Alonso-Pérez M, Segura R J, Luján S, Vidal E D, Cachaldora J A, Vidal J, Sanchez J
Service of Vascular Surgery, Hospital Juan Canalejo, A Coruña, Oviedo, Spain.
Vasc Surg. 2001 Nov-Dec;35(6):457-61. doi: 10.1177/153857440103500606.
This study was undertaken to analyze immediate and mid-term knitted Dacron graft dilation and to establish which parameters should be taken as a reference when aortic graft dilation is evaluated. A Dacron knitted microvel double velour vascular graft (Hemashield Gold) was implanted in 30 patients with aneurysmal (19 cases, 63%) or occlusive (11 cases, 37%) aortic disease. The stems of bifurcated prostheses (27 patients, 90%) and tube grafts (3 patients, 10%) were measured. The package sizing (labelled size) was compared with the external diameter measured intraoperatively with a slide caliper, prior to implantation and after complete clamp release. Additional measurements were obtained by ultrasound 1 and 6 months after implantation, and in 16 cases (53% of the patients) ultrasound and computed tomography (CT) were performed at the end of the first year. The means of the measurements were compared using Student's t test for matched pairs. The statistical significance level was set at p values < 0.05. There was a statistically significant difference between the package sizing (15.3 +/- 1.1 mm) and the external diameter measured prior to implantation (18.7 +/- 1.3 mm); and with the external diameter following implantation (19.6 +/- 1.4 mm), (p < 0.01). External diameters measured prior to grafting and following implantation (after complete clamp release), when compared with the manufacturer's size, showed a mean increase in graft diameter of 3.4 mm (22%) and 4.3 mm (28%), respectively. There were no statistical differences between the external diameter measured after clamp release (19.6 +/- 1.4 mm) and the size determined by ultrasound 4 weeks (19.3 +/- 1.2 mm) and 6 months (19.8 +/- 1.5 mm) following surgery (p values 0.11 and 0.56, respectively). Considering size after clamp release as a reference (19.6 +/- 1.4 mm), an almost significant (p = 0.08) increase in the diameter (0.7 +/- 1.5 mm) was obtained at the end of the first year when the measurement was performed with ultrasound. However, when the measurement was performed by CT at the end of the first year, the differences (0.9 +/- 1.6 mm) revealed statistical relevance (p = 0.04). There was no statistically significant difference between the sizes obtained by ultrasound (20.3 +/- 2.1 mm) and by CT (20.5 +/- 2.2 mm) at the end of the first year (p values 0.07). The package sizing is not a reliable parameter for choosing the size of knitted Dacron grafts. Immediate increase in diameter noted in Dacron grafts is caused by discrepancies between the package sizing and the measured diameter after clamp release during implantation, and by an initial adaptation of the textile structure. This must be taken into account for an accurate investigation of the immediate graft dilation rate, and if further follow-up is contemplated, a measurement to be taken as a reference should be performed by ultrasound or CT in the immediate postoperative period.
本研究旨在分析针织涤纶移植物的即刻和中期扩张情况，并确定在评估主动脉移植物扩张时应将哪些参数作为参考。将一种涤纶针织微绒双层丝绒血管移植物（Hemashield Gold）植入30例患有动脉瘤性（19例，63%）或闭塞性（11例，37%）主动脉疾病的患者体内。对分叉型假体（27例，90%）和直管型移植物（3例，10%）的柄部进行测量。将包装尺寸（标记尺寸）与植入前术中用游标卡尺测量的外径以及完全松开血管夹后测量的外径进行比较。在植入后1个月和6个月通过超声进行额外测量，并且在16例患者（占患者总数的53%）中，在第1年末进行了超声和计算机断层扫描（CT）检查。使用配对t检验比较测量均值。统计学显著性水平设定为p值<0.05。包装尺寸（15.3±1.1 mm）与植入前测量的外径（18.7±1.3 mm）以及植入后测量的外径（19.6±1.4 mm）之间存在统计学显著差异（p<0.01）。与制造商尺寸相比，移植前和植入后（完全松开血管夹后）测量的外径显示移植物直径平均分别增加了3.4 mm（22%）和4.3 mm（28%）。血管夹松开后测量的外径（19.6±1.4 mm）与术后4周（19.3±1.2 mm）和6个月（19.8±1.5 mm）超声测定的尺寸之间无统计学差异（p值分别为0.11和0.56）。以血管夹松开后的尺寸（19.6±1.4 mm）为参考，在第1年末用超声测量时，直径有近乎显著的增加（0.7±1.5 mm）（p = 0.08）。然而，在第1年末用CT测量时，差异（0.9±1.6 mm）具有统计学相关性（p = 0.04）。在第1年末，超声测量的尺寸（20.3±2.1 mm）与CT测量的尺寸（20.5±2.2 mm）之间无统计学显著差异（p值为0.07）。包装尺寸不是选择针织涤纶移植物尺寸的可靠参数。涤纶移植物中观察到的直径即刻增加是由包装尺寸与植入期间血管夹松开后测量的直径之间的差异以及织物结构的初始适应性引起的。在准确研究移植物即刻扩张率时必须考虑到这一点，如果考虑进一步随访，应在术后即刻通过超声或CT进行一次作为参考的测量。
