Synthetic microvascular prostheses

✍ Scribed by Marco Lanzetta

• Publisher: John Wiley and Sons
• Year: 1998
• Tongue: English
• Weight: 804 KB
• Volume: 18
• Category: Article
• ISSN: 0738-1085
• DOI: 10.1002/(sici)1098-2752(1998)18:4<256::aid-micr8>3.0.co;2-h

✦ Synopsis

The advances of microvascular surgery over the years have resulted in an increased need for small caliber replacements. Reversed autologous vein grafts are presently the most suitable material for use as arterial substitutes in microsurgical procedures. However, dissecting, harvesting, and preparing a vein graft adds time to any microsurgical procedure. The choice of veins may be limited by a number of factors, including poor anatomy, trauma, or obliterative vascular disease. Additionally, one or more veins must be sacrificed, a donor site scar is left, and usually one must compromise in terms of matching sizes and diameters between vein graft and recipient vessel.

Bridging microvascular defects with synthetic prostheses would have the great advantage of providing a choice of the most optimal size and shape, with decreased operative time. Large-bored synthetic grafts of PTFE, Teflon, and Dacron, with their various lengths and numerous configurations, have gradually found their place in vascular surgery and are currently very widely used in a great variety of clinical situations. Small bore grafts have not left the laboratory, as they have been disappointing in their high rate of thrombosis, and are still considered unreliable.

Several alternative microvascular grafts have been studied with variable results. The materials tested include silicone, 1 ovine collagen, 2 alcohol-preserved or dialdehydetanned arteries, 3 denatured or tanned human umbilical arteries, 2,4,5 expanded polytetrafluoroethylene, 6-11 ultra-light weight woven Teflon, 12 polyurethane, both plain and composite, [13][14][15][16] polycarbonate urethane, 17 and other polyesters. 18 The largest number of experimental studies have been carried out using different types of PTFE prostheses.