A new ePTFE stretch graft for aorto-iliac reconstructions. Surgical evaluation and one year follow-up with magnetic resonance imaging

Since its introduction at the beginning of the 60s Dacron has proved to be a reliable and durable substitute for aortic reconstructions. It is however susceptible to late thrombosis, infection and aneurysmal dilatation in a significant number of cases. ePTFE vascular prosthesis, introduced in 1972, have proved to perform well for peripheral reconstructions and was used in aortoiliac position since 1980. In 1931 a new type of ePTFE rendered longitudinally extensible (Gore-Tex® Stretch) was introduced into clinical practice. The aim of this study is to evaluate surgical performance, short term patency and interaction with periprosthetic tissues of Gore-Tex® Stretch straight and bifurcated prosthesis. Between October 1991 and December 1993, 59 patients underwent aortic reconstruction at our Institution either for infrarenal aortic aneurysm (19 patients, 16 males, 3 females, mean age 68.8 ± 8.5 years) or for aortoiliac occlusive disease (40 patients, 36 males, 4 females, mean age 60.5 ± 7.2 years). Fourthy-eight bifurcated and eleven straight grafts were implanted using Gore-Tex® sutures. Preoperative workup included Ultrasonography, Magnetic Resonance Imaging (MRI) in patients with aneurysms and Intra Arterial Digital Subtraction Arteriography (DSA) in patients with occlusive disease. Intraoperative parameters were recorded. Postoperative follow-up included ultrasonographic evaluation at 1st and 7th day, 15th postoperative week and at 3 monthly intervals; Intra Venous DSA before dismission and MRI at the 1st and 15th postoperative week. Intraoperatively the grafts proved to be soft and flexible with good handling and suturing characteristics. Perioperative bleeding was 480 ± 299 ml for occlusive disease cases and 633 ± 314 for aneurysm cases. No operative mortality was recorded. Postoperative IVDSA revealed 2 early graft limb occlusions that required thrombectomy. Follow up ranged between 3 and 29 months (mean 13.3 months), no late occlusion was recorded and secondary patency was 100%. MRI studies confirmed graft patency and revealed no prosthetic dilatation or anastomotic false aneurysm in any of the patients. Moreover no significant perigraft fluid or air collection were observed. In conclusion Gore-Tex® Stretch straight and bifurcated grafts seem suitable conduits for use in aorto-iliac reconstruction and demonstrated satisfactory performance and excellent graft incorporation over the period studied. Larger series and longer follow-up are required to define the late failure rate of this graft.