| Harnessing haemodynamic forces for the suppression of anastomotic intimal hyperplasia: the rationale for precuffed grafts. | |
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MedLine Citation:
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PMID: 11397026 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Standardisation of cuff geometry by manufacturing prosthetic precuffed grafts (PCG) theoretically optimises haemodynamic forces. This study was designed in order to determine whether these beneficial flow patterns are replicated in vivo in PCG. PATIENTS AND METHODS: Flow visualisation and Doppler studies performed on anatomically accurate PCG models characterised in vitro anastomotic flow patterns. Thirty-two patients (median age 68 years) in whom autologous vein was unavailable, underwent bypass using PCG. Post-operative analysis included qualitative assessment of flow within the distal anastomosis using Doppler colour flow mapping. Cardiac gating techniques and assessment of velocity distribution were performed to gain additional information. These in vivo results were validated against the bench studies. RESULTS: A cohesive vortex was identified within the distal anastomosis of in vitro models and had an integral relationship with the cardiac cycle. This flow structure was also characterised using Doppler colour flow mapping in both longitudinal and transverse planes, confirming the location of the vortex within the body and proximal part of the anastomosis. Twenty-two patients (69%) undergoing bypass with a PCG underwent successful Doppler assessment one week post-operatively, of whom 17 (77%) had a vortical flow structure identified at the distal anastomosis, similar to that characterised in vitro. Cardiac gating verified the same integral relationship of the vortex with the cardiac cycle as that described in vitro. CONCLUSION: The geometric configuration of precuffed grafts induced vortices within the distal anastomoses in 17 out of 22 patients undergoing arterial reconstruction, thereby harnessing the haemodynamic forces that may suppress anastomotic hyperplasia and improve patency rates. |
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Authors:
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R K Fisher; T V How; I M Toonder; M T Hoedt; J A Brennan; G L Gilling-Smith; P L Harris |
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Publication Detail:
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Type: In Vitro; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Volume: 21 ISSN: 1078-5884 ISO Abbreviation: Eur J Vasc Endovasc Surg Publication Date: 2001 Jun |
Date Detail:
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Created Date: 2001-06-08 Completed Date: 2001-07-19 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9512728 Medline TA: Eur J Vasc Endovasc Surg Country: England |
Other Details:
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Languages: eng Pagination: 520-8 Citation Subset: IM |
Copyright Information:
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Copyright 2001 Harcourt Publishers Limited. |
Affiliation:
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Department of Clinical Engineering, The Royal Liverpool University Hospital, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Anastomosis, Surgical / methods Blood Flow Velocity Blood Vessel Prosthesis* Blood Vessel Prosthesis Implantation / methods Equipment Design Female Graft Occlusion, Vascular / pathology, prevention & control* Hemodynamics* Humans Hyperplasia / prevention & control Male Middle Aged Models, Biological Polytetrafluoroethylene Tunica Intima / pathology* Ultrasonography, Doppler, Color |
| Chemical | |
Reg. No./Substance:
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9002-84-0/Polytetrafluoroethylene |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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