoperative course should be promptly recognised and managed by a clinician with appropriate expertise.&#x0D; &#x0D; &#x0D;

External Stenting (Exostenting) to Correct Vascular Torsion and Angulation.

Organ transplantation can be associated with vascular torsions and angulations of both recipient and donor vessels. Such kinks and/or torsions of vessels can compromise the vascular integrity, obstruct inflow and/or outflow, and result in loss of the organ and/or body parts. On many occasions, mild angulations and torsions can be successfully addressed by repositioning the organ. In cases where the abnormal findings persist, maneuvers such as placing a fat pad to create a smoother curve, or even opening the peritoneum (in the case of kidney transplants) to allow for a better positioning of the organ, are associated with successful outcomes. When such torsions/angulations persist despite these approaches, further innovative tactics are required. In the current report, we propose a technique that involves longitudinally opening of a synthetic graft that is rigid enough to maintain its shape, such as a ringed polytetrafluoroethylene graft, and placing it as an external stent around the angulated/torsioned vessel. This maneuver will correct the underlying vascular compromise without having to perform any further invasive interventions, such as reimplanting the organ or resecting part of the involved vessel. Although primarily illustrated for application by describing an instance in which exostenting was applied during kidney transplantation, our approach could be applied to any vessel under many circumstances where angulations/twists are encountered. In this report, we describe the use of an external stent, also called exostenting, to correct a severe torsion/angulation of the external iliac artery in a kidney transplant recipient where all other measures were unsuccessful.

Intrabronchial migration of hemostatic agent through a bronchial fistula after lung transplantation: a case report

BackgroundA bronchial fistula is a relatively rare and potentially fatal complication after lung transplantation. Thoracic surgeons and pulmonologists often face challenges when selecting treatment options. We herein report an exceptional case of intrabronchial migration of a nonabsorbable hemostatic agent, which had been placed around the pulmonary artery at the time of lung transplantation, through a bronchial fistula.Case presentationA 61-year-old man developed respiratory distress 1 year after left single-lung transplantation for idiopathic interstitial pneumonia. Bronchoscopic examination revealed an apparent foreign body protruding from the mediastinum into the distal site of the bronchial anastomosis. The foreign body was easily removed bronchoscopically and appeared to be a hemostatic agent that had been placed during the previous lung transplantation. The patient developed a similar clinical episode and finally developed hemoptysis. Computed tomography revealed a foreign body located between the bronchus and pulmonary artery, partially protruding into the bronchial lumen. Given the possibility of a bronchopulmonary arterial fistula, surgical treatment was performed. The foreign body was located between the bronchus and left pulmonary artery and was easily removed. Multiple bronchial fistulas were found, and all were closed with direct sutures. Bypass grafting of the left pulmonary artery was then performed, initially with a homograft but eventually with an extended polytetrafluoroethylene graft. The patient was finally discharged 5 months after the surgery.ConclusionWe experienced an extremely rare case of intrabronchial migration of hemostatic agents used during the previous lung transplantation through a bronchial fistula, which were successfully managed by direct bronchial closure and bypass grafting of the left pulmonary artery.

Ten-year follow-up of direct interposition graft repair of persistent sciatic artery aneurysm.

A 58-year-old woman had presented with a pulsatile swelling in the left gluteal region and pain in the limb on the same side in 2010. Magnetic resonance angiography was performed, which revealed a type 2 persistent sciatic artery (PSA) with an aneurysm in the gluteal region (A). She underwent direct endoaneurysmorrhaphy with an interposition polytetrafluoroethylene (PTFE) graft through a posterior gluteal approach. The patient was placed in the lateral decubitus position, and the aneurysm sac was approached after dividing the overlying gluteal muscles.

ASO Visual Abstract: Venous Reconstruction During Pancreatectomy Using Polytetrafluoroethylene Grafts: A Single-Center Experience with Standardized Perioperative Management

ASO Visual Abstract: Venous Reconstruction During Pancreatectomy Using Polytetrafluoroethylene Grafts: A Single-Center Experience with Standardized Perioperative Management

Midterm results of salvage surgery for autogenous dialysis access in aneurysmal arteriovenous fistulas.

