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Related Experiment Videos

PTFE, collars, and patches.

M R Tyrrell1, M W Rampling, J H Wolfe

  • 1St. Mary's Hospital Vascular Unit & Irvine Laboratory, London, England.

Journal of Investigative Surgery : the Official Journal of the Academy of Surgical Research
|January 1, 1992
PubMed
Summary
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Correction.

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See all related articles

Polytetrafluoroethylene (PTFE) grafts to crural vessels show poor outcomes. However, vein interposition techniques like the Taylor patch and Miller collar improve PTFE graft patency and reduce anastomotic resistance in critical limb ischemia.

Area of Science:

  • Vascular Surgery
  • Biomedical Engineering
  • Hemodynamics

Background:

  • Polytetrafluoroethylene (PTFE) grafts have demonstrated suboptimal patency rates when anastomosed directly to crural vessels.
  • This has led some surgeons to consider amputation for critical limb ischemia when autologous vein is unavailable.
  • Alternative anastomotic techniques using interposed vein segments show promise.

Purpose of the Study:

  • To evaluate the hemodynamic performance of two vein interposition techniques (Taylor patch and Miller collar) for PTFE crural grafts.
  • To compare these techniques against a standard end-to-side PTFE anastomosis.
  • To identify potential sources of anastomotic resistance.

Main Methods:

  • A pulsatile flow model was used to test PTFE grafts with Taylor patch and Miller collar anastomoses.

Related Experiment Videos

  • These were compared to a standard end-to-side PTFE anastomosis to a cadaver internal mammary artery.
  • Hemodynamic parameters including flow and downstream resistance were measured.

    • Main Results:

    • One-year patency rates were 74% for Taylor patch and 47% for Miller collar.
    • No significant difference in flow was observed between the anastomotic methods.
    • Downstream resistance was significantly influenced by recipient vessel diameter with vein interposition, but not with direct PTFE anastomosis.

    Conclusions:

    • Direct PTFE-arterial anastomosis to crural vessels may introduce significant anastomotic resistance.
    • The Taylor patch and Miller collar techniques, utilizing vein interposition, mitigate this resistance.
    • These findings provide experimental evidence supporting the use of vein interposition techniques to improve PTFE graft outcomes in crural revascularization.