The geometry of the distal anastomosis of a femoropopliteal bypass influences local hemodynamics and formation of intimal hyperplasia. We hypothesized that the distal anastomosis of an above-knee femoropopliteal bypass undergoes remodeling that results in displacement of the original course of the popliteal artery and change in the anastomosis angle. We identified 43 CT angiography examination with proximal femoropopliteal bypass and either a preserved contralateral popliteal artery or previous CTA before construction of the bypass for comparison. In these examinations, we measured the displacement distance and angle at the level of the distal anastomosis and compared these measurements with clinical and imaging data. The displacement distance was 8.8±4.9 mm (P<0.0001) and the displacement angle was -1° (IQR=44°). The angle between the inflow and outflow artery was 153±16° (P<0.0001). There was a negative association between the displacement angle and the angle between the bypass and the outflow artery (r=-0.318, P=0.037). Patients with reversed venous grafts had a greater displacement of the anastomosis (14.7±3.0 mm) than patients with prosthetic grafts (8.0±4.5 mm, P=0.0011). We conclude that construction of a distal anastomosis of proximal femoropopliteal bypass results in displacement of the original course of the popliteal artery towards the bypass and this effect is more pronounced in reversed venous grafts.
We compared graft outcome between two types of a novel
composite three-layer carp-collagen-coated vascular graft in
low-flow conditions in a sheep model. Collagen in group A
underwent more cycles of purification than in group B in order to
increase the ratio between collagen and residual fat. The grafts
were implanted end-to-side in both carotid arteries in sheep
(14 grafts in 7 sheep in group A, 18 grafts in 9 sheep in group B)
and artificially stenosed on the right side. The flow in the grafts
in group A decreased from 297±118 ml/min to 158±159 ml/min
(p=0.041) after placement of the artificial stenosis in group A,
and from 330±164ml/min to 97±29 ml/min (p=0.0052) in
group B (p=0.27 between the groups). From the five surviving
animals in group A, both grafts occluded in one animal 3 and 14
days after implantation. In group B, from the six surviving
animals, only one graft on the left side remained patent
(p=0.0017). Histology showed degradation of the intimal layer in
the center with endothelization from the periphery in group A
and formation of thick fibrous intimal layer in group B. We
conclude that the ratio between collagen and lipid content in the
novel three-layer graft plays a critical role in its patency and
structural changes in vivo.