Comparison of Open Arterial Revascularization Using Expandable PTFE Stent Grafts vs Sewn PTFE Interposition Bypass in an Infected Field Porcine (Sus scrofa) Model
Abstract
Objectives: Autologous reconstruction for vascular injuries in a contaminated field requires time, technique, and appropriately sized conduit. Expandable polytetrafluoroethylene (ePTFE) grafts are often used. Direct-site endovascular repair (DSER) with ePTFE stent grafts may offer an expeditious alternative to sewn graft in this setting. We hypothesized that DSER would demonstrate less device failure and less morbidity when compared to ePTFE interposition bypass. Methods: Bilateral iliac arteries were transected in Fourteen Yorkshire-cross swine One randomly assigned artery received sewn ePTFE bypass while the other was treated with DSER followed by contamination with Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Device failure was assessed with ultrasound and angiography on day 7 and 21 respectively. Physiologic measurements and arterial samples were obtained at the terminal procedure. Results: No devices failed at day 7. DSER had less failure at day 21 (0/14 vs. 9/14, p=<0.001). DSER was faster (246 min vs. 6217 min, p=<0.001). No difference was seen in gross infection (10/14 vs. 7/14, p=0.440) and flow rates at baseline, placement, or harvest (p=0.921, 0.252, 0.321). Conclusion: DSER demonstrated superior efficacy, faster placement, and similar infection rates when compared to ePTFE bypass for open arterial revascularization in an infected field. DSER may improve outcomes as a bridge to definitive repair. Grant: Dr. Davidson received support for this project from the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jul 19, 2018
- Accession Number
- AD1056389
Entities
People
- Anders Davidson
Organizations
- David Grant USAF Medical Center