Autologous arteriovenous fistulas are commonly constructed in patients undergoing hemodialysis for end-stage renal disease. However, they are associated with a high rate of aneurysm formation, and aneurysmal arteriovenous fistulas that have become symptomatic require surgical intervention. This study was performed to evaluate the midterm results of salvage surgery for autogenous dialysis access in patients with aneurysmal arteriovenous fistulas. Of 1326 arteriovenous fistula operations, 81 involving surgery for aneurysmal arteriovenous fistulas between January 2008 and January 2012 were included in this study. The database was searched to identify all complicated arteriovenous fistula patients undergoing surgery for vascular access. The number of complicated arteriovenous fistula surgeries, for example for aneurysms, was greater than the number of patients undergoing surgery to create a new arteriovenous fistula. We performed three different surgical procedures to treat arteriovenous-related aneurysms in our clinic: primary repair, resection and saphenous vein interposition, and resection and polytetrafluoroethylene (PTFE) interposition. We compared the patency rates at the 12- and 24-month follow-ups among these three techniques. The study population consisted of 24 cases of primary repair, 29 cases of resection and saphenous vein interposition, and 30 cases of resection and PTFE graft interposition. True aneurysms occurring in patients undergoing hemodialysis did not require treatment unless they were symptomatic. Arteriovenous access salvage therapy is recommended after the aneurysm has become symptomatic. Symptomatic arteriovenous fistula aneurysms can be treated by maintaining arteriovenous fistula continuity. Moreover, patient safety is ensured by long-term patency.

Evaluation of heparin-bonded ePTFE grafts for forearm loop vascular access: Comparison between Gore® PROPATEN vascular graft and ACUSEAL vascular graft.

This retrospective study evaluates the clinical outcomes of two heparin-bonded expanded polytetrafluoroethylene grafts, PROPATEN and ACUSEAL (W. L. Gore & Associates, Flagstaff, AZ, USA), for forearm loop vascular access. We prospectively collected data on 60 patients who had undergone arteriovenous graft of the forearm loop type between January 2015 and December 2019. The primary endpoints were graft primary, assisted primary, and secondary patency rates. Secondary endpoints were time to first cannulation and postoperative complications. We enrolled 36 patients in the PROPATEN group (Group P) and 24 in the ACUSEAL group (Group A). All procedures were successful without any 30-day mortality. The median times to first cannulation were 16.5 days and 3 days in Groups P and A, respectively (p < 0.001). Mean follow-up periods were 13.4 ± 14.5 and 17.3 ± 9.3 months, respectively. Primary patency rates were 81% and 64%, respectively, at 6 months, and 60% and 40%, respectively, at 12 months (p = 0.008). Assisted primary patency rates were 96% and 83% at 6 months, 91% and 73% at 12 months, and 81% and 35% at 24 months (p = 0.044). Secondary patency rates were 96% and 81% at 12 months, and 87% and 62% at 24 months (p = 0.207). As a remote-period complication, disruption of the luminal layer of the graft was observed in two patients (4.2%) in Group A due to puncture and thrombectomy. Although the ACUSEAL graft offers the advantage of early cannulation, its primary and assisted primary patency outcomes were inferior to those of the PROPATEN graft. It is important for physicians to be aware of the different characteristics of each graft to select the best option for each patient.

Evaluation of 3D Templated Synthetic Vascular Graft Compared with Standard Graft in a Rat Model: Potential Use as an Artificial Vascular Graft in Cardiovascular Disease

Although the number of vascular surgeries using vascular grafts is increasing, they are limited by vascular graft-related complications and size discrepancy. Current efforts to develop the ideal synthetic vascular graft for clinical application using tissue engineering or 3D printing are far from satisfactory. Therefore, we aimed to re-design the vascular graft with modified materials and 3D printing techniques and also demonstrated the improved applications of our new vascular graft clinically. We designed the 3D printed polyvinyl alcohol (PVA) templates according to the vessel size and shape, and these were dip-coated with salt-suspended thermoplastic polyurethane (TPU). Next, the core template was removed to obtain a customized porous TPU graft. The mechanical testing and cytotoxicity studies of the new synthetic 3D templated vascular grafts (3DT) were more appropriate compared with commercially available polytetrafluoroethylene (PTFE) grafts (ePTFE; standard graft, SG) for clinical use. Finally, we performed implantation of the 3DTs and SGs into the rat abdominal aorta as a patch technique. Four groups of the animal model (SG_7 days, SG_30 days, 3DT_7 days, and 3DT_30 days) were enrolled in this study. The abdominal aorta was surgically opened and sutured with SG or 3DT with 8/0 Prolene. The degree of endothelial cell activation, neovascularization, thrombus formation, calcification, inflammatory infiltrates, and fibrosis were analyzed histopathologically. There was significantly decreased thrombogenesis in the group treated with the 3DT for 30 days compared with the group treated with the SG for 7 and 30 days, and the 3DT for 7 days. In addition, the group treated with the 3DT for 30 days may also have shown increased postoperative endothelialization in the early stages. In conclusion, this study suggests the possibility of using the 3DT as an SG substitute in vascular surgery.

Venous Reconstruction During Pancreatectomy Using Polytetrafluoroethylene Grafts: A Single-Center Experience with Standardized Perioperative Management.

