| Knitted nitinol represents a new generation of constrictive external vein graft meshes. | |
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MedLine Citation:
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PMID: 21802240 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Constriction of vein grafts with braided external nitinol meshes had previously led to the successful elimination of neointimal tissue formation. We investigated whether pulse compliance, smaller kink-free bending radius, and milder medial atrophy can be achieved by knitting the meshes rather than braiding, without losing the suppressive effect on intimal hyperplasia. METHODS: Pulse compliance, bending stiffness, and bending radius, as well as longitudinal-radial deformation-coupling and radial compression, were compared in braided and knitted nitinol meshes. Identical to previous studies with braided mesh grafts, a senescent nonhuman primate model (Chacma baboons; bilateral femoral interposition grafts/6 months) mimicking the clinical size mismatch between vein grafts and runoff arteries was used to examine the effect of knitted external meshes on vein grafts: nitinol mesh-constricted (group 1); nitinol mesh-constricted and fibrin sealant (FS) spray-coated for mesh attachment (group 2); untreated control veins (group 3), and FS spray-coated control veins (group 4). RESULTS: Compared with braided meshes, knitted meshes had 3.8-times higher pulse compliance (3.43 ± 0.53 vs 0.94 ± 0.12%/100 mm Hg; P = .00002); 30-times lower bending stiffness (0.015 ± 0.002 vs 0.462 ± 0.077 Nmm(2); P = .0006); 9.2-times narrower kink-free bending radius (15.3 ± 0.4 vs 140.8 ± 22.4 mm; P = .0006), and 4.3-times lower radial narrowing caused by axial distension (18.0% ± 1.0% vs 77.0% ± 3.7%; P = .00001). Compared with mesh-supported grafts, neointimal tissue was 8.5-times thicker in group I (195 ± 45 μm) vs group III (23.0 ± 21.0 μm; P < .001) corresponding with a 14.3-times larger neointimal area in group I (4330 ± 957 × 103 μm(2)) vs group III (303 ± 221× 103 μm(2); P < .00004). FS had no significant influence. Medial muscle mass remained at 43.4% in knitted meshes vs the 28.1% previously observed in braided meshes. CONCLUSION: Combining the suppression of intimal hyperplasia with a more physiologic remodeling process of the media, manifold higher kink-resistance, and lower fraying than in braided meshes makes knitted nitinol an attractive concept in external vein graft protection. |
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Authors:
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Peter Zilla; Loven Moodley; Michael F Wolf; Deon Bezuidenhout; Mazin S Sirry; Nasser Rafiee; Wilhelm Lichtenberg; Melanie Black; Thomas Franz |
Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2011-07-29 |
Journal Detail:
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Title: Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter Volume: 54 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-10-26 Completed Date: 2011-12-15 Revised Date: 2012-04-16 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1439-50 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Christiaan Barnard Department of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa. peter.zilla@uct.ac.za |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Alloys* Animals Biomechanics Compliance Equipment Design Femoral Artery / physiopathology, surgery*, ultrastructure Femoral Vein / physiopathology, transplantation*, ultrastructure Fibrin Tissue Adhesive Hyperplasia Materials Testing Microscopy, Electron, Scanning Models, Animal Papio ursinus Pulsatile Flow Surgical Mesh* Time Factors Vascular Grafting / adverse effects, instrumentation* |
| Grant Support | |
ID/Acronym/Agency:
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R03 TW008941-02/TW/FIC NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Alloys; 0/Fibrin Tissue Adhesive; 52013-44-2/nitinol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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