Jose J. Norberto, MD, Anton N. Sidawy, MD, Karim S. Trad, MD, Bruce A

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Presentation transcript:

The protective effect of vein cuffed anastomoses is not mechanical in origin Jose J. Norberto, MD, Anton N. Sidawy, MD, Karim S. Trad, MD, Bruce A. Jones, MD, Richard F. Neville, MD, Samer F. Najjar, MD, Mary K. Sidawy, MD, Ralph G. DePalma, MD Journal of Vascular Surgery Volume 21, Issue 4, Pages 558-566 (April 1995) DOI: 10.1016/S0741-5214(95)70187-7 Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 a, Left side distal anastomosis in group A. Vein cuff is interposed between e-PTFE graft and carotid artery. A′, A, B, and C denote sectioning levels for intimal hyperplasia thickness measurements. Same levels were used for right side. b, Right-side distal anastomosis in group A. Vein cuff is snugly encircled by e-PTFE jacket, which is incorporated in graft/cuff anastomosis. (Reprinted with permission, Sidawy AN, et al. Effect of vein cuff and e-PTFE on the development of outflow intimal hyperplasia. Surg Forum 1991;42:345-6). Journal of Vascular Surgery 1995 21, 558-566DOI: (10.1016/S0741-5214(95)70187-7) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Acute angle distal anastomosis e-PTFE graft/left carotid artery (group A); B, 90-degree angle distal anastomosis e-PTFE graft/right carotid artery (group B). Journal of Vascular Surgery 1995 21, 558-566DOI: (10.1016/S0741-5214(95)70187-7) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Acute angle distal anastomosis e-PTFE graft/left carotid artery (group A); B, 90-degree angle distal anastomosis e-PTFE graft/right carotid artery (group B). Journal of Vascular Surgery 1995 21, 558-566DOI: (10.1016/S0741-5214(95)70187-7) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Strain gauge plethysmography of the control (a) and jacketed (b) vein cuffs. Respective waveforms depicted show 7:1 ratio of amplitudes, which corresponds to equivalent reduction in expansibility of vein cuff with addition of restricting e-PTFE jacket. Journal of Vascular Surgery 1995 21, 558-566DOI: (10.1016/S0741-5214(95)70187-7) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Strain gauge plethysmography of the control (a) and jacketed (b) vein cuffs. Respective waveforms depicted show 7:1 ratio of amplitudes, which corresponds to equivalent reduction in expansibility of vein cuff with addition of restricting e-PTFE jacket. Journal of Vascular Surgery 1995 21, 558-566DOI: (10.1016/S0741-5214(95)70187-7) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Representative cross-sectional views from distal anastomosis as seen with light microscopy. A, Right side, jacketed cuff, level B: vein cuff (v) is interposed between graft (g) and carotid artery (a), and snugly encircled by e-PTFE jacket (j), which is incorporated in graft/cuff anastomosis (asterisk). B, Left side, non-jacketed cuff, level C: unrestricted vein cuff (v) is interposed between artery (a) and graft (g). No jacket was placed. Journal of Vascular Surgery 1995 21, 558-566DOI: (10.1016/S0741-5214(95)70187-7) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Representative cross-sectional views from distal anastomosis as seen with light microscopy. A, Right side, jacketed cuff, level B: vein cuff (v) is interposed between graft (g) and carotid artery (a), and snugly encircled by e-PTFE jacket (j), which is incorporated in graft/cuff anastomosis (asterisk). B, Left side, non-jacketed cuff, level C: unrestricted vein cuff (v) is interposed between artery (a) and graft (g). No jacket was placed. Journal of Vascular Surgery 1995 21, 558-566DOI: (10.1016/S0741-5214(95)70187-7) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Comparison of thickness of intimal hyperplasia at outflow anastomosis between jacketed and control groups. All units are in micrometers, x ± SEM (n = 8). A′, 1 mm distal to toe of anastomosis, A, toe of anastomosis; B, midportion of anastomosis; and C, heel of anastomosis. Journal of Vascular Surgery 1995 21, 558-566DOI: (10.1016/S0741-5214(95)70187-7) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions