Document Detail

Is there a haemodynamic advantage associated with cuffed arterial anastomoses?
MedLine Citation:
PMID:  12231279     Owner:  NLM     Status:  MEDLINE    
The development of intimal hyperplasia at arterial bypass graft anastomoses is a major factor responsible for graft failure. A revised surgical technique, involving the incorporation of a small section of vein (vein cuff) into the distal anastomosis of PTFE grafts, results in an altered distribution of intimal hyperplasia and improved graft patency rates, especially for below-knee grafts. Numerical simulations have been conducted under physiological conditions to identify the flow behaviour in a typical cuffed bypass model and to determine whether the improved performance of the cuffed system can be accounted for by haemodynamic factors. The flow patterns at the cuffed anastomosis are significantly different to those at the conventional end-to-side anastomosis. In the former case, the flow is characterised by an expansive, low momentum recirculation within the cuff. Separation occurs at the graft heel, and at the cuff toe as the blood enters the recipient artery. Wall shear stresses in the vicinity of the cuff heel are low, but high shear stresses and large spatial gradients in the shearing force act on the artery floor during systole. In contrast, a less disturbed flow prevails and the floor shear stress distribution is less adverse in the conventional model. In conclusion, aspects of the anastomotic haemodynamics are worsened when the cuff is employed. The benefits associated with the cuffed grafts may be related primarily to the presence of venous material at the anastomosis. Therefore, caution is advised with regard to the use of PTFE grafts, pre-shaped to resemble a cuffed geometry.
J S Cole; J K Watterson; M J G O'Reilly
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Publication Detail:
Type:  Comparative Study; Journal Article; Validation Studies    
Journal Detail:
Title:  Journal of biomechanics     Volume:  35     ISSN:  0021-9290     ISO Abbreviation:  J Biomech     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-09-16     Completed Date:  2003-03-18     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0157375     Medline TA:  J Biomech     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1337-46     Citation Subset:  IM    
School of Aeronautical Engineering, The Queen's University of Belfast, BT9 5AG, Belfast, UK.
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MeSH Terms
Anastomosis, Surgical / methods*
Blood Flow Velocity
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation / methods*
Computer Simulation*
Equipment Failure Analysis / methods
Femoral Artery / physiopathology*,  surgery*
Finite Element Analysis
Models, Cardiovascular*
Pulsatile Flow
Sensitivity and Specificity
Stress, Mechanical
Veins / transplantation

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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