J.Jpn. Surg. Soc.. 89(10): 1707-1715, 1988

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Original article

INFLUENCE OF FLOW DISTURBANCE ON AN ANASTOMOTIC INTIAL HYPERPLASIA：EXPERIMENTAL AND CLINICAL STUDY

Experimental and clinical studies were made of the localizzation and morphology of anastomotic intimal hyperplasia (AIH) at the end-to-side anastomosis in relation to flow disturbances.
In vitro experimental findings showed that boundary layer separation (BLS) became promient as proximal outflow segment (POS) flow increased. An aorto-right iliac bypass was performed on 30 dogs using 22 Biografts, 3 EPTFES and 5 Dacron grafts. Distal end-to-side anastomoses were made at 3 different angles, i. e., 30° (Group I), 90° (Group II) and 150° (Group III). BLS was likely to occur at the toe in Group I because POS flow exceeded 50％, while not in Group III. Up to 35 months observation, AIH was noted to develope at the toe 36％ in Group I, 25％ in Group II but in none in Group III.
Thirty five reconstructions using Biograft in which angiography was performed Iater than 6 months postoperatively were chosen for clinical study. Invariably in all cases of AIH occurring following a femoropopliteal bypass, severe stenosis was noted to occur at the toe and heel of the distal end-to-side anastomosis.
In conclusion, a disproportionate increase in POS flow was considered a likely cause of marked BLS and, consequently, an important precipitating cause of AIH. When POS flow exceeds 50％, a distal anastomosis dividing flow distribution should be considered as a salvage operation of potential usefulness.

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