ABSTRACT
The use of natural or synthetic replacement parts in vascular repair and vascular reconstruction is extensive, with a vascular graft market of approximately $200 million worldwide. A multitude of biologic grafts and synthetic prostheses are available, each with distinct qualities and potential applications [Rutherford, 1989; Veith et al., 1994]. The ideal vascular graft would (1) be biocompatible, (2) be nonthrombogenic, (3) have long-term potency, (4) be durable yet compliant, (5) be infection resistant, and (6) be technically facile. There is currently no ideal conduit available, but overall, the autogenous saphenous vein is preferred for small-vessel reconstruction, and synthetic prostheses are best suited for large-vessel replacement. Large diameter (>10 mm) vascular grafts are predominantly used for aortic/iliac artery reconstruction with Dacron (80%) and PTFE (20%) being the standard construction materials. Synthetic grafts function well in these high-flow, low-resistance circuits with high long-term patencies. Small-caliber (<10 mm) vascular grafts are used for a variety of indications including lower-extremity bypass procedures, coronary artery bypass grafting (CABG), hemodialysis access, and extra-anatomic bypasses. Saphenous vein is the conduit of choice for lower-extremity revascularization and CABG procedures and shows superior patency rates compared to synthetic grafts. Internal mammary artery (IMA) grafts are used extensively for CABG with better long-term patency than saphenous vein grafts. Synthetic prostheses are used for hemodialysis access and extra-anatomic bypass grafting, especially PTFE due to its durability and resistance to external pressure. Bovine carotid heterografts are also used for hemodialysis access with fair success, but their value is questionable because of aneurysmal changes over time due to graft degeneration.
