Chapter 64 - Prosthetic grafts Flashcards
Ideal prosthetic conduit features
1) impermeable
2) compliant
3) biocompatible
4) durable
5) easy to sterilize
6) facile to implant
7) available in different sizes
8) resistant to thrombosis and infection
9) cost effective
Current types of prosthetic grafts
Standard ePTFE/Dacron Sealed ePTFE/Dacron Heparin modified ePTFE/dacron carbon modified ePTFE silver modified dacron collagen based polyurethane
First dacron graft
1941 Whinfield and Dickinson
Knitted vs woven
Knitted = better compliance, larger pores
Woven = less compliance but tighter seal
coat with albumin to prevent leakage
ePTFE first desxription
Matsumoto 1973
Polypropylene benefit
high tensile strength and relative inertness
Polyurethane pro and con
high elasticity
poor biostability and loss of compliance
Miller cuff
Taylor cuff patency
St. Mary’s Boot
Distal vein patch (linton)
Miller - 50-80% 1 year; 30-64% 3 year
Taylor - 71-88% 1 year; 57-77% 3 year
St. Mary’s boot - 40% 2 year; 38% 3 year
Linton - 79-82% 1 year; 65-69% 3 year
Advantage of venous adjunct at distal anastamosis
1) venous endothelium with fibrinolytic and antiplatelet activity
2) minimize expansibility mismatch
3) improve anastomotic geometry
4) larger lumen before hemodynamic stenosis ensues
Patency of heparin bound grafts in below knee bypass
82% primary and 97% secondary 1 year patency
Spiral laminar flow graft patency for above and below knee
above knee 1 and 2 year
86 and 81%
below knee 1 and 2 year
73 and 57%
Distal AVF for bypass patency
62% at 36 months
same with common ostium AV fistula
Dutch trial on ASA or warfarin for bypass patency
ASA better for prosthetic grafts
warfarin better for vein grafts
VA trial on ASA and warfarin vs ASA alone
Benefit for small <6 mm prosthetic graft
2x increase major hemorrhage
Clopidogrel and ASA in bypass surgery for peripheral arterial disease CASPAR
1) DAPT vs asa
2) DAPT reduced graft occlusion in prosthetic graft by 35% but not in vein graft
3) no significant difference in bleed
