Increased compliance near vascular anastomoses

Abstract

Mismatch in mechanical properties (compliance mismatch) between host artery and prosthetic graft has been suggested as a cause of graft failure, but no mechanism linking the two has been identified. With the use of a simplified model based on isocompliant arterial grafts, pulsed ultrasound was used to generate detailed longitudinal profiles of diameter and compliance near the anastomoses. These longitudinal profiles revealed that although arterial diameter decreases monotonically to a minimal level at an anastomosis, arterial compliance first increases by approximately 50% before decreasing to 60% of the control value. This para-anastomotic hypercompliant zone (PHZ) is centered 3.6 mm from the anastomosis. PHZ also occurs in the artery adjacent to compliant or stiff grafts and is probably caused by transmitted effects of the suture line on the arterial wall. PHZ adds to any mismatch in compliance that already exists between artery and graft and can produce a compliance mismatch even between an artery and a nominally isocompliant prosthetic graft. It is hypothesized that PHZ, a region of increased cyclic stretch, promotes subintimal hyperplasia near anastomoses and may thus be a link between the mechanical properties of arteries and the failure of bypass grafts.