Although primary end-to-end anastomosis is preferred for portal vein-superior mesenteric vein (PV-SMV) reconstruction, interposition graft use may be required in some situations. We investigated the efficacy of polytetrafluoroethylene (PTFE) grafts when used during pancreatectomy in this context. From 2014 to 2019, 19 patients who underwent pancreatectomy requiring PV-SMV reconstruction using ringed PTFE grafts were entered prospectively into a clinical database (NCT02871336, CNIL No. Sy50955016U). Unfractionated heparin was used during the first 24 h postoperatively. The administration of low-molecular-weight heparin was initiated twice a day (two injections of 1 mg/kg enoxaparin) on postoperative day 2 and was continued until the first clinical follow-up. Patency was assessed by CT scan before home discharge. Patients were switched to antiplatelet therapy (75 mg of aspirin-based drug Kardegic®) without a deadline. Pancreatoduodenectomy was the most commonly performed procedure (15 patients, 79%), and pancreatic duct adenocarcinoma was the predominant etiology (17 patients, 89%). The median PTFE graft diameter and length were 10 mm and 8 cm, respectively. The median clamping time was 25 min. The overall severe morbidity and 90-day mortality values were 21% and 10%, respectively. None of the patients experienced anticoagulation-related morbidity or PTFE graft-related infection. The 6-month PTFE graft patency rate was 68%. Patients who underwent distal pancreatectomy showed a higher late thrombosis rate than those who underwent a pancreaticoduodenectomy (50% vs. 8%, p = 0.049). The median long-term PTFE graft patency duration was 37 months. PTFE reconstruction can be safely performed with simple perioperative management in cases requiring interposition graft use.

Venous outflow reconstruction using a polytetrafluoroethylene (PTFE) graft in right lobe living donor liver transplantation: A single center study

BackgroundVenous outflow reconstruction is very important especially in right lobe living donor liver transplantation without middle hepatic vein. Various interposition (venous or synthetic) grafts have been recommended for reconstruction of anterior sector tributaries. MethodsWe aimed to describe our surgical technique and analyze anterior sector venous reconstruction using expanded polytetrafluroethylene graft. Retrospective analysis of prospectively collected data for 760 primary right lobe living donor liver transplantations performed at our institute between December 2011 and June 2018. Reconstruction of anterior sector: expanded polytetrafluroethylene (group A, n = 705) and autologous vein (group B, n = 55). ResultsPretransplant characteristics were comparable among both groups. Group A has significantly lower cold ischemia time (68.7 ± .3.5 minutes vs 127.8 ± 7.2 minutes; P < .001) and anhepatic time (116.3 ± 5.5 minutes vs 190.81 ± 9.35 minutes; P < .001) compared with group B. There was no difference in recovery pattern of liver functions, morbidity, and mortality between the 2 groups. One- and 6-month patency rates of interposition grafts were 97.6% and 84.4% (group A) and 96.4% and 78.1% (group B), respectively. ConclusionIn centers with limited access to homologous or autologous vascular grafts, use of expanded polytetrafluroethylene graft for anterior sector venous outflow reconstruction in right lobe living donor liver transplantation is a viable option with excellent patency and patient outcomes.

Use of Heparin-Bonded Expanded Polytetrafluoroethylene Grafts for Renal Artery Reconstruction

BackgroundThe purpose of this study was to analyze our initial experience in renal artery reconstruction with heparin-bonded expanded polytetrafluoroethylene (ePTFE) grafts. MethodsThe authors retrospectively reviewed the data of consecutive patients who received open renal reconstruction with a heparin-bonded ePTFE graft at our institution between January 2014 and December 2019. ResultsA total of 22 renal reconstructions with a heparin-bonded ePTFE graft were performed in 17 consecutive patients. In all cases, renal reconstruction was a concomitant procedure during surgical or endovascular aortic procedures. Postoperative complications within 30 days were observed in 9 (53%) patients, including acute kidney injury (n = 6), pneumonia (n = 1), retrograde type B aortic dissection (n = 1), and lower limb ischemia (n = 1). The 30-day mortality rate was 0%. In a median follow-up period of 32 (19–39) months, all grafts were patent without re-intervention. Six patients with preoperative stage 2 chronic kidney disease progressed to stage 3 during follow-up. No patient required temporary or permanent hemodialysis. One patient died from intestinal ischemia at 23 months after surgery. ConclusionsThis study showed that the patency after open renal reconstruction with a heparin-bonded ePTFE graft was excellent, with acceptable renal outcomes, and demonstrates its safety as a concomitant procedure during an aortic procedure. Heparin-bonded ePTFE grafts are a feasible and effective choice for open renal reconstruction in contemporary practice.