Increased thrombogenicity after polymer coating: experiences with the first version of a new woven Dacron graft for aortic reconstruction

OBJECTIVE

To assess the initial results of insertion of a new woven Dacron graft coated with a polymer for occlusive and aneurysmal aortoiliac disease.

DESIGN

Open study.

SETTING

Four Swedish vascular surgical units.

SUBJECTS

28 patients who required aortoiliac or aortofemoral reconstruction between September 1988 and June 1989.

MAIN OUTCOME MEASURES

Incidence of, and time to, occlusion; type of intervention; whether the graft needed to be replaced; and mortality.

RESULTS

Two patients died in the postoperative period, and five during follow-up, giving an overall mortality of 25%. None of the tube grafts occluded but 17 of 24 bifurcation grafts did (71%), the median time to occlusion being 126 days (range 10-820). Our results have led to this graft being removed from the market while modifications are made in the process of impregnation of polymer.

CONCLUSIONS

Strict protocols for the assessment of new graft materials should be introduced and enforced.

Avoiding blow-out of the aortic stump by reinforcement with fibrin glue. A report of two cases

Generally vascular surgeons agree that the most rational way to treat a patient with an infected aortic graft or aortoenteric fistula is excision of the graft, closure of the aortic stump and construction of an axillobifemoral bypass. Due to the feared complication of blow-out of the aortic stump, other solutions have been proposed, such as in-situ reconstruction with homologous saphenous veins or even with a synthetic graft, provided the perigraft fluid is non-purulent. Since this alternative is not always feasible, various methods to reinforce the closure of the aortic stump have been proposed. The present report describes two cases, where fibrin glue (Tisseel) was successfully used to reinforce the suture row of the aortic stump.

Natural history of patients with abdominal aortic aneurysm

Factors determining the outcome for patients with abdominal aortic aneurysm (AAA) were analysed in a retrospective population-based study of 187 consecutively diagnosed AAAs at one hospital during a 9-year period. All aneurysms were diagnosed by ultrasound, and those cases that were not primarily operated upon, were followed by repeat ultrasound examinations. An expansion rate of more than 0.4 cm/year was seen in 27% of the aneurysms and a tendency towards a higher rate of expansion could be seen with larger lesions. The overall cumulative rupture rate was 12% at 5 years. For patients with small (less than 5 cm) aneurysms it was 2.5% at 7 years, and no aneurysm could definitively be shown to be smaller than 5 cm at the time of rupture. The rupture risk was significantly higher (28% at 3 years) for larger aneurysms (greater than or equal to 5 cm). The only reliable predictor for rupture was aneurysm size. The overall cumulative survival was 51% at 5 years. Patients with large aneurysms did not have a significantly shorter survival although a tendency for this to be the case was found. There was a significant difference between the proportion of deaths caused by aneurysm rupture in patients with small aneurysms when compared to those with large aneurysms, 5.5 and 53%, respectively. The expansion rate for AAA was highly individual and aneurysm diameter was the only recognisable predictor of rupture. The rupture rate for AAAs smaller than 5 cm was lower than previously reported.

Abdominal aortic aneurysm with perianeurysmal fibrosis: experience from 11 Swedish vascular centers

Case records of 2026 patients operated on because of abdominal aortic aneurysms from 11 Swedish Vascular Centers were reviewed and revealed 98 cases (4.8%) of inflammatory abdominal aortic aneurysm. Also included in this case-control study was an analysis of a randomized group of 82 patients from the same centers who had noninflammatory abdominal aortic aneurysms. Four inflammatory aneurysms were ruptured, compared with 16 in the noninflammatory group (p less than 0.01). A higher proportion of patients with inflammatory abdominal aortic aneurysms had symptoms that led to radiographic investigations. The median erythrocyte sedimentation rate was 39 mm versus 19 mm (26% of patients with inflammatory abdominal aortic aneurysms had erythrocyte sedimentation rates greater than 50 mm; p less than 0.001), and the serum creatinine level was increased in 27 and 8 patients (p less than 0.01) in the inflammatory and noninflammatory groups, respectively. Preoperative investigations revealed ureteral obstruction in 19 patients with inflammatory abdominal aortic aneurysms, of whom 12 had preoperative nephrostomy or ureteral catheter placement. At operation, 20 additional patients exhibited fibrosis around one or both ureters. Although ureterolysis was performed in 19 patients, preoperative and postoperative creatinine levels did not differ between these patients and the conservatively treated ones. Duration of surgery (215 vs 218 minutes), intraoperative blood loss (2085 vs 2400 ml) and complications did not differ significantly between the groups. Overall operative (30-day) mortality was equal (11% vs 12%) but was increased for patients undergoing elective surgery for inflammatory abdominal aortic aneurysms (9% vs 0%; p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)