Introduction:
The wall thickness of polyurethane (PU) artificial blood vessels is approximately 1.0 mm. On the other hand, e-PTFE also has products that allow early puncture, but they seem to be divided into two systems: one system has a wall thickness of more than 1.0 mm, but a multilayer structure including an elastomer layer that allows early puncture by reconstructing the puncture hole, as in PU. The other is a type of standard e-PTFE, such as HILEX graft plus, that has a wall thickness of 0.5 to 0.6 mm, but can be punctured several days after implantation by utilizing the edematous subcutaneous tissue that develops around the artificial vessel.
Methods:
[Methods. I] Even standard type e-PTFE may allow early puncture within a few days after surgery. The perivascular tissue was examined by H&E and antifibrinogen antibody staining.
[Methods. II] Standard type e-PTFE dialysis vessels were implanted within the subcutaneous fat layer of the upper limb (HILEX graft: 18 cases, HILEX graft plus: 1 case). Withdrawal type tunneler or hollow type tunneler was used in combination with PU, and the time to the first postoperative puncture and stable puncture were observed, and the difference between PU and PU was observed.
Results:
[Results . I] In the specimens implanted using the hollow tunneler, a wide area around the graft was stained, which was thought to be stained by fibrin of plasma components seeping out of the e-PTFE; in the cases using the shaft tunneler, a narrow area was stained, and the 5 mm PTFE and the pull-out tunneler at 2 weeks after implantation In the combination of 5 mm PTFE and a pull-out tunneler at 2 weeks after implantation, there were few unnecessary gaps between the PTFE artificial vessel and the surrounding tissue, and the artificial vessel was integrated with the surrounding area with little fibrin layer formed.
[Results . II] In the combination of 5 mm HILEX graft and withdrawal tunneler, the first puncture was performed within 9 POD in all 12 cases. In 5 of these cases, the first puncture was performed within 5 POD.
The results of I and II indicate that it is possible to control the degree of edema even with standard-type e-PTFE artificial vessels, depending on the tunneler used and the technique.
Conclusions:
[Conclusion] Early puncture was possible even with standard type e-PTFE if the edema situation was controlled by the implantation method, technique, and product.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.