Polyester Tubular Mesh For Vein Graft Scaffolding: Where, When And How

The first choice material for revascularization (whatever district is taken in consideration) is the great saphenous vein. In some cases it is no more available or may be varicose or ectatic; other vein sources, such as the upper arm and the small saphenous vein, may often be of poor quality and prone to develop aneurismal dilatation. Other grafts (cryopreserved veins or allogenic graft materials) have been almost abandoned because of the poor results in terms of patency and the high risk of graft rupture. This paper reports the use of a new polyester mesh as external support for vein grafts. Some authors have also reported that the application of the mesh is expected, not only to prevent graft dilatation, but also to reduce neointimal formation, responsible of graft stenosis and bypass failure. This was a single center experience describing a new polyester mesh external support for scaffolding vein graft segments. From 2008 up to June 2010, 11 consecutive patients underwent elective arterial reconstruction in different districts: femoro-popliteal bypass (5), popliteal artery (4), hepatic artery (1), coronary artery bypass (1). Indication for surgery were: critical limb ischemia (4), popliteal aneurism (3), graft infection (1), intermittent claudication (1), hepatic artery aneurism (1), coronary artery disease (1). All grafts are patent after a mean follow-up of 13 months (min. 6, max 20). Duplex ultrasound, CT scan and angiography surveillance showed patency of all the implanted graft without any sign of stenoses due to intimal thickening. In challenging surgical cases, the good results prove the simplicity and reliability of this method. The external mesh is very ductile and can be used in different complicated situations and anatomic districts. Further investigation will be necessary to prove the reliability on large scale of this method.