Ld. Wijesinghe et al., Axial flow fields in cuffed end-to-side anastomoses: Effect of angle and disease progression, EUR J VAS E, 18(3), 1999, pp. 240-244
Citations number
22
Categorie Soggetti
Surgery
Journal title
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Objective: to visualize the axial flow fields in standard and cuffed end-to
-side anastomoses (ESA).
Design: in vitro experiments using a flow rig, custom-built glass models an
d frame-by-frame video analysis of flow patterns in standard and cuffed ESA
.
Subjects: glass models of standard or cuffed (1 cm or 2 cm high) ESA of ang
les 15, 30, 45 and 60 degrees.
Results: the cross-sectional area of standard ESA is much smaller than that
of ESA between graft and cuff. The size of the vortex in the anastomotic z
one of both standard and cuffed ESA increased with increasing ESA angle and
cuff height, but did not change with flow rate. The presence of the vortex
maintains a zone of flow separation and low shear at the heel of standard
and graft/cuff anastomoses.
Conclusions: the observations explain the clinical findings of intimal hype
rplasia (IH) at the heel of PTFE/cuff anastomoses. The improved patency rat
es of cuffed ESA may be due not to decreased IH, but to an increased abilit
y of the cuff to accommodate IH before causing a significant stenosis.