Long-term dilatation of polyester and expanded polytetrafluoroethylene tube grafts after open repair of infrarenal abdominal aortic aneurysms
Objectives Since 1995, expanded polytetrafluoroethylene (ePTFE) grafts have been implemented in open surgical repair (OSR) of abdominal aortic aneurysms (AAA) and are supposed to show less dilatation than polyester grafts. This study examined differences in graft dilatation and clinical outcome. Met...
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| Veröffentlicht in: | Journal of vascular surgery 2011-06, Vol.53 (6), p.1506-1513 |
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| creator | Stollwerck, Peter L., MD Kozlowski, Bartosz, MD Sandmann, Wilhelm, MD Grabitz, Klaus, MD Pfeiffer, Tomas, MD |
| description | Objectives Since 1995, expanded polytetrafluoroethylene (ePTFE) grafts have been implemented in open surgical repair (OSR) of abdominal aortic aneurysms (AAA) and are supposed to show less dilatation than polyester grafts. This study examined differences in graft dilatation and clinical outcome. Methods This single-center long-term, prospective randomized study monitored 99 consecutive patients after OSR of AAA. Implanted were 90 tube ePTFE Gore-Tex Stretch grafts, 56 tube Dacron grafts (Uni-Graft KDV, polyester, B. Braun, knitted), and 51 tube Dacron grafts (Gelseal Plus, polyester, Vascutek, triaxial knitted). Follow-up with ultrasound examination was performed at discharge, at 12 months, and at 6 years. Results Patients were a mean age of 67 years. Thirty-day mortality was 2.5% (n = 5 of 199), without significant differences among the groups. The Kaplan-Meier analysis showed 5-year survivals of 0.82 (ePTFE/Gore), 0.81 (polyester/Braun), and 0.83 (polyester/Vascutek). Mean ± standard deviation dilatation of the midgraft segment was 1% ± 5% (ePTFE/Gore), 10% ± 9% (polyester/Braun), and 7% ± 8% (polyester/Vascutek) ( P ≤ .001) at discharge; 8% ± 11% (ePTFE/Gore), 24% ± 7% (polyester/Braun), and 20% ± 13% (polyester/Vascutek; P ≤ .001) after 12 months; and 19% ± 21% (ePTFE/Gore), 33% ± 22% (polyester/Braun), and 23% ± 19% (polyester/Vascutek; ( P ≤ .001) after 6 years. No graft failure or rupture occurred. Graft patency was 100%. Conclusions After a mean implantation of 6 years, the ePTFE/Gore, polyester/Braun, and polyester/Vascutek tube grafts presented with significant differences. The ePTFE grafts showed a stronger resistance against dilatation than the two types of polyester grafts. Owing to similar perioperative and postoperative courses, no advantage could be identified in any group concerning the overall outcome. Vascular implants for OSR of AAA made of ePTFE and polyester are safe, even after a long implantation time. Therefore, the choice of the suitable graft does not depend on its postimplantation dilative characteristics. The outcome is not likely to be connected with dilatation of the implanted graft, because a causal connection between graft dilatation and death cannot be made. The study does not offer a basis for the preference of one of the three graft types. Nevertheless, continuous ultrasound examinations should be performed after implantation of an aortic tube graft to identify possible problems arising from changes in the graft and the |
| doi_str_mv | 10.1016/j.jvs.2011.02.028 |
| format | Article |
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This study examined differences in graft dilatation and clinical outcome. Methods This single-center long-term, prospective randomized study monitored 99 consecutive patients after OSR of AAA. Implanted were 90 tube ePTFE Gore-Tex Stretch grafts, 56 tube Dacron grafts (Uni-Graft KDV, polyester, B. Braun, knitted), and 51 tube Dacron grafts (Gelseal Plus, polyester, Vascutek, triaxial knitted). Follow-up with ultrasound examination was performed at discharge, at 12 months, and at 6 years. Results Patients were a mean age of 67 years. Thirty-day mortality was 2.5% (n = 5 of 199), without significant differences among the groups. The Kaplan-Meier analysis showed 5-year survivals of 0.82 (ePTFE/Gore), 0.81 (polyester/Braun), and 0.83 (polyester/Vascutek). Mean ± standard deviation dilatation of the midgraft