Vascular Grafts, Patches, and Sutures

Abstract

Modern vascular surgery became possible with the development of acceptable arterial substitutes. The usefulness of an arterial substitute is determined by several essential qualities. These qualities include porosity, durability, tissue reactivity, and flexibility. The ideal conduit should be impermeable to blood and capable of lasting the duration of the recipient’s life. Graft durability is dependent on its ability to maintain its characteristics and strength over time, resisting dilatation and degeneration. Graft durability is also related to its short- and long-term patency rates. The ideal conduit should be able to resist thrombosis even in low flow states. In addition, its compliance, which measures its volume change with variations in pressure, should match that of the replaced arterial segment. Compliance mismatch has been identified as a possible cause of neointimal hyperplasia, which is a leading cause of graft failure. The graft should also stimulate minimal antigenicity and should not induce significant tissue reaction. The conduit should be flexible with good handling characteristics. It should be resistant to infection and easily available for elective or emergency use. Finally, the graft should be affordable. Vascular grafts can be classified according to their source of origin into autogenous, homologous, bovine, and synthetic (prosthetic) grafts. It is hard to find, in the currently available vascular grafts, one conduit that possesses all the characteristics of the ideal arterial substitute; this explains why the ultimate arterial substitute is still to be developed. In general, in high-flow situations, such as aortic reconstructive surgery, large-caliber prosthetic grafts perform well and are the conduits of choice. In infrainguinal reconstructions, the best performance has been achieved with autogenous conduits.