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Procedure for Human Saphenous Veins Ex Vivo Perfusion and External Reinforcement
Published on: October 1, 2014
Myointimal hyperplasia in vein collars for ePTFE grafts
1Kent and Sussex Hospital, Mount Ephraim, Tunbridge Wells, U.K.
Summary
Myointimal hyperplasia at the interface of expanded polytetrafluoroethylene (ePTFE) grafts and vein collars causes graft failure. Understanding this can improve ePTFE graft patency rates.
Area of Science:
- Vascular Surgery
- Histopathology
- Radiology
Background:
- Expanded polytetrafluoroethylene (ePTFE) grafts are used in vascular reconstructions.
- Venous boots are sometimes used with ePTFE grafts, potentially improving patency.
- The causes of intermediate ePTFE graft failure, particularly when using a venous boot, require further investigation.
Purpose of the Study:
- To determine the underlying cause of intermediate ePTFE graft failure when a venous boot is employed.
- To investigate how the use of a venous boot influences graft patency.
Main Methods:
- Histological and radiological examination of failed and failing ePTFE grafts.
- Retrospective review of patients undergoing surgery with ePTFE grafts and venous boots.
- Angiographic correlation in a subset of patients.
Main Results:
- Myointimal hyperplasia was identified at the interface between the ePTFE graft and the vein collar in occluded grafts.
- The recipient artery at the anastomosis site showed relative sparing from hyperplasia.
- Angiography confirmed these findings in additional patients.
Conclusions:
- Myointimal hyperplasia predominantly occurs at the ePTFE graft-vein collar junction, not the artery.
- Targeting the site of myointimal hyperplasia may be a strategy to enhance ePTFE graft patency.
