Prosthetic Graft Research Articles (Page 1)

This study aimed to evaluate the diagnostic performance of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for prosthetic aortic graft infection (PAGI) detection and describe its outcomes. This retrospective study had two groups: the N-PAGI group (patients without PAGI who underwent 18 F-FDG-PET/CT for detailed cancer screening) and the PAGI group (patients with PAGI). The PAGI group had two subgroups: the PET group (PAGI patients who underwent 18 F-FDG-PET/CT), and the non-PET group (PAGI patients who did not undergo 18 F-FDG-PET/CT). We compared the semi-quantitative analyses between the PET group and the N-PAGI group. The zones of aorta were labelled into 13 zones. Outcomes were compared between the PET group and the non-PET group. In total, 46, 19, and 24 patients were enrolled in the N-PAGI group, PET group, and non-PET group, respectively, between January 2008 and December2023. The PAGI group had significantly higher FDG uptake intensity score (4.7 ± 0.2 vs 3.2 ± 0.2), SUVmax value (9.6 ± 0.5 vs 4.5 ± 0.4), and TBR value (5.8 ± 0.3 vs 2.9 ± 0.2) than did the N-PAGI group. In the PAGI group, the in-hospital mortality, 5-year overall survival, and freedom from infection-related death were 15.9%, 69.3 ± 6.8%, and 81.8 ± 5.8%, respectively. The PET group (5.9 ± 0.4 zones) had previously undergone a significantly more extensive replacement or coverage than the non-PET group (3.5 ± 0.3 zones). However, late outcomes did not significantly differ between these two groups. Although 18 F-FDG-PET/CT is useful for diagnosing PAGI, the in-hospital mortality remained high. Long-term outcomes of PAGI were acceptable.

Subclavian venous valve stenosis is a rare but significant cause of upper extremity venous hypertension in hemodialysis patients. When standard endovascular treatments are not feasible, alternative techniques may be required. A man in his 60s with end-stage renal disease on maintenance hemodialysis for 19 years, with a right forearm prosthetic arteriovenous graft (AVG), presented with right upper extremity edema and dialysis dysfunction due to subclavian vein occlusion. Intravascular ultrasound (IVUS) revealed fibrotic valve leaflets at the occlusion site. An 8 mm balloon was pulled through the lesion under IVUS and fluoroscopic guidance, resulting in partial cusp rupture. A second 12 mm balloon and a kissing balloon technique with a cutting balloon achieved complete valve disruption. The pressure gradient dropped from 20 to 0 mmHg, and dialysis resumed without complications. This is the first reported case of IVUS-guided balloon-assisted cusp avulsion (BACA) technique for treating fibrotic venous valve stenosis. This approach may offer a viable stentless option when conventional stenting is not feasible due to anatomical or technical limitations.

New challenger has entered the arena: bioengineered vascular conduit, autologous vein, and prosthetic graft in extremity vascular trauma

Comparative Outcomes of Paclitaxel-Coated Balloons and Simple Plain Balloon Angioplasty in the Treatment of Infrainguinal Bypass Anastomotic Stenosis.

Background: The Sandwich technique is a commonly adopted method for reinforcing the dissected aortic wall during acute Type A aortic dissection (ATAAD) repair, using either felt or bovine pericardial strips. However, complications such as anastomotic bleeding, distal anastomotic new entry (DANE) and persistent false lumen (PFL) remain major challenges. This study evaluated and compared the sealing efficacy of felt versus pericardium in a human cadaver model. Methods: ATAAD was simulated in 20 fresh human cadavers. Repairs were performed using the sandwich technique with either felt (n = 10) or pericardium (n = 10), followed by end-to-end prosthetic graft anastomosis. Procedure time was recorded. Following the repair, the aortas were perfused at 160/90 mmHg using a glycerol-water solution to assess fluid leakage (mL), DANE and PFL. Results: Median leakage was significantly lower in the pericardium group (67.5 mL [IQR 40–198.8]) compared to the felt group (315 mL [IQR 285–445], p = 0.002). Procedure times were comparable between groups. DANE occurred in 20% (pericardium) and 30% (felt) of cases, while PFL was observed in 30% of cases in both groups; differences were not statistically significant. Conclusions: The superior sealing properties of pericardium in this study suggest a promising approach for reducing leakage in ATAAD repair. While rates of DANE and PFL were comparable, the advantage of pericardium was confined to leakage reduction. These findings highlight the need for further research to determine whether this experimental benefit translates into improved clinical outcomes.

