Clinical significance of aortic graft dilation

To determine if there is a relationship between aortic graft dilation and graft complications, 443 serial ultrasound studies performed on 106 patients were analyzed. Of 443 studies, 243 were done retrospectively on 59 patients from 3 to 144 months (mean, 38 months) after graft implantation. Forty-seven additional patients were studied prospectively, with direct measurement of external graft diameter after aortic clamp release. Subsequent ultrasound examinations at 3, 6, 9, and 12 months and then annually (n = 200) were routinely performed. Mean follow-up was 12 months (range, 3 to 48). Knitted double velour Dacron prostheses were used in all cases reported in this study. This cohort was culled from our ongoing graft surveillance program, which includes grafts of other materials and manufacturers. Comparison of the manufacturer's recorded box size with follow-up ultrasound measurements in all cases demonstrated a mean increase in graft diameter of 3.7 mm (23%). Little dilation occurred after 1 year. In 47 patients with direct graft diameter measurements taken after declamping, an immediate mean increase of 1.7 mm (11%) was noted. Dilation was not related to surgical indication (aneurysm vs occlusive disease) or hypertension. Analysis of the 10% segment of the series with the greatest dilation (mean, 39%) did not demonstrate a predilection for graft complications. No significant dilation was noted in the single cases encountered of femoral and iliac anastomotic aneurysms and perigraft seroma. Although dilation of knitted Dacron grafts is to be anticipated, no association between graft dilation and graft complications was found in this series.