PubMed1989
An intraluminal sutureless prosthesis is now used for vascular reconstruction of dissecting aneurysms and atherosclerotic aortic aneurysms. Although excellent results have been reported from ligature have been very little studied. An experimental study of the sutureless prosthesis in dogs and our clinical experience with 15 cases are reported in this article. Twenty-three mongrel dogs were anesthetized and their left pleural cavity was entered through the third or fourth intercostal space. A stainless steel tube covered with low porosity woven Dacron graft, both internally and externally, was inserted into the descending aorta and tied into place tightly with suture materials. After 73 to 542 days (average 154 days) the aorta, including the tube, was removed and the aortic wall was examined histologically. A tensile strength test was also performed with 10 dogs. Severe histological changes, that is, complete disruption of elastic fibers of media, or partial exposure of the ligature inside the aorta, was found in 19 of 37 examined portions (51.3%). In the tensile strength test on the ligated area, the maximal load which ruptured the specimen was within 100 +/- 10% of the values for the control aortic wall in three dogs, 111% or more in three dogs and 89% or less in four dogs. The elongation was less than 100% in all dogs. No relationship was apparent between the time elapsed since operation, the severity of histologic change and maximal tension. During the period from February, 1979 to November, 1984, eleven men and four women, whose average age was 60, underwent aortic reconstructions using an intraluminal sutureless prosthesis at our center. Ten patients had dissecting aneurysms and 5 had atherosclerotic thoracic aneurysms. The mean operating time and mean bleeding volume was 8 hours 18 minutes and 2,513 ml, respectively. Five patients died in hospital. Three, with type I dissections died of bleeding, cerebral damage and renal failure. Two, with atherosclerotic aneurysms, died from cerebral damage due to insufficient cerebral perfusion. During eight years of follow-up (mean follow-up 55 months), six further patients died from several different causes. One patient who received aortic arch replacement for atherosclerotic aneurysm, died following rupture at the proximal site of fixation 76 months postoperatively. Another patient, who underwent ascending aortic reconstruction for type I dissection, died of renal failure 40 months postoperatively. Autopsy revealed partial exposure of the proximal fixing tape in the aorta.(ABSTRACT TRUNCATED AT 400 WORDS)