Extended study of aneurysm formation in umbilical vein grafts

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Presentation transcript:

Extended study of aneurysm formation in umbilical vein grafts William S. Karkow, M.D., John J. Cranley, M.D., Robert D. Cranley, M.D., Charles D. Hafner, M.D., Bruce A. Ruoff, M.D., Kurt J. Stedje, B.A., Lawrence J. Hannan, B.S., Negussie Aseffa, B.S. Journal of Vascular Surgery Volume 4, Issue 5, Pages 486-492 (November 1986) DOI: 10.1016/0741-5214(86)90385-X Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Schematic diagram shows location of scan by zone. Each graft was measured at half zone increments. IVC = inferior vena cava; CIV = common iliac vein; CFV = common femoral vein; DFV = deep femoral vein; SFV = superficial femoral vein; GSV = great saphenous vein; POP = popliteal vein; LSV = lesser saphenous vein; ATV = anterior tibial vein; Per = peroneal vein; PTV = posterior tibial vein. Journal of Vascular Surgery 1986 4, 486-492DOI: (10.1016/0741-5214(86)90385-X) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Midshaft aneurysms by type. Vertical dashed lines indicate dimensions of a 150% diameter enlargement. Uppermost fusiform enlargement fails to meet the 150% diameter enlargement criteria and is classified as normal. Journal of Vascular Surgery 1986 4, 486-492DOI: (10.1016/0741-5214(86)90385-X) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Anastomotic aneurysm as measured by transverse scan (horizontal dashed line). Even a normal anastomosis may measure more than the sum of graft and host diameters but does not exceed 150%. Journal of Vascular Surgery 1986 4, 486-492DOI: (10.1016/0741-5214(86)90385-X) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Schematic illustration of typical fusiform aneurysm. Internal and external diameters are indicated by zone. Journal of Vascular Surgery 1986 4, 486-492DOI: (10.1016/0741-5214(86)90385-X) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Diagram of scan image of fusiform aneurysm. Skin (S), subcutaneous tissue (SQ), graft aneurysm in longitudinal profile, and muscle (M) are seen from left to right. UVG = umbilical vein graft; T = thrombus. Journal of Vascular Surgery 1986 4, 486-492DOI: (10.1016/0741-5214(86)90385-X) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 B-mode ultrasound image at 4 MHz of fusiform aneurysm corresponding to Figs. 4 and 5. Note the lining thrombus and residual lumen. Journal of Vascular Surgery 1986 4, 486-492DOI: (10.1016/0741-5214(86)90385-X) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 Schematic illustration of eccentric saccular aneurysm caused by absence of umbilical vein component along one wall. Journal of Vascular Surgery 1986 4, 486-492DOI: (10.1016/0741-5214(86)90385-X) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 8 Diagram of scan image of aneurysm with umbilical vein defect as seen in longitudinal view. Umbilical vein graft (UVG) communicates through defect in mesh (M) with lumen of eccentric aneurysm (A), which is lined by thrombus (T). Muscle (also M) is identified to right. S = skin; SQ = subcutaneous tissue. Journal of Vascular Surgery 1986 4, 486-492DOI: (10.1016/0741-5214(86)90385-X) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 9 B-mode ultrasound image at 8 MHz of eccentric saccular aneurysm with intact Dacron mesh but umbilical vein defect. Pulsatile flow outside confines of graft was documented by directed Doppler signal. Findings confirmed on opening excised graft segment. Journal of Vascular Surgery 1986 4, 486-492DOI: (10.1016/0741-5214(86)90385-X) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 10 Scattergram of all external diameter measurements taken by duplex scanning from 64 patent grafts of 3 to 8 years' duration, grouped by zone (y axis). No specific level of aneurysmal enlargement is evident. Vertical line indicates upper limit of normal. Journal of Vascular Surgery 1986 4, 486-492DOI: (10.1016/0741-5214(86)90385-X) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions