A new approach to the prevention of anastomotic neointimal hyperplasia

• Main Author: Chalmers, R. T. A.
• Published: University of Edinburgh 1995
• Subjects: 617
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.642709

The need for an effective means of limiting the development of anastomic neointimal hyperplasia forms the basis of this thesis. Endovascular stents were developed for use in native arteries after balloon angioplasty to overcome vessel elastic recoil as well as to rescue immediate angioplasty failures and intimal dissections. The work presented in this thesis was performed in order to investigate the effect on the site and development of anastomotic neointimal hyperplasia of placing such a device across the distal anastomosis of an animal model of an arterial bypass graft. A canine model of an aorto-bi-iliac bypass graft was developed and two separate distal anastomotic patterns investigated in separate experiments, namely the end-to-end and the end-to-side configurations. The early and late effects of stenting the distal anastomoses were examined for both models. In the following Sections, an overview of anastomotic neointimal hyperplasia is presented. After outlining basic histological and pathophysiological considerations, a review of a variety of operative and pharmacological approaches to anastomotic neointimal hyperplasia that have been described in the literature is presented. There follows a general review of the use of endovascular stents prior to a description of my own experimental work on endovascular anastomotic stenting and the results obtained. These results are then analysed with particular focus on possible future refinements and modifications of the experimental model as well as the clinical applicability of anastomotic stenting. The work presented in this thesis represents a novel approach to the problem of anastomotic neointimal hyperplasia in lower limb arterial bypass grafts.