Does the end-to-end venous anastomosis offer a functional advantage over the end-to- side venous anastomosis in high-output arteriovenous grafts? Mark.

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Presentation transcript:

Does the end-to-end venous anastomosis offer a functional advantage over the end-to- side venous anastomosis in high-output arteriovenous grafts? Mark F. Fillinger, MD, D.Brent Kerns, MD, David Bruch, MS, Emanuel R. Reinitz, MD, Robert A. Schwartz, MD Journal of Vascular Surgery Volume 12, Issue 6, Pages 676-690 (December 1990) DOI: 10.1067/mva.1990.24914 Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Configuration for graft implantation. Journal of Vascular Surgery 1990 12, 676-690DOI: (10.1067/mva.1990.24914) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Subdivision of the two anastomotic configurations for histologic and hemodynamic measurements. Note the location numbers for orientation in the text and other figures. Journal of Vascular Surgery 1990 12, 676-690DOI: (10.1067/mva.1990.24914) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Three-dimensional schematic representation of perianastomotic tissue vibration. B, and C, Schematic representations of longitudinal and transverse views of perianastomotic tissue vibration. See reference 11 for actual color figures. Journal of Vascular Surgery 1990 12, 676-690DOI: (10.1067/mva.1990.24914) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 A, Mean pressures versus location for the end-to-side configuration. Note the pressure drops across the arterial and venous anastomoses. B, Mean pressures versus location for the end-to-end configuration. See text for details and statistical data. Pressures are significantly different for artery, graft, and vein in both configurations. Journal of Vascular Surgery 1990 12, 676-690DOI: (10.1067/mva.1990.24914) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Comparison of volumetric flow rates (VFR) for the end-to-side (ES) and end-to-end (EE) anastomoses over time. *VFR increases significantly between week 1 and week 4 for both configurations (p < 0.05). ES and EE configurations are statistically equivalent at each time period. Journal of Vascular Surgery 1990 12, 676-690DOI: (10.1067/mva.1990.24914) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Comparison of the volume of perivascular tissue vibration for the two anastomotic types over time. *Volume of perivascular tissue vibration increases significantly between week 1 and week 4 for both configurations (p < 0.05). ES and EE configurations are statistically equivalent at each time period. Journal of Vascular Surgery 1990 12, 676-690DOI: (10.1067/mva.1990.24914) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Amplitude of relative vessel wall motion versus anastomotic type for various locations at 1 and 12 weeks after implantation (see text for details). ES, End-to-side; EE, end-to-end anastomoses. 1 and 12 indicate weeks after implantation. *p < 0.05 for EE anastomosis at 12 weeks versus all other values at that location. †Relative wall motion for prosthetic graft is also statistically different from arterial and venous values (p < 0.05). Journal of Vascular Surgery 1990 12, 676-690DOI: (10.1067/mva.1990.24914) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Relative vessel wall velocity versus anastomotic type for various locations at 1 and 12 weeks after implantation (see text for details). Vein location numbers are shown in Fig. 2. a, Location just anterior to the vein; b, location just posterior to the vein. ES, End-to-side; EE, end-to-end. 1 and 12 indicate weeks after implantation. *p < 0.05 for ES 12 versus ES 1; **p < 0.05 for EE 12 versus all other data points. Journal of Vascular Surgery 1990 12, 676-690DOI: (10.1067/mva.1990.24914) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 Venous intimal-medial thickness for end-to-side and end-to-end anastomotic types at 12 weeks after implantation. Numbers refer to vein location numbers shown in Fig. 3. Cntrl, Normal control vein. No statistical difference is noted between the two anastomotic types (see text). Journal of Vascular Surgery 1990 12, 676-690DOI: (10.1067/mva.1990.24914) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions