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Comparison of straight and Venaflo-type cuffed arteriovenous ePTFE grafts in an animal study  Michael Heise, MD, MBA, Inga Husmann, MD, Ann-Kathrin Grüneberg,

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Presentation on theme: "Comparison of straight and Venaflo-type cuffed arteriovenous ePTFE grafts in an animal study  Michael Heise, MD, MBA, Inga Husmann, MD, Ann-Kathrin Grüneberg,"— Presentation transcript:

1 Comparison of straight and Venaflo-type cuffed arteriovenous ePTFE grafts in an animal study 
Michael Heise, MD, MBA, Inga Husmann, MD, Ann-Kathrin Grüneberg, Alexander Knobel, Petra Kirschner, Christoph Heidenhain, MD  Journal of Vascular Surgery  Volume 53, Issue 6, Pages (June 2011) DOI: /j.jvs Copyright © 2011 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Angiogram (A) and intraoperative situs (B) of a Venaflo graft 12 months after implantation in a 68-year-old male. A subtotal stenosis at the graft vein anastomosis is present. The stenosis comprised both of pseudointima at the graft wall and intimal hyperplasia of the recipient vein. The stenosis was treated with a polytetrafluoroethylene (PTFE) patch implantation. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Intraoperative situs of an arteriovenous loop graft. The graft was inserted between the left iliac artery and vein. The grafts were covered using a reinforced 8 mm expanded polytetrafluoroethylene (ePTFE) graft to prevent kinking. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Diagram of the measurement sites of intimal hyperplasia at the venous wall. The neointimal hyperplasia (IH) was measured on five evenly distributed sites of the hyperplastic lesion. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Kaplan-Meier curves of the postoperative patency of straight and Venaflo-type arteriovenous expanded polytetrafluoroethylene (ePTFE) grafts. The patency of straight grafts was lower. The grafts started to fail during the first week, while the occlusions in the Venaflo-type group occurred toward the end of the follow-up. However, the differences were statistically not significant (log-rank test). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Comparison of intimal hyperplasia development on the vein wall. The amount of neointimal hyperplasia (IH) was almost doubled in the straight graft group (ns). ePTFE, Expanded polytetrafluoroethylene. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

7 Fig 6 Hypothesis of the pathophysiology of pseudointima development in cuffed expanded polytetrafluoroethylene (ePTFE) grafts. The sudden widening of the anastomosis in the cuff section leads to flow separation areas near the ePTFE wall. Comparable flow separations were previously found both in in vitro studies as well as in computational fluid dynamics calculations.8,9 In the flow separation zones the flow recirculates forward and backward with a long contact time between blood and graft wall. Due to the high thrombogenicity of PTFE, eventually a pseudointima develops in the separation areas during the course of weeks and months after the implantation. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

8 Fig 7 Comparison of the venous anastomosis of a straight and cuffed arteriovenous graft. The pseudointima development was more pronounced in the straight graft, leading to a subtotal stenosis. In the Venaflo-type grafts, the pseudointima development was more prominent in the hood section of the anastomosis. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

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