A NEW EPTFE STRETCH GRAFT FOR AORTOILIAC RECONSTRUCTIONS - SURGICAL EVALUATION AND ONE-YEAR FOLLOW-UP WITH MAGNETIC-RESONANCE-IMAGING

Since its introduction at the beginning of the 60s Dacron has proved t o be a reliable and durable substitute for aortic reconstructions. It is however susceptible to late thrombosis, infection and aneurysmal di latation in a significant number of cases. ePTFE vascular prosthesis, introduced in 1972, have proved to perform well for peripheral reconst ructions and was used in aortoiliac position since 1980. In 1991 a new type of ePTFE rendered longitudinally extensible (Gore-Tex(R) Stretch ) was introduced into clinical practice. The aim of this study is to e valuate surgical performance, short term patency and interaction with periprosthetic tissues of Gore-Tex(R) Stretch straight and bifurcated prosthesis. Between October 1998 and December 1993, 59 patients underw ent aortic reconstruction at our Institution either for infrarenal aor tic aneurysm (19 patients, 16 males, 3 females, mean age 68.8+/-8.5 ye ars) or for aortoiliac occlusive disease (40 patients, 36 males, 4 fem ales, mean age 60.5+/-7.2 years). Fourthy-eight bifurcated and eleven straight grafts were implanted using Gore-Tex(R) sutures. Preoperative workup included Ultrasonography, Magnetic Resonance Imaging (MRT) in patients with aneurysms and Intra Arterial Digital Subtraction Arterio graphy (DSA) in patients with occlusive disease. Intraoperative parame ters were recorded. Postoperative follow-up included ultrasonographic evaluation at 1st and 7th day, 15th postoperative week and at 3 monthl y intervals; Intra Venous DSA before dismission and MRI at the 1st and 15th postoperative week. Intraoperatively the grafts proved to be sof t and flexible with good handling and suturing characteristics. Periop erative bleeding was 480+/-299 ml for occlusive disease cases and 633/-314 for aneurysm cases. No operative mortality was recorded. Postope rative IVDSA revealed 2 early graft limb occlusions that required thro mbectomy. Follow up ranged between 3 and 29 months (mean 13.3 months), no late occlusion was recorded and secondary patency was 100%. MRI st udies confirmed graft patency and revealed no prosthetic dilatation or anastomotic false aneurysm in any of the patients. Moreover no signif icant perigraft fluid or air collection were observed. In conclusion G ore-Tex(R) Stretch straight and bifurcated grafts seem suitable condui ts for use in aorto-iliac reconstruction and demonstrated satisfactory performance and excellent graft incorporation over the period studied . Larger series and longer follow-up are required to define the late f ailure rate of this graft.