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Improved patency of prosthetic arteriovenous grafts with an acute anastomotic angle and flow diffuser.

Abstract：

OBJECTIVE:Conventional end-to-side anastomosis to establish venous outflow for prosthetic arteriovenous grafts often requires operative patch angioplasty within 1 year because of venous stenosis. Rather than conventional venous anastomosis, a modified end-to-side anastomosis at a 15-degree angle with a flow diffuser was constructed. Such diffusers allow decreased flow velocity and increased pressure, inhibiting boundary layer separation. METHODS:Ten brachial artery to axillary vein 6 mm straight se-polytetrafluoroethylene prosthetic arteriovenous grafts were created with this technique. Patients included 6 men and 4 women (mean age, 66.4 years; range, 54-80 years), all with renal failure and a history of diabetes. The degree of stenosis at the venous anastomosis was determined with duplex scanning at intervals of 6 months. Analysis of survival and cumulative primary patency estimates were determined with the Kaplan-Meier method. RESULTS:Primary cumulative patency estimate of 100% for the modified group at 18 and 24 months was significantly greater than that for age-matched historic control fistulas with the conventional end-to-side anastomosis (n = 20): 18 months, 32%; 24 months, 32% (P <.05). Although venous stenosis could not be quantitated for thrombosed conventional fistulas, modified anastomoses had minimal stenosis at 24 months: mean area reduction, 30% (range, 20%-45%). CONCLUSION:Incorporation of a flow diffuser and a 15-degree anastomotic angle significantly increases patency of prosthetic brachial artery to axillary vein grafts.

journal_name

J Vasc Surg

journal_title

Journal of vascular surgery

authors

Hakaim AG,Nalbandian MN,Heller JK,Chowla AC,Oldenburg WA

doi

10.1067/mva.2003.187

subject

Has Abstract

pub_date

2003-05-01 00:00:00

pages

1032-5

issue

5

eissn

0741-5214

issn

1097-6809

pii

S0741521402751276

journal_volume

37

pub_type

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