segment was 1% ± 5% (ePTFE/Gore), 10% ± 9% (polyester/Braun), and 7% ± 8% (polyester/Vascutek) ( P ≤ .001) at discharge; 8% ± 11% (ePTFE/Gore), 24% ± 7% (polyester/Braun), and 20% ± 13% (polyester/Vascutek; P ≤ .001) after 12 months; and 19% ± 21% (ePTFE/Gore), 33% ± 22% (polyester/Braun), and 23% ± 19% (polyester/Vascutek; ( P ≤ .001) after 6 years. No graft failure or rupture occurred. Graft patency was 100%. Conclusions After a mean implantation of 6 years, the ePTFE/Gore, polyester/Braun, and polyester/Vascutek tube grafts presented with significant differences. The ePTFE grafts showed a stronger resistance against dilatation than the two types of polyester grafts. Owing to similar perioperative and postoperative courses, no advantage could be identified in any group concerning the overall outcome. Vascular implants for OSR of AAA made of ePTFE and polyester are safe, even after a long implantation time. Therefore, the choice of the suitable graft does not depend on its postimplantation dilative characteristics. The outcome is not likely to be connected with dilatation of the implanted graft, because a causal connection between graft dilatation and death cannot be made. The study does not offer a basis for the preference of one of the three graft types. Nevertheless, continuous ultrasound examinations should be performed after implantation of an aortic tube graft to identify possible problems arising from changes in the graft and the residual vascular branches over time.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2011.02.028</identifier><identifier>PMID: 21536404</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal - surgery ; Biocompatible Materials ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Vessel Prosthesis - adverse effects ; Blood Vessel Prosthesis Implantation - adverse effects ; Cardiology. Vascular system ; Dilatation, Pathologic ; Diseases of the aorta ; Female ; Humans ; Male ; Medical sciences ; Middle Aged ; Polyesters ; Polytetrafluoroethylene ; Postoperative Complications ; Prospective Studies ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Time Factors ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><ispartof>Journal of vascular surgery, 2011-06, Vol.53 (6), p.1506-1513</ispartof><rights>Society for Vascular Surgery</rights><rights>2011 Society for Vascular Surgery</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c480t-60256827e11937eaf0d8664b9576e2aa8f38a5c62a582dce91e007c82a8b04ef3</citedby><cites>FETCH-LOGICAL-c480t-60256827e11937eaf0d8664b9576e2aa8f38a5c62a582dce91e007c82a8b04ef3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvs.2011.02.028$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24212818$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21536404$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stollwerck, Peter L., MD</creatorcontrib><creatorcontrib>Kozlowski, Bartosz, MD</creatorcontrib><creatorcontrib>Sandmann, Wilhelm, MD</creatorcontrib><creatorcontrib>Grabitz, Klaus, MD</creatorcontrib><creatorcontrib>Pfeiffer, Tomas, MD</creatorcontrib><title>Long-term dilatation of polyester and expanded polytetrafluoroethylene tube grafts after open repair of infrarenal abdominal aortic aneurysms</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Objectives Since 1995, expanded polytetrafluoroethylene (ePTFE) grafts have been implemented in open surgical repair (OSR) of abdominal aortic aneurysms (AAA) and are supposed to show less dilatation than polyester grafts. This study examined differences in graft dilatation and clinical outcome. Methods This single-center long-term, prospective randomized study monitored 99 consecutive patients after OSR of AAA. Implanted were 90 tube ePTFE Gore-Tex Stretch grafts, 56 tube Dacron grafts (Uni-Graft KDV, polyester, B. Braun, knitted), and 51 tube Dacron grafts (Gelseal Plus, polyester, Vascutek, triaxial knitted). Follow-up with ultrasound examination was performed at discharge, at 12 months, and at 6 years. Results Patients were a mean age of 67 years. Thirty-day mortality was 2.5% (n = 5 of 199), without significant differences among the groups. The Kaplan-Meier analysis showed 5-year survivals of 0.82 (ePTFE/Gore), 