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Salvatore Tarantini U.O. Chirurgia Vascolare Rimini Direttore Dr Massimiliano Gessaroli

Incremento della pervietà negli accessi vascolari protesici modificati con cuffia compliante in ePTFE. Salvatore Tarantini U.O. Chirurgia Vascolare Rimini Direttore Dr Massimiliano Gessaroli. XII Congresso nazionale SICVE Bari 6-8 ottobre 2013.

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Salvatore Tarantini U.O. Chirurgia Vascolare Rimini Direttore Dr Massimiliano Gessaroli

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  1. Incremento della pervietà negli accessi vascolari protesici modificati con cuffia compliante in ePTFE Salvatore Tarantini U.O. Chirurgia Vascolare Rimini Direttore Dr Massimiliano Gessaroli XII Congresso nazionale SICVE Bari 6-8 ottobre 2013

  2. primary ePTFE AVG patency rate < 40% at 1 yr. brachial-cephalic J-loop AVG brachial-cephalic straigth AVG brachial-axillary J-loop AVG Femoro-femoral U-loop AVG Stenosis followed by thrombosis is the major cause of failure of PTFE grafts for chronic hemodialysis and it occurs most commonly at the graft-venous anastomosis Prosthetic grafts for haemodialysis access: 10 years experience. Mukherjee K, Das J, Majumdar U, Sarkar R. J Indian Med Assoc. 2012 Jul;110(7):477-80.

  3. Stenosis at vein-graft anastomosis Neointimal Hyperplasia development

  4. Neointimal hyperplasia associated with synthetic hemodialysis grafts. Li L, Terry CM, Shiu YT, Cheung AK. Kidney Int. 2008 Nov;74(10):1247-61.

  5. Various factors have been proposed to predispose the development of neointimal hyperplasia • The three most important are: • the disturbance of hemodynamic conditions in the region of anastomosis • vein-wall vibration • mismatched compliance between graft and vein

  6. mismatched compliance between graft and vein the disturbance of hemodynamic conditions in the region of anastomosis Vein-wall vibration

  7. Vein interposition cuffs decrease the intimal hyperplastic response of polytetrafluoroethylene bypass grafts. Kissin M, Kansal N, Pappas PJ, DeFouw DO, Durán WN, Hobson RW 2nd. J Vasc Surg. 2000 Jan;31(1 Pt 1):69-83. The use of The Vein Cuff and PTFE Neointimal hyperplasia Neointimal hyperplasia - PTFE PTFE - - - - Vein cuff stenosis stenosis The use of the vein cuff shifts the neointimal hyperplasia development from vessel wall – graft anastomosis to cuff-graft anastomosis

  8. Primary patency rate 37.7% at 1 year

  9. At this moment ePTFE vascular graft manufacturer technology does not permit to build an ePTFE vascular graft with radial stretch This invention exceed this technologic gap by means of ePTFE hand- made cuff with radial stretch using usual ePTFE stretch Gore vascular graft (standard-walled, thin-walled, Intering, Propaten) or different type of ePTFE vascular grafts with longitudinal stretch.

  10. an experimental study on animal model (pig) in collaboration with Faculty of Veterinary of Bologna University Twelve ePTFE stretch grafts (six modified grafts and six non modified grafts) were surgically placed as artero-venous graft between carotid artery and external jugular vein in six pigs. In each pig were placed one modified ePTFE stretch graft at one side and one corresponding model non-modified ePTFE stretch graft at the other side as control graft. In four pigs were used standard stretch ePTFE Gore grafts and in two pigs heparine-bonded stretch Gore grafts; 3 pigs were also treated with antiplatelet drug. All implanted grafts had a total length of 8 cm and a diameter size of 6 mm. This study had been previously submitted to Ethical Commitee on Animal Experimentation (October 28, 2009) and sent to Italian Ministry of Health (November 18, 2009)

  11. graft Jugular Vein Carotid Artery

  12. Pig 4 (28 days later without anti-platelets therapy ) non-modified PROPATEN ePTFE stretch graft modified PROPATEN ePTFE stretch graft

  13. Pig 5 (28 day later surgery with anti-platelets therapy ) modified STANDARD ePTFE stretch graft STANDARD ePTFE stretch graft c

  14. Pig 6 (28 day later with anti-platelets therapy ) modified PROPATEN ePTFE stretch graft PROPATEN ePTFE stretch graft c

  15. Neointimal Hyperplasia development Student’ t-test P < 0,001 P < 0,001 c

  16. 1 può la cuffia compliante modificare l’emodinamica nella regione anastomotica? 2 possiamo ottenere gli stessi risultati nei pazienti con accessi vascolari protesici?

  17. 2009 - 2011 31 pazienti con cuffia compliante 26 J loop omero-ascellare, 4 U loop-inguine, 1 U loop gomito 23 pazienti protesi Propaten (W.L Gore & A) 8 pazienti protesi Intering (W.L Gore & A) pervietà primaria a 12 e 24 mesi vs 60 pazienti senza cuffia compliante

  18. Pervietà primaria 12 mesi 24 mesi

  19. Pervietà primaria

  20. Ecocolordoppler GRAFT VEIN

  21. Color Flow Doppler in non-modified AVG graft graft end graft vein The flow velocity is similar or decrease

  22. Color Flow Doppler in modified AVG graft graft cuff vein The flow velocity is increased

  23. Propaten modificata J – loop omero-ascellare

  24. Intering modificata U –loop safeno-femorale

  25. Propaten modificata U – loop axillo-axillare la cuffia compliante modifica l’emodinamica nella regione anastomotica permette di ottenere risultati migliori in termini di pervietà

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