ABSTRACT
Of 394 carotid endarterectomies performed during a 10-year period, 36 (9%) included Dacron patch graft angioplasties. Patch graft angioplasties were used selectively in patients because they had undergone previous carotid endarterectomy or had small-caliber vessels. There were no postoperative infections, occlusions, emboli, stroke, or pseudoaneurysms. In addition, no clinically detectable recurrent stenoses developed in this high-risk group of patients. Twenty-four of the 27 patients available for follow-up were screened for asymptomatic stenoses with spectral analysis and B-mode imaging; there was no sign of hemodynamically significant recurrent stenosis in this group. These encouraging results support the continued selective use of Dacron patch graft angioplasty in carotid surgery.
Subject(s)
Blood Vessel Prosthesis , Carotid Artery Diseases/surgery , Endarterectomy , Polyethylene Terephthalates , Carotid Artery, Internal/surgery , Constriction, Pathologic/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Recurrence , Risk FactorsABSTRACT
Long-term follow-up data from several leading centers concerning patients undergoing coronary artery bypass clearly demonstrate the superiority of the internal mammary artery (IMA) with patency rates of 83 to 94% at 7 to 12 years compared with the saphenous vein and its patency rates of 41 to 53%. Our experimental studies provide a biological basis for understanding this difference. Thin-walled arterial autografts undergo no histological change after being implanted in the arterial system, while venous autografts undergo major changes with an initial scattered loss of endothelium and marked thickening due to a proliferative reaction. The challenge to the cardiac surgeon is to revascularize the entire left ventricle with the IMAs. We have found this possible in most patients with advanced three-vessel disease by using both IMAs either as in situ grafts or free grafts with as many sequential anastomoses as necessary to achieve full revascularization. Our use of the term in situ refers to the graft's origin from the subclavian artery as opposed to a free IMA graft arising from another site.
Subject(s)
Coronary Artery Bypass/methods , Mammary Arteries/transplantation , Thoracic Arteries/transplantation , Vascular Patency , Wound Healing , Aged , Animals , Blood Pressure , Carotid Arteries/pathology , Carotid Arteries/surgery , Coronary Artery Bypass/adverse effects , Coronary Vessels/surgery , Dogs , Female , Follow-Up Studies , Graft Occlusion, Vascular/prevention & control , Humans , Jugular Veins/pathology , Jugular Veins/surgery , Male , Mammary Arteries/pathology , Middle Aged , Saphenous Vein/pathology , Saphenous Vein/surgery , Time FactorsABSTRACT
We have examined the clinical results of 56 externally-supported (EXS) Dacron grafts in the axillofemoral position and 117 in the femoropopliteal position. Results have been analyzed from two perspectives: primary patency concerns only those grafts that had never occluded; extended patency refers to all open grafts including those whose continued patency is the result of thrombectomy. The 5-to 7-year life-table patency rates are: axillofemoral 8 mm and 6 mm bypass: primary 75% and extended 97%; above-knee femoropopliteal 6 mm bypass: primary 78% and extended 93%; below-knee 6 mm femoropopliteal bypass: primary 41% and extended 91%. In contrast, the results for the 5 mm grafts used for femoropopliteal bypass were inferior to the 6 mm grafts: femoropopliteal 5 mm bypasses had an above-knee primary patency rate of 44% and an extended rate of 55%, with a below-knee primary patency rate of 15% and an extended rate of 32%. Rendering the noncrimped porous Dacron prosthesis kink and compression resistant by an external support coil appears to increase its potential for successful use, especially in 8 mm axillofemoral and 6 mm femoropopliteal bypasses.