Predictors of Surgical Site Infection Following Infra-Inguinal Bypass Surgery: An Analysis of the Vascular Quality Initiative Data.

There is growing recognition in regenerative cardiovascular tissue engineering that transmural vessel ingrowth is the predominant—if not exclusive—mechanism for achieving in-situ endothelialization in prosthetic vascular grafts and heart valves in humans This process requires continuous ingrowth channels with dimensions sufficient to accommodate capillaries or even arterioles. While a variety of methods—such as electrospinning—exist to create porous scaffolds, current characterization techniques fail to determine whether the resulting structures offer well-defined and consistently continuous ingrowth spaces. Drawing on principles from geological porous media research, we applied a combination of nano-computer-tomography, deep-learning segmentation and super-resolution algorithms, and pore network modelling, to characterize the full thickness pore space morphology of electrospun scaffolds. Scaffolds were non-destructively reconstructed at high resolution (0.54 microns) and large fields of view, 57x faster than a brute-force approach, achieving total sample volumes greater than 1x108 um3 in just a few hours. Electrospun scaffolds showed a median pore size and median pore volume of 5.51um (IQR: 5.15)/418.07um2 (IQR: 1153.74), n = 15 698, for the 16% polymer weight percentage group; 5.40um (IQR: 6.23)/412.24um2 (IQR: 1485.24), n = 13 437, for 18%; and 5.40um (IQR: 4.22)/356.34um2 (IQR: 826.53), n = 28 620, for 20%. On deeper analysis, continuous, interconnected pore networks of <10 microns in minimum diameter were extracted, with the 18% group showcasing the most extensive, surface-to-surface networking. This analysis highlights the limited ability of single-needle electrospinning to produce sufficient growth space for reliable transmural capillary endothelialisation. With the advent of cutting-edge additive and reductive manufacturing techniques, alternative methods for porous scaffold construction show promise.

One of the complications of autogenous arteriovenous fistula (AVF) used for hemodialysis is the development of a true arteriovenous vein (VA) aneurysm. The consequences of aneurysm formation – including infection – skin changes at the aneurysm site, bleeding, rupture, thrombosis, and impaired blood flow – can result in inadequate hemodialysis. Among these complications, the most critical indication requiring urgent intervention is life-threatening bleeding. The standard treatment for a massive AVF aneurysm often involves ligation or resection with prosthetic interposition. Whenever possible, the first surgical intervention should aim to preserve natural access ideally without prosthetic grafting, creation of new vascular anastomoses or fistula ligation. Partial aneurysmectomy with or without reductive venoplasty, has been proposed as a method of managing this complication while maintaining fully autogenic access. The article describes a simple surgical technique for correcting a double aneurysmally altered AVF in a patient 7 years after the creation of an AVF mid-forearm. The procedure did not require postoperative central catheter implantation. Given the risk of partial fistula thrombosis, suppuration, and potentially fatal hemorrhage due to rupture, reconstructive surgery was performed. The operation consisted of partial excision of of the diseased venous segments (aneurysmorrhaphy), while preserving AVF function. The advantages of aneurysmorraphy include technical simplicity, safety under local anesthesia, effective removal of diseased tissues; and preservation of AVF function. This approach maintains inherent benefits of an autogenous AVF, while conserving vascular access site for future use. Aneurysmorraphy – also referred as reductive aneurysmoplasty, partial aneurysmectomy, or restoration/recalibration – represents a valuable surgical option, particularly for megaphystules. It emphasized preservation of native access while allowing flexibility in surgical technique tailoring individual case.

Aortic endograft infections have worse outcomes compared to aortic surgical grafts or primary mycotic aortic infections.

The robotic approach to liver and pancreatic surgery is expanding worldwide. However, limited data are available on vascular management in these complex procedures. The unique characteristics of the robotic platform may enhance the feasibility of minimally invasive vascular resection and reconstruction. This retrospective, single-arm, single-center study includes patients who underwent liver, biliary, and pancreatic resections with superior mesenteric and portal vein resection performed robotically between April 2021 and June 2024. The study evaluates short-term outcomes and provides technical insights. Eight patients underwent superior mesenteric or portal vein resection during the study period. Among them, six cases occurred during pancreatic resections, while two were performed during liver resections. In four cases, the chosen strategy involved tangential clamping and direct suturing (Type 1). In two cases, the vessel was repaired using a patch (Type 2). The remaining two cases required end-to-end anastomosis-one performed directly (Type 3) and one with the interposition of a prosthetic graft (Type 4). Postoperatively, only two patients developed complications classified as > 3a according to the Clavien classification, with Comprehensive Complication Index (CCI) scores of 47.6 and 37.1, respectively. Vascular reconstructive skills are essential for surgeons performing hepatopancreatobiliary (HPB) surgery to achieve R0 resections in locally advanced cases. The robotic approach to vascular resection and reconstruction requires a stepwise implementation to ensure favorable oncologic and postoperative outcomes.

