الفهرس 
Arterial graftsOnly 14 pages are availabe for public view
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Abstract
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-SU-M--M-A-RYThe
arterial reconstructive surgery is classified
into direct and indirect arterial surgery.The direct
surgery as the arterial repair, bypass grafting,endar_
terectomy and arteriotomy, and embolectomy and thrombectomy.
They are used either to restore the continuity
of blood flow, or to provide an alternative channel
(Bypass). The indi~ect arterial surgery as sympathectomy
which is used for the treatment of vasospastic
disease as RayanaUd’s disease and peripheral arteries
and in atherosclerotic vessels as plantar or digital
arteries where its vasodilator effect in imprOVing skin
lesions as small ischemic ulcers, is required.
In this subject we discuss the arterial grafts or
substitutes which can be used in arterial reconstructive
surgery ( bypass grafting) and the discussion comprises
the follOWing points : Firstly the optimal arterial
graft which shoul.d be durable, easily, reliable, resistant
to infection and of high long term patency and others.
Secondly: Types of grafts are being used currently both
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clinically and experimentally , including arterial
autografts, arterial allografts, arterial xenografts,
venous autografts, venous allografts, synthetic grafts,
composite or compound grafts and solid tube grafts.
Considerable evidence at present suggests that large
arteries are best replaced by textile grafts and small
arteries by venous autografts of approperiate size.
Then we discuss the procedures of arterial reconstructive
surgery ( e.g bypass grafting and endarterectomy)
in different sites of the arterial system of the body.
In aortic reconstructive surgery as in the aortoiliac
reconstruction for occlusive and stenotic diseases
in the infrarenal abdominal aorta and the iliac axis,the
optimal treatment is either by means of endarterectomy
of the occlusive process is localised or by insertion
of an aorto-femoral or aorto-iliac bypass grafts if the
obliterative disease is extensive·.. However, there is
alternative approaches to the patient. with total occlusion
of the infrarenal abdominal aorta, including aXillary _
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1..<. •
femoral bypass and bypass from the ascending or descending
thoracic aorta to femoral arteries.
The proper choice of operation depends on the general
patient, the extent of the arterio-scleortic occlusive
disease and the experience of the surgeon.
The procedures are discussed in a variety of points
as indications, technique, Materials used as a graft,
and results.
In aorto iliac bypass surgery using Dacron grafts
give better longterm results than endarterectomy in men
but not in women. Women have a higher incidence of
localised disease at the aorticbifuercation.
In patients who have a patient superficial femoral artery,
equally good results were obtained for endarterectomy and
Dacron grafts.
The extra anatomio arterial bypass grafting is used when
the risk of standard operations is high because of associated
disease or anticipated technical problems. The
most Common indication for this type of operation is
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pUlmonary or cardiac disease.
The extra anatomic bypass grafting includes femrofemoral.
axillofemoral grafts or a combination of both.
The most pressing indication for an extranatomic
bypass procedure-which is an absolute one, is infection
in a previously, placed aorto-iliac graft. the treatment
of choice in this instance, is total removal of
the infected graft. with ligation of the infra-renal
abdominal aorta and iliac arteries and bypass of the
abdominal infection is performed with axillo-femoral or
femorofemoral grafts or both.
The graft materials used for extra-anatomic bypass
may consists of autogenous vein, woven or kinitted
Dacron. or the newer polytetrafluroethylene grafts.
Obturator foramen bypass grafting is used for infection
in the groin of a previously placed graft from the aorta
to the femoral artery and for infection in the femoral
region of a femoro-popliteal bypass graft. particularly
if the graft is of a plastic material and is used. for
other indications.
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The graft materials used in obturator foramen
bypass grafting are autogenous saphenous vein woven
or knitted Dacron or the newer polytetrafluroethYlene
grafts.
The .profundop1asty is required as an adjunct to an
inflow, procedure such as aorto-femoral, ax1llofemoral,
or femoro-femoral bypasses, To avoid early thrombosis
of a limb of an aorto-femoral.graft • and May be considered
as an alternative to femoro poplitial bypass when
either operation is available to the surgeon.
Angiography is the most effective technique for identi-.
fying patients in need of profunoplasty.
Femora-popliteal and Femoro-tibial reconstruction are
indicated for the salvage of a limb e.g. ischemic lower
extremity. Gangrene itself does nto rule out SUccessful
limbs salvage provided it involves a limited area to
permi t SUccessful amputat·ion on the foot when the gangrenous
tissue is ultimately excised. They are used also
in claudication. The graft matErials Used for both are:
autogenous saphenous vein or cepholic vein, PTFE,Ruman
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umblical vein or Knitted Dacron grafts. The autogenous
vein graft prefered and has the best results.
Arterial reconstruction of the aortic dissecting
aneurysms included transection of the aorta oversewing
of the false lwnen, with or without interposition of
a synthetic graft or local reentery procedures •
Wall reinforcement with highly parous Dacron Meshin
aortic surgery used for prevention of suture line complication
particularly in aortic aneurysDls without resection
and Reinforcement of Hdventitia or autogenous
vein following thromboendarterectomy.
The experience of many authors indicates that nothing
is better than the autogenous saphenous vein in Aorto-
Coronary artery bypass grafting. In cases in which saphenous
vein is not available, the cephalic vein along the
lateral aspect of the arm has proved to be.a very acceptable
substitute.
For ao!to-renal bypass, autogenous saphenous vein
has many advantage over the synthetic either Knitted
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Dacron or expanded teflon( Impra ) grafts.
Endarterectomy is a method of arterial reconstruction
limited to the aorta and common iliac arteries
and to special areas such as the proximal perfounda
femoris, renal, carotid or subclavian arteries.
The use of sympathectomy is arterial reconstruction
patients Lncz’ea.ra the total limb blood flow during the
early postoperative period.
Lastly we d.Lac uss the complications after arterial
reconstruction procedures which are divided into early
and late complications and the appropriate management
of each.