J.Jpn. Surg. Soc.. 94(9): 1051-1056, 1993

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Original article

A MODIFIED COMPOSITE GRAFT: GLUTARALDEHYDE TREATMENT OF THE VEIN AND IMPERVIOUS COVERING ON THE COMPOSITE SITE
－AN EXPERIMENTAL AND CLINICAL STUDY－

Composite grafts have a tendency to develope intimal hyperplasia (IH) at the anastomosis between the different graft materials. The author developed a new prosthesis, modified composite graft (MCG) to control this problem. Experimental study : MCG consists of proximal 3cm of Dardik Biograft and a distal 3cm of autogenous vein (AV). Proximal segment of AV, which is anastomosed to the Biograft, was treated with 1% glutaraldehyde during operation. Then MCG was implanted in the canine infrarenal abdominal aorta. The anastomosis between Biograft and AV was wrapped with a strip of Biograft to prevent the invasion from the surrounding tissue that may also cause IH. The patency rate at 33 months was 75% (9/12). No IH was observed at Biograft-AV anastomosis. Clinical study : Thirty MCG's were implanted in patients with chronic obstructive arterial disease. None of the patients had enough autogenous vein for a complete graft. Cumulative patency rates were 67.3% at 1 year and 31.6% at 5 years. Over-all limb salvage rate was 75%. All graft failure was caused by IH at the site of proximal anastomosis between the femoral artery and Biograft or graft thrombosis probably due to low blood flow. In conclusion, IH was successfully prevented at the site of Biograft-AV anastomosis in MCG.

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