In vitro laser recanalization of chronically occluded prosthetic grafts

Polytetrafluoroethylene (PTFE) and Dacron grafts were implanted in canine femoral and carotid arteries using PTFE and Prolene suture, respectively. Arteries containing occluded grafts were explanted and laser recanalization was attempted in vitro. Laser recanalization was successful in 78% of PTFE grafts compared to 30% of Dacron grafts. Recanalization was complete (residual stenosis less than 5%) in opened PTFE grafts, whereas residual stenosis averaged 60% in recanalized Dacron grafts. PTFE graft/PTFE suture anastomotic tensile strength was unchanged after recanalization, while Dacron graft/Prolene suture anastomotic tensile strength decreased significantly. In addition, anastomotic bursting pressure was significantly higher for lased PTFE grafts with PTFE sutures (300 mg Hg) compared to lased Dacron grafts with Prolene sutures (70 mm Hg). Chronically occluded PTFE grafts with PTFE suture can be safely and effectively opened by laser recanalization. In contrast, attempted laser recanalization of Dacron grafts sutured with Prolene suture is seldom successful, significantly weakens the graft artery anastomosis, and should be avoided.