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Abnormal wall strain at distal end-to-side anastomoses
W C Pevec1, G J L'Italien, J Megerman
1Division of Vascular Surgery, Massachusetts General Hospital, Boston 02114.
Annals of Vascular Surgery
|January 1, 1993
Summary
Focal increases in cyclic stretch at arterial anastomoses may stimulate intimal hyperplasia. This study found significantly higher strains at anastomosis regions, suggesting a link between mechanical stress and this vascular disease.
Area of Science:
- Biomedical Engineering
- Cardiovascular Research
- Vascular Biology
Background:
- Cyclic stretch influences endothelial and smooth muscle cell activity.
- These cellular processes are implicated in intimal hyperplasia development.
Purpose of the Study:
- To investigate if arterial anastomosis regions experience increased cyclic stretch.
- To test the hypothesis that this focal stretch stimulates intimal hyperplasia.
Main Methods:
- Developed an end-to-side anastomosis model using latex tubes.
- Applied physiologic pulse waves and measured arterial diameters.
- Calculated circumferential and suture line strains at various intervals.
Main Results:
- Circumferential strain was maximal at the proximal third of the anastomosis (6.0% vs. 3.3%).
- Maximal strain across the suture line occurred in the same region (3.9% vs. 2.0%).
- Anastomotic regions experienced double the cyclic strain of other arterial areas.
Conclusions:
- End-to-side anastomoses create focal regions of significantly elevated cyclic stretch.
- This increased mechanical stress at anastomoses may be a key stimulus for intimal hyperplasia development.