0.81 (polyester/Braun), and 0.83 (polyester/Vascutek). Mean ± standard deviation dilatation of the midgraft segment was 1% ± 5% (ePTFE/Gore), 10% ± 9% (polyester/Braun), and 7% ± 8% (polyester/Vascutek) ( P ≤ .001) at discharge; 8% ± 11% (ePTFE/Gore), 24% ± 7% (polyester/Braun), and 20% ± 13% (polyester/Vascutek; P ≤ .001) after 12 months; and 19% ± 21% (ePTFE/Gore), 33% ± 22% (polyester/Braun), and 23% ± 19% (polyester/Vascutek; ( P ≤ .001) after 6 years. No graft failure or rupture occurred. Graft patency was 100%. Conclusions After a mean implantation of 6 years, the ePTFE/Gore, polyester/Braun, and polyester/Vascutek tube grafts presented with significant differences. The ePTFE grafts showed a stronger resistance against dilatation than the two types of polyester grafts. Owing to similar perioperative and postoperative courses, no advantage could be identified in any group concerning the overall outcome. Vascular implants for OSR of AAA made of ePTFE and polyester are safe, even after a long implantation time. Therefore, the choice of the suitable graft does not depend on its postimplantation dilative characteristics. The outcome is not likely to be connected with dilatation of the implanted graft, because a causal connection between graft dilatation and death cannot be made. The study does not offer a basis for the preference of one of the three graft types. Nevertheless, continuous ultrasound examinations should be performed after implantation of an aortic tube graft to identify possible problems arising from changes in the graft and the residual vascular branches over time.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Biocompatible Materials</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Vessel Prosthesis - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Cardiology. Vascular system</subject><subject>Dilatation, Pathologic</subject><subject>Diseases of the aorta</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Polyesters</subject><subject>Polytetrafluoroethylene</subject><subject>Postoperative Complications</subject><subject>Prospective Studies</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Time Factors</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Ul2L1TAQDaK419Uf4Iv0RXzqNUnbJEUQlsUvuOCD-hzSdLqmpk1N0sX7I_zPTvdeFXwQhkyYnDMzmTOEPGV0zygTL8f9eJv2nDK2pxxN3SM7RltZCkXb-2RHZc3KhrP6gjxKaaQIbJR8SC44aypR03pHfh7CfFNmiFPRO2-yyS7MRRiKJfgjJHwozNwX8GNBB_1dOEOOZvBriAHy16OHGYq8dlDcYDinAg-khQXmIsJiXNzyuXmIJsJsfGG6Pkzu7hZidhYrwBqPaUqPyYPB-ARPzv6SfHn75vP1-_Lw8d2H66tDaWtFcykob4TiEhhrKwlmoL0Sou7aRgrgxqihUqaxgptG8d5Cy4BSaRU3qqM1DNUleXHKu8TwfcVv6sklC95jJ2FNWgklhWhli0h2QtoYUoow6CW6ycSjZlRvIuhRowh6E0FTjqaQ8-ycfe0m6P8wfk8dAc_PAJOs8TiY2br0F1dzxhXbEr064QBncesg6mQdzBZ6F8Fm3Qf33zZe_8O23s0OC34DlHYMa0QNkmY6IUF_2rZlWxbGKK14Latfrwe85Q</recordid><startdate>20110601</startdate><enddate>20110601</enddate><creator>Stollwerck, Peter L., MD</creator><creator>Kozlowski, Bartosz, MD</creator><creator>Sandmann, Wilhelm, MD</creator><creator>Grabitz, Klaus, MD</creator><creator>Pfeiffer, Tomas, MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110601</creationdate><title>Long-term dilatation of polyester and expanded polytetrafluoroethylene tube grafts after open repair of infrarenal abdominal aortic aneurysms</title><author>Stollwerck, Peter L., MD ; Kozlowski, Bartosz, MD ; Sandmann, Wilhelm, MD ; Grabitz, Klaus, MD ; Pfeiffer, Tomas, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c480t-60256827e11937eaf0d8664b9576e2aa8f38a5c62a582dce91e007c82a8b04ef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Biocompatible Materials</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Vessel Prosthesis - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Cardiology. Vascular system</topic><topic>Dilatation, Pathologic</topic><topic>Diseases of the aorta</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Polyesters</topic><topic>Polytetrafluoroethylene</topic><topic>Postoperative Complications</topic><topic>Prospective Studies</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Time Factors</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stollwerck, Peter