Kommerell's diverticulum (KD) combined with a right-sided aortic arch (RAA) and an aberrant left subclavian artery (ALSA) is a rare congenital vascular anomaly causing significant compressive dysphagia. Treatment options, including open surgery, thoracic endovascular aortic repair and hybrid approaches, are debated due to anatomical complexities. We report a 48-year-old female with dysphagia from symptomatic KD, RAA and ALSA, clearly delineated by preoperative computed tomography angiography. A right thoracotomy enabled aortic arch replacement. Deep hypothermic circulatory arrest and retrograde cerebral perfusion were utilized for neuroprotection. KD was resected, and ALSA was reconstructed via interposition graft, anastomosed end-to-side to the main prosthetic graft. Meticulous dissection, including division of the ligament on the diverticulum's greater curvature, and careful handling of fragile aortic tissue with felt-pledgeted sutures were key. The patient recovered uneventfully, with complete dysphagia resolution and discharge on postoperative Day 10, without complications. Right thoracotomy offers excellent exposure for comprehensive repair of complex KD with RAA and ALSA. This case demonstrates the feasibility and effectiveness of open surgical repair with meticulous technique and cerebral protection for favourable outcomes in such rare and challenging vascular anomalies.

We present the case of a man in the 50s with a decade-old history of surgical revascularisation for aortoiliac and femoropopliteal occlusive disease, who presented with new-onset critical limb ischaemia in the right lower extremity. A CT angiography revealed occlusion of the prior prosthetic femoropopliteal bypass graft and progression of atherosclerosis into the tibioperoneal segment, the distal vessel being patent but small-calibre posterior tibial artery. Considering the patient's extensive vascular history, vessel calcification and unsuitability for further prosthetic grafting, a redo bypass from the right common femoral artery to the posterior tibial artery was performed using a reversed great saphenous vein from the contralateral leg. Postoperative recovery was uneventful with return of distal pulses and symptomatic relief. This case highlights the importance of utility of saphenous vein graft not just in coronary artery disease, but also in surgical revascularisations in lower limb arteries that can be complex owing to their small size where prosthetic graft usage is not feasible.

Development of a 0D digital twin for assessment of the impact of vascular graft on ex-vivo porcine aortas.

Peripheral artery disease, a manifestation of systemic atherosclerosis, often necessitates surgical revascularization in advanced stages, with femoropopliteal bypass serving as a primary intervention to restore adequate lower limb perfusion. When autologous vein grafts are not available, prosthetic conduits are commonly used. However, these heterologous materials carry an increased risk of infectious complications, which, although rare, are associated with substantial morbidity and mortality. This study aims to review the current literature on prosthetic graft infections in femoropopliteal bypass surgeries, focusing on epidemiology, risk factors, microbiology, diagnostic methods, treatment strategies, and preventive measures. A narrative review of the literature was conducted using databases such as PubMed to identify relevant studies on vascular prosthetic infections, particularly in femoropopliteal bypass surgeries. Prosthetic graft infections occur in approximately 2.6% of femoropopliteal bypass surgeries. Staphylococcus epidermidis is the most commonly isolated pathogen. Other relevant Gram-positive bacteria include Staphylococcus aureus, and Gram-negative bacteria such as Pseudomonas aeruginosa. Accurate identification of the etiological agent through microbiological and diagnostic methods is essential for improving clinical outcomes. Early diagnosis is crucial to enable timely and effective treatment, which generally combines antibiotic therapy with surgical intervention, often necessitating graft removal. Furthermore, adopting preventive measures, such as perioperative antibiotic prophylaxis, is fundamental to reducing the incidence of these complications and minimizing the morbidity and mortality associated with prosthetic graft infections. Prosthetic graft infections in femoropopliteal bypass surgeries remain a challenging complication. A multidisciplinary approach encompassing early detection, evidence-based treatment, and targeted prevention strategies is essential to improve outcomes, preserve limb function, and mitigate long-term morbidity.

