Why Patencies of Femoropopliteal Bypass Grafts with Distal End-to-End Anastomosis are Comparable with End-to-Side Anastomosis
Autor: | Thien How, Paul Poyck, Cees H. A. Wittens, M.T.C. Hoedt |
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Rok vydání: | 2015 |
Předmět: |
Models
Anatomic Pulmonary and Respiratory Medicine Flow visualization medicine.medical_specialty Time Factors Hemodynamics Femoral artery Anastomosis Blood Vessel Prosthesis Implantation Peripheral Arterial Disease Stress Physiological Blood vessel prosthesis medicine.artery medicine Humans Popliteal Artery Vascular Patency Computed tomography angiography medicine.diagnostic_test business.industry Anastomosis Surgical Models Cardiovascular Gastroenterology General Medicine Secondary flow Popliteal artery Blood Vessel Prosthesis Surgery Femoral Artery Regional Blood Flow Original Article Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Nuclear medicine Blood Flow Velocity |
Zdroj: | Annals of Thoracic and Cardiovascular Surgery. 21:157-164 |
ISSN: | 2186-1005 1341-1098 |
Popis: | Objective: Despite the theoretical favourable hemodynamic advantage of end-to-end anastomosis (ETE), femoropopliteal bypasses with distal ETE and end-to-side anastomosis (ETS) have comparable clinical patencies. We therefore studied the effects of different in vivo anastomotic configurations on hemodynamics in geometrically realistic ETE and ETS in vitro flow models to explain this phenomenon. Methods: Four ETE and two ETS models (30° and 60°) were constructed from in vivo computed tomography angiography data. With flow visualization physiological flow conditions were studied. Results: In ETS, a flow separation and recirculation zone was apparent at anastomotic edges with a shifting stagnation point between them during systole. Secondary flow patterns developed with flow deceleration and reversal. Slight out of axis geometry of all ETE resulted in flow separation and recirculation areas comparable to ETS. Vortical flow patterns were more stable in wider and longer bevelled ETE. Conclusion: Primary flow disturbances in ETE are comparable to ETS and are related to the typical sites where myointimal hyperplasia develops. In ETS, reduction of anastomosis angle will diminish flow disturbances. To reduce flow disturbances in ETE, the creation of a bulbous spatulation with resulting axial displacement of graft in relation to recipient artery should be prevented. |
Databáze: | OpenAIRE |
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