1.A comparison of distal endoluminal graft fixation methods: Healing characteristics of metallic stents and the endoluminal suture technique.
Ricardo Jose T. Quintos II ; Takao Ohki ; Frank J. Veith
Philippine Journal of Surgical Specialties 2019;74(1):1-8
RATIONALE:
Endoluminal grafts (EG) are a promising alternative to
conventional open surgical approaches in the treatment of aneurysmal
and occlusive arterial diseases. These devices generally employ
metallic stents to secure the proximal and distal EG extents. However,
the problem of intimal hyperplasia at the distal EG anastomotic ends
similarly affect long-term outcomes as in conventional interposition
grafting methods. A technique of distal EG anastomosis using handsewn endoluminal sutures is described and its effects on subsequent
development of intimal hyperplasia compared with that of metallic
endoluminal stents
METHODS:
Ten adult mongrel dogs underwent bilateral common iliac
artery endoluminal grafting procedures. On one side, the distal EG
anastomosis was anchored with metallic stents while on the
contralateral side the distal EG was secured with endoluminal
sutures. The grafts were harvested after one month and the intimal
characteristics were observed using histopathological methods.
RESULTS:
Distal EG metallic stents and endoluminal sutures resulted
in similar patency rates of 90%. The average time to deploy distal
EG metallic stents was 56 seconds, while the average time to secure
the distal EG anastomosis using endoluminal sutures was 3 minutes
42 seconds. Metallic stents induced the development of intimal
hyperplasia to a degree greater than endoluminal sutures (316 ±
12 μm vs. 245 ± 30 μm, p<0.05), but did not affect patency.
CONCLUSION
Hand sewn endoluminal suture technique results in a
lesser degree of intimal hyperplasia compared with that produced by
endoluminal metallic stents, while the patency rates are comparable.
Stents