Prosthetic vascular graft infections (PVGI) pose a significant clinical challenge due to high morbidity and mortality. FDG-PET/CT has emerged as a promising diagnostic tool, however, differentiating between infected and non-infected grafts is complex because non-infected grafts can also exhibit inflammatory FDG uptake. This overlap complicates interpretation, necessitating the refinement of diagnostic criteria. We evaluated the diagnostic utility of FDG-PET/CT in distinguishing infected from non-infected grafts, focusing on FDG uptake intensity and pattern while determining optimal semi-quantitative thresholds.A retrospective analysis was conducted on 80 patients who underwent FDG-PET/CT and had either infected or non-infected grafts. FDG-PET/CT images were analyzed based on FDG uptake intensity using a visual grading scale, FDG uptake pattern, and semi-quantitative parameters such as standardized uptake value (SUV) and target-to-background ratio (TBR).FDG uptake intensity assessment demonstrated that 92.6% of PVGI patients exhibited grade 3 uptake, compared to 62.3% of non-infected patients. Analysis of FDG uptake patterns also showed a significant difference, with focal uptake observed in 66.7% of infected patients versus 20.8% of non-infected patients. PVGI patients displayed significantly higher median SUVmax and TBR values than non-infected grafts. An SUVmax threshold of 6.2 demonstrated a sensitivity of 70% and a specificity of 79% for PVGI diagnosis. Similarly, a TBR cutoff of 3.3 yielded a sensitivity of 74% and a specificity of 81%.FDG-PET/CT is increasingly recognized as a valuable diagnostic tool for PVGI, particularly through the assessment of uptake intensity, pattern, SUVmax, and TBR parameters. Our study strengthens its established role and provides important data that may help refine diagnostic thresholds, further enhancing its utility in clinical practice. However, cautious interpretation remains essential to avoid unnecessary procedures.

Use of Cryopreserved Arterial Allografts as a Reconstruction Strategy in Peripheral Sarcoma Surgery.

A protocolized approach to chyle leaks to mitigate prosthetic graft infection

Anastomotic aneurysms (AA) manifest as late complications of aortic-iliac-femoral reconstruction with a prosthetic graft. We studied open and endovascular repair of complex aortic iliac and femoral AA was performed for (A) Rupture, (B) Large symptomatic aneurysms, (C) Recurrent, (D) Femoral AA requiring simultaneous arterial reconstruction for critical limb ischemia in two teaching hospitals. Between 1990 and 2024, 100 aorto-femoral-iliac AA were repaired with 32 representing complex AA involving aorta (n = 6), iliac (n = 3), femoral (n = 23). Aortic and iliac anastomotic aneurysms underwent endovascular repairs in 5 patients and open repair in 4 patients with satisfactory outcomes in all. All 23 patients presenting with complex femoral anastomotic aneurysms were repaired via open technique, including five presenting with rupture with mortality in two, and one mortality among those presenting with large aneurysms. Complex femoral AA take longer to present after index operative, showed greater operative time, intra-operative blood loss but had similar mortality to patients with non-complex AAs. Most aortic and iliac AA can be repaired with endovascular and open techniques with satisfactory results, while complex femoral AA required open repair.

Autogenous paneled femoral vein grafts for mycotic thoracic aortic aneurysms

To investigate the feasibility, safety, and efficacy of percutaneous transhepatic endovascular recanalization and stenting after venous graft thrombosis in pancreatic cancer patients who underwent pancreatoduodenectomy (PD) with venous reconstruction and assess risk factors of occlusion. This retrospective study was approved by the institutional review board. The clinical characteristics of 227 patients who underwent PD were compared among patients who underwent PD with/without porto-mesenteric venous resection (PMVR) ± prosthetic graft interposition. Out of 227 patients, 18 (8%) underwent PD with PMVR and prosthetic graft interposition. Seven out of 18 patients had prosthetic graft occlusion. Occlusion was symptomatic in most cases (86%) and associated with tumor recurrence in 43%. On univariable logistic regression analysis, small postoperative graft diameter (OR: 0.141; 95% CI 0.021-0.970) and caudal anastomosis diameter measured on CT (OR: 0.226; 95% CI 0.059-0.859) were clear predictors of graft occlusion (p = 0.047 and p = 0.029, respectively). Interventional recanalization was performed in five patients. Technical success was 100%, with no complications. Percutaneous transhepatic prosthetic graft recanalization and stenting is feasible and may be considered a safe and effective technique with immediate restoration of porto-mesenteric blood flow and symptom relief. Small grafts and venous anastomosis diameters are particularly at risk of thrombosis.