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Enabling sutureless vascular bypass grafting with the exovascular sleeve anastomosis  David W. Chang, MD, Allen Chan, MD, R.Armour Forse, MD, PhD, William.

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Presentation on theme: "Enabling sutureless vascular bypass grafting with the exovascular sleeve anastomosis  David W. Chang, MD, Allen Chan, MD, R.Armour Forse, MD, PhD, William."— Presentation transcript:

1 Enabling sutureless vascular bypass grafting with the exovascular sleeve anastomosis 
David W. Chang, MD, Allen Chan, MD, R.Armour Forse, MD, PhD, William M. Abbott, MD  Journal of Vascular Surgery  Volume 32, Issue 3, Pages (September 2000) DOI: /mva Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

2 Fig. 1 Schematic representation of the exovascular sleeve anastomosis. The assembly consists of a cable tie band (B ) with independently mobile teeth elements (T ) and spacing elements (S ) premounted on a PTFE graft (G ). The graft is drawn over the artery (A ) resulting in a sleeve (Sl ) of vessel within the graft. As the band is tightened by a cable tie applicator over an intraluminal obturator, the teeth are anchored into the artery. The unidirectional locking mechanism (L ) of the cable tie prevents the band from loosening. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

3 Fig. 2 A model of the exovascular anastomotic device demonstrating anchoring of the teeth (seen best at the 5-o'clock position) through a backlit cross-section of polyethylene tubing representing an artery. As shown, the device has been applied to Dacron grafts as well as PTFE grafts. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

4 Fig. 3 Separation of the interface between graft and artery (functional load) then complete uncoupling of the anastomosis (maximum load) are reported in anastomoses with the Exovascular Anastomotic Device and sutures. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

5 Fig. 4 Intraoperative angiogram of a pig aorta just before explantation of device shows no stenosis of the sutureless anastomosis relative to the graft, the distal sutured anastomosis, or the obturator used to apply the device (bottom left ). After a 2-month survival course, there is an increased diameter of the native proximal and distal aorta as the animal grows from 35 to 70 kg. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

6 Fig. 5 Longitudinal section of explanted goat aorta at 40 weeks with exovascular sleeve anastomosis on the left and sutured anastomosis on right. The slight buckling of the aorta at the exovascular anastomosis is an artifact of formalin fixation in an unpressurized environment (and not seen on angiogram). Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

7 Fig. 6 A, Photomicrograph of goat aorta at 40 weeks with a longitudinal section of a portion of the exovascular sleeve anastomosis on the right. The location of the anastomotic band is at the lower right (b ); ×30, hematoxylin and eosin. B, Magnified view of the sleeve anastomosis showing incorporation of the PTFE graft with cellular elements (arrow ). There is minimal neointimal hyperplasia in the anastomotic sleeve; ×150, hematoxylin and eosin. C, The internal elastic lamina and elastin within the aortic wall (red staining) are preserved as well as endothelial cells (arrow ); ×300, Masson. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

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