Numerical Study of the Influence of Anastomotic Configuration on Hemodynamics in Miller Cuff Models

Xiong, Fangli; Chong, C. K.

doi:10.1007/s10439-008-9617-6

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…The use of a supplementary cuff between the graft and the target artery is controversial, but as CFD simulations showed, it can also be optimized in terms of the length-to-height ratio of the boot (Xiong and Chong 2009). In vivo, a supplementary cuff produces less favorable flow than a vein patch which approximates the straight anastomotic pattern (Neville et al 2011).…”

Section: Discussionmentioning

confidence: 99%

The Influence of the Anastomosis Angle on the Hemodynamics in the Distal Anastomosis in the Infrainguinal Bypass: an In Vitro Study

et al. 2016

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The geometric shape of the distal anastomosis in an infrainguinal bypass has an influence on its durability. In this article, we compared three different angles of the anastomosis with regard to the hemodynamics. Three experimental models of the distal infrainguinal anastomosis with angles of 25°, 45°, and 60° respectively were constructed according to the similarity theory to assess flow in the anastomoses using particle image velocimetry and computational fluid dynamics. In the toe, heel, and floor of the anastomosis that correspond to the locations worst affected by intimal hyperplasia, adverse blood flow and wall shear stress were observed in the 45° and 60° models. In the 25° model, laminar blood flow was apparent more peripherally from the anastomosis. In conclusions, decreasing the distal anastomosis angle in a femoropopliteal bypass results in more favorable hemodynamics including the flow pattern and wall shear stress in locations susceptible to intimal hyperplasia.

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Section: Discussionmentioning

confidence: 99%

The Influence of the Anastomosis Angle on the Hemodynamics in the Distal Anastomosis in the Infrainguinal Bypass: an In Vitro Study

et al. 2016

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“…A large length-to-height ratio may result in an unfavourable cuff performance. 13 Most of anastomoses in practice have non-planar configuration, which induce a swirling flow pattern that may normalize wall shear stress and reduce intimal hyperplasia. 14 However, the configuration may depend to the tunnelling of the graft and thus, alteration of the non-planal configuration may occur on several occasions.…”

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confidence: 99%

Lower Limb Revascularization with Infragenicular Bypass Using PTFE Graft and the Distal Vein Patch Technique: Does It Confer Any Advantage over the Distal Vein Cuff Techniques?

Giannoukas

2012

European Journal of Vascular and Endovascular Surgery

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The need for a prosthetic graft in lower limb revascularization is increasing because of the lack of venous conduits as a result of previous revascularization in the same limb or coronary bypass. Evidence that a PTFE graft with the use of a vein patch or cuff at the distal anastomosis can be associated with acceptable patency rates for femoropopliteal below the knee or femorodistal bypass has provided a new alternative for limb-salvaging procedures. 1e4 However, technical skills remain of paramount importance for the successful construction of these complex distal anastomoses using a vein cuff or patch. It is therefore of special interest the results of another vein patch technique that Neville et al. present in their article claiming that it confers at least equivalent patency with the previously described techniques in association with simplicity in its construction. 5 The authors present in their current publication their mature experience on a previously described by them technique, 6 the use of distal vein patch (DVP), reporting on 270 infrapopliteal prosthetic bypass grafts performed in 252 patients using a distal vein patch.From a technical point of view the DVP technique described by Neville et al. 5,6 appears as being simpler than the other previously described vein patch or cuff techniques. From a clinical effectiveness viewpoint the authors in their current report using their technique showed remarkable patency rates of 79% at 1 year, 75% at 2 years, 65% at 3 years and 51% at 4 years, which are favourably comparable with those reported in the literature using either the Taylor patch 1,7 or the Miller cuff. 8,9 Unfortunately because this study was of the retrospective nature the authors could not provide an analysis of the factors determining graft failure, including data on the status of run-off vessels.The main reasons for the use of an interposition vein material between prosthesis and artery at the distal anastomosis of an infragenicular bypass are considered to be technical by avoiding to suture the prosthetic material to small and very often calcified small arteries and haemodynamic by creating a "buffer" venous zone in which the hyperplastic response may be less intense and when it happens this to be in the vein and not in the tibial artery. It was proposed that the interposed vein improves distal flow because it reduces the anastomotic resistance as it is more compliant. 10 Subsequentl, it was shown that the use of a venous cuff may optimise the mechanical properties of saphenous vein, protect small arteries from anastomotic distortion 11 and decreases the downstream resistance. 12 Nevertheless, it appears that when using a vein cuff in the distal anastomosis of an infragenicular bypass the geometry, specifically the length-to-height ratio of the cuff configuration, plays important role in the favourable redistribution of intimal hyperplasia. A large length-to-height ratio may result in an unfavourable cuff performance. 13 Most of anastomoses in practice have non-planar configuration, which in...

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Comparison of Endovascular Versus Bypass Surgery in Femoropopliteal TASC II D Lesions: A Single-Center Study

Veraldi

Mezzetto

Macrì

et al. 2018

Annals of Vascular Surgery

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Numerical Study of the Influence of Anastomotic Configuration on Hemodynamics in Miller Cuff Models

Cited by 3 publications

References 33 publications

The Influence of the Anastomosis Angle on the Hemodynamics in the Distal Anastomosis in the Infrainguinal Bypass: an In Vitro Study

The Influence of the Anastomosis Angle on the Hemodynamics in the Distal Anastomosis in the Infrainguinal Bypass: an In Vitro Study

Lower Limb Revascularization with Infragenicular Bypass Using PTFE Graft and the Distal Vein Patch Technique: Does It Confer Any Advantage over the Distal Vein Cuff Techniques?

Comparison of Endovascular Versus Bypass Surgery in Femoropopliteal TASC II D Lesions: A Single-Center Study

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