The choice of the appropriate graft in the treatment of vascular diseases
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The Choice of the Appropriate Graft in the Treatment of Vascular Diseases Review Article D. N Moris, F. C Sigala, S. E Georgopoulos, I. P Bramis Received 03/02/2010 Accepted 10/03/2010
Abstract Aim: To give a conceptual description of the different kinds of grafts used in vascular surgery as well as their benefits and handicaps. Methods-Data sources: The data were retrieved mainly from publications listed in MEDLINE and PubMed. The main search term was “GRAFT”. Results: It appears that the major saphenous (MSV) and umbilical vein (HUV) are superior compared to synthetic grafts (Dacron, PTFE) as far as primary and secondary patency are concerned. The compliance and adaptability of graft at the point of anastomosis, as well as the regulation of the mismatching of the graft diameter concerning the vessels to be anastomosed, are necessary prerequisites towards ensuring effectiveness of synthetic grafts in procedures under the inguinal ligament. The internal thoracic artery constitutes the graft of choice for coronary vessels with many comparative advantages. The radial artery provides the potential for parallel connection with internal thoracic artery, due to its advantages as far as the adoption is concerned, rendering it also an efficient graft. Finally, new biosynthetic grafts are expected to decrease restenosis, maintaining a long-term satisfactory patency in the vessel. Proteomics is another interesting field that warrants more research concerning the role of micro-mRNA in the pathophysiology of vascular diseases. Conclusion: The explosive growth presented by vascular surgery since the middle of the twentieth century is strongly associated with the development and widespread availability of vascular grafts, which have been successfully used for the replacement or circumvention of sick arterial sections. The major saphenous and umbilical vein are superior com-
-Vascular Surgical Unit, 1st Propedeutic Surgical Clinic, Hippokration Hospital, Medical School, Kapodistrian University of Athens, Greece -1st Surgical Clinic of Medical School, Kapodistrian University of Athens, Greece e-mail: [email protected]
pared to synthetic grafts (Dacron, PTFE). The internal thoracic artery constitutes the graft of choice for the coronary vessels. The radial artery may become an alternative to the application of internal thoracic artery. Finally, new biosynthetic grafts are expected to play a key role in future therapeutic approaches. Micro-mRNA assays also show promise, especially in the field of research, in addressing the pathophysiology of vascular diseases.
Keywords
Venous and arterial graft, Femoro-popliteal bypass, Internal thoracic artery, Radial artery, Artificial grafts, Restenosis, Tissue engineering, MicroRNAs, Stem cells
The explosive growth that Vascular Surgery has shown since the middle of the twentieth century is Table 1 Historic milestones in the evolution of vascular grafts Authors
Grafts
Carrel
Implantation of homologous and heterologous grafts in dogs
Goyanes
Implantation of vein grafts in the human a
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