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Background. Fluid mechanical factors are suspected to be involved in the pathogenesis and localization
of intimal hyperplasia in anastomosed vessels. However, no direct correlation has
been established between the flow and the exact sites of intimal hyperplasia. Hence
we have studied the relationship between the flow and preferred sites of wall thickening
in 90-degree- and 45-degree-cut and end-to-end anastomosed vessels.
Methods. Twenty-five 90-degree and twenty-five 45-degree end-to-end anastomoses were performed
on the femoral arteries of 17 adult mongrel dogs. The vessels were harvested at 3
months after operation, fixed at 100 mm Hg, dehydrated with ethanol, and rendered
transparent by immersing them in methyl salicylate. Exact locations and sizes of intimal
thickening and characteristics of the flow prevailing at sites of anastomoses were
studied in detail by means of flow visualization and cinemicrographic techniques.
Results. It was found that a perfect correlation exists between the preferred sites of intimal
thickening and the regions of slow recirculation flows with low wall shear stresses.
In both 90-degree and 45-degree anastomosed vessels, intimal thickening developed
only in those vessels in which formation of slow recirculation flows was observed.
It was also found that although a pronounced and localized intimal thickening developed
in 45-degree anastomosed vessels, the degree of circumferential constriction caused
by both surgical procedures and development of intimal thickening was much milder
in 45-degree than 90-degree anastomosed vessels.
Conclusions. The results suggest that key hemodynamic factors involved in the localization of
intimal thickening in end-to-end anastomosed vessels are low velocity of flowing blood
and the resultant low shear stresses acting on the vessel wall.
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Article info
Footnotes
†Supported by grant HL-41187 from the National Heart, Lung and Blood Institute, National Institutes of Health.
Identification
Copyright
© 1995 Mosby-Year Book, Inc. Published by Elsevier Inc.
