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Panminerva Medica 1999 March;41(1):72-7

lingua: Inglese

Non-­suture end-to-end anas­to­mos­es ­between poly­tet­ra­flu­o­roe­thy­lene graft and ves­sels for blood ­access

Sumimoto K., Tanaka I., Fukuda Y., Haruta N., Dohi K.*, Ito H.**, Tsuchiya T.***, Ikada Y.****

From the First Department of Surgery Hiroshima Prefectural Hospital
* The Second Department of Surgery, Hiroshima University Medicine School, Hiroshima
** The Department of Pathology, Tottori University Medicine School, Tottori
*** Akane Foundation Tsuchiya Hospital, Hiroshima
**** Research Center Biomedical Engineering, University of Kyoto, Kyoto, Japan


Background. Non-­suture end-to-end anas­to­moses ­between poly­tet­ra­flu­o­roe­thy­lene ­grafts and ­blood ves­sels ­were ­achieved ­using absorb­able ­cuff mate­rial in experi­mental and clin­ical ­studies. The ­cuff was ­made of a syn­thetic bio­de­grad­able mate­rial, a ­lactic-gly­colic ­acid copol­ymer, sim­ilar in com­po­si­tion to con­ven­tional absorb­able sur­gical ­sutures.
Methods. In the experi­mental ­study, vas­cular anas­to­moses for pros­thetic inter­po­si­tion of the infra­renal ­aorta in rab­bits ­were ­created ­using the ­cuff ­method. Six ­months ­after sur­gery, the ­cuff anas­to­moses ­sites ­were exam­ined angio­graph­i­cally and micro­scop­i­cally and ­found to be ­patent and ­smooth ­without neo­in­timal hyper­plasia.
Results. The ­cuff ­layer had ­been com­pletely ­absorbed. The clin­ical appli­ca­tion ­used a sim­ilar tech­nique and ­involved the crea­tion of ­forearm ­bridge ­graft fis­tula in ­twelve ­patients for hemo­di­al­ysis. In ­eight ­patients, Doppler fis­tula ­flow ­rate ­ranged ­from 167 ml/min to 392 ml/min. Ten of the ­twelve ­patients con­tinued dial­ysis unevent­fully. The one-­year ­patency ­rate was 78% (7/9). The ­longest ­patency ­period was 920 ­days and the ­graft ­access con­tinued to main­tain suf­fi­cient ­blood ­flow for hemo­di­al­ysis.
Conclusions. This absorb­able ­cuff mate­rial is there­fore ­well ­suited for the con­struc­tion of pros­thetic vas­cular end-to-end anas­to­moses.

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