L., MD</creatorcontrib><creatorcontrib>Kozlowski, Bartosz, MD</creatorcontrib><creatorcontrib>Sandmann, Wilhelm, MD</creatorcontrib><creatorcontrib>Grabitz, Klaus, MD</creatorcontrib><creatorcontrib>Pfeiffer, Tomas, MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stollwerck, Peter L., MD</au><au>Kozlowski, Bartosz, MD</au><au>Sandmann, Wilhelm, MD</au><au>Grabitz, Klaus, MD</au><au>Pfeiffer, Tomas, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term dilatation of polyester and expanded polytetrafluoroethylene tube grafts after open repair of infrarenal abdominal aortic aneurysms</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2011-06-01</date><risdate>2011</risdate><volume>53</volume><issue>6</issue><spage>1506</spage><epage>1513</epage><pages>1506-1513</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>Objectives Since 1995, expanded polytetrafluoroethylene (ePTFE) grafts have been implemented in open surgical repair (OSR) of abdominal aortic aneurysms (AAA) and are supposed to show less dilatation than polyester grafts. This study examined differences in graft dilatation and clinical outcome. Methods This single-center long-term, prospective randomized study monitored 99 consecutive patients after OSR of AAA. Implanted were 90 tube ePTFE Gore-Tex Stretch grafts, 56 tube Dacron grafts (Uni-Graft KDV, polyester, B. Braun, knitted), and 51 tube Dacron grafts (Gelseal Plus, polyester, Vascutek, triaxial knitted). Follow-up with ultrasound examination was performed at discharge, at 12 months, and at 6 years. Results Patients were a mean age of 67 years. Thirty-day mortality was 2.5% (n = 5 of 199), without significant differences among the groups. The Kaplan-Meier analysis showed 5-year survivals of 0.82 (ePTFE/Gore), 0.81 (polyester/Braun), and 0.83 (polyester/Vascutek). Mean ± standard deviation dilatation of the midgraft segment was 1% ± 5% (ePTFE/Gore), 10% ± 9% (polyester/Braun), and 7% ± 8% (polyester/Vascutek) ( P ≤ .001) at discharge; 8% ± 11% (ePTFE/Gore), 24% ± 7% (polyester/Braun), and 20% ± 13% (polyester/Vascutek; P ≤ .001) after 12 months; and 19% ± 21% (ePTFE/Gore), 33% ± 22% (polyester/Braun), and 23% ± 19% (polyester/Vascutek; ( P ≤ .001) after 6 years. No graft failure or rupture occurred. Graft patency was 100%. Conclusions After a mean implantation of 6 years, the ePTFE/Gore, polyester/Braun, and polyester/Vascutek tube grafts presented with significant differences. The ePTFE grafts showed a stronger resistance against dilatation than the two types of polyester grafts. Owing to similar perioperative and postoperative courses, no advantage could be identified in any group concerning the overall outcome. Vascular implants for OSR of AAA made of ePTFE and polyester are safe, even after a long implantation time. Therefore, the choice of the suitable graft does not depend on its postimplantation dilative characteristics. The outcome is not likely to be connected with dilatation of the implanted graft, because a causal connection between graft dilatation and death cannot be made. The study does not offer a basis for the preference of one of the three graft types. Nevertheless, continuous ultrasound examinations should be performed after implantation of an aortic tube graft to identify possible problems arising from changes in the graft and the residual vascular branches over time.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>21536404</pmid><doi>10.1016/j.jvs.2011.02.028</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Aortic Aneurysm, Abdominal - surgery Biocompatible Materials Biological and medical sciences Blood and lymphatic vessels Blood Vessel Prosthesis - adverse effects Blood Vessel Prosthesis Implantation - adverse effects Cardiology. Vascular system Dilatation, Pathologic Diseases of the aorta Female Humans Male Medical sciences Middle Aged Polyesters Polytetrafluoroethylene Postoperative Complications Prospective Studies Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Time Factors Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels |
| title | Long-term dilatation of polyester and expanded polytetrafluoroethylene tube grafts after open repair of infrarenal abdominal aortic aneurysms |
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