Successful interposition synthetic graft between aorta and right coronary artery. Angiographic follow-up to sixteen months.

A knitted Dacron filamentous vascular prosthesis, 4 cm. long and 3.5 mm. in diameter, was used as an interposition graft between the aorta and right coronary artery in a 65-year-old woman on Oct. 25, 1974. The prosthesis was used to transplant the right coronary artery incident to removal of a saccular aneurysm if the ascending aorta. Concomitant mitral valve replacement and tricuspid annuloplaty were performed. The graft was demonstrated patent by angiograms 2 weeks, 7 months, and 16 months after the operation, and the patient continues to be clinically well 17 months postoperatively. The literature records the successful use of aorta-coronary Dacron prostheses in 2 other patents, both children with coronary anomalies. One of these grafts closed after a while: the second was demonstrated patent by angiograms 8 years after implantation. These cases demonstrate that prostheses can function in the aorta-coronary position, and the reports of saphenous vein failures indicate the need for a reasonable substitute when a patient's saphenous veins are absent or inadequate. In all 3 cases, the prostheses were quite short and were used as interposition grafts between the ascending aorta and the proximal end of the coronary artery. Our review did not reveal successful use of a synthetic graft for aorta-coronary bypass.

Axillofemoral bypass: a critical reappraisal of its role in the management of aortoiliac occlusive disease.

Two hundred twenty-four consecutive patients (361 graft limbs) who underwent bypass grafting with the USCI Sauvage filamentous velour Dacron arterial prosthesis for aortoiliac occlusive disease over the 9 year period 1970 to 1979 are reviewed. Eighty-four axillofemoral (23 percent of patients), 210 aortofemoral (47 percent of patients), and 67 femorofemoral grafts (30 percent of patients) had cumulative patency rates of 72.1, 91.1, and 86.4 percent, respectively. Experimental and clinical factors influencing the patency of axillofemoral grafts are discussed, and the concept of an improved porous Dacron prosthesis specific for the axillofemoral site is presented.

Presence of endothelium in an axillary-femoral graft of knitted Dacron with an external velour surface.

An axillary-bilateral common femoral graft of knitted Dacron with an external velour surface was examined within one hour after the patient's death from non-graft-related causes. The prothesis, implanted for 20 months, was patent and was completely healed over 32% of the flow surface--that is, full wall fibrous tissue encapsulation of the graft had occurred, and 32% of the flow surface was endothelialized. The remaining flow surface was formed of fibrin, but fibrous tissue healing had reached the inner surface of the graft material, and the fibrin overlay was very thin. The healed protions of the graft included not only the areas adjacent to the anastomoses, but were scattered throughout the 45 cm length of the prosthesis. To our knowledge, this is the first report of complete healing (fibrous tissue encapsulation and endothelialization) documented at points beyond the plannus ingrowth at the prosthesis-artery anastomosis.

Effects of compliance alteration on healing of a porous dacron prosthesis in the thoracic aorta of the dog.

In our study, the results reveal that a marked reduction in the compliance of an external-velour, weft-knit Dacron prosthesis did not impair healing of either the graft wall or of the anastomoses when these grafts were implanted in the upper part of the descending thoracic aorta of the dog for 56 days. These observations are clinically relevant, since they are important to the design of noncrimped fabric prostheses which are resistant to kink and compression when used for axillofemoral, femoropopliteal and femorotibial bypass. However, experimental studies of the influence of compliance disparity should be extended to such grafts implanted for several years.

A healable filamentous Dacron surgical fabric. Experimental studies and clinical experience.

A strong, lightweight, highly compliant Dacron surgical fabric of warp-knit, velour construction has been developed as an outgrowth of research on filamentous tubular vascular prostheses. This material has excellent suturability and conformability, high preclotting efficiency, and is imprinted with calibration marks at 2 cm intervals. Experimentally, iliac artery and descending thoracic aorta patch grafts of this material were completely healed 28 days after implantation in dogs. Light and electron microscopy showed excellent healing. This paper reports clinical results of 119 patches implanted in 109 patients who have been followed for a mean of 26.4 months (range: 16--34 months). Of these, 20 patches were used in arterial reconstructions, and 99 were used in the heart for repair of 95 congenital and four acquired defects. The 20 patch angioplasties were performed in the carotid artery (four patches), subclavian artery, (one patch), common femoral artery, profunda femoris artery, or superficial femoral artery (10 patches), and in the popliteal artery (five patches). This new surgical fabric is easily adaptable to complex angioplasties and for repair of intracardiac abnormalities. No complications intrinsic to the surgical fabric have been observed in clinical use of this material in 109 patients.

The preclotting of porous arterial prostheses.

A four-step preclotting method is presented for use with porous filamentous Dacron prostheses in the fully-heparinized patient. The method employs controlled fibrin formation within graft interstices, heparin neutralization of all thrombin remaining in the graft wall, and delay of systemic heparin neutralization until 15--20 minutes after clamp release. The resulting flow surface is impervious, smooth and hypothrombogenic. Experimental data are presented which support the rationale of this four-step preclotting method. Four years of clinical experience with the method are summarized, involving 300 prosthesis limbs used in aortic bifurcation, aortofemoral, femorofemoral, axillary-femoral and femoropopliteal positions in 192 patients. A clinical perspective of preclotting techniques is presented in which the proper use of this new method is suggested.