A METHOD OF PLASTIC REPLACEMENT OF AORTIC DEFECTS

V.G. Valter, S.A. Shashin, A.P. Shashin, A.E. Vasiliev
Chair of Surgery, Faculty of Advanced Medical Training, Chair of Surgical Diseases and Childhood Surgery, Astrakhan State Medical Academy;
Department of Vascular Surgery, Alexandro-Mariinsk Regional Clinical Hospital,
Astrakhan, Russia

Experiments on dogs were made to replace lateral (5 dogs) and circular (5 dogs) abdominal aortic defects by a seromuscular-submucous pedicle graft and circular aortic defects by a full thickness free gastric graft (6 dogs), (Application for invention No.98108499/14, priority from April 30, 1998). In all the experiments, the gastric graft was inverted to the aortic lumen by the serous membrane (peritoneum). During replacement of aortic defects by the seromuscular-submucous pedicle graft, the latter was advanced to the aorta through a window in the mesocolon. While tailoring a free full thickness graft the stomach was covered with a rectangular wire stent, along the contour of which the gastric wall was sewn by through hemostatic sutures and excised. The use of the stent permitted to obtain material of the required size more precisely, in conformity with the size of the aortic defect. All the animals survived and were followed up over the period 1, 7, 30 days, 6 months and 12 months. After the experiments were completed, the grafts underwent visual assessment, angiography and morphologic studies. The gastric wall is a high-strength material; its thickness exceeds the aortic wall 1.5-2-fold. The taking of the graft starts immediately after transplantation while its good coalescence with the aorta is noticed toward the sixth month. By this time the serous membrane will contain mesothelium and an aorta-like structure will be formed in the graft wall. This structure resists with safety the pressure in the aorta and does not expand over the period as long as one year. After one year the mucous membrane of the full thickness free graft was devoid of epithelium. No cavities or fluid collection around the graft were recorded. In the first and second series, the stomach had a ridge on the side of the mucous membrane, namely at the site where the graft had been harvested. In the third series, the stomach had a small scar. left. The data obtained allow for the trial of the present method on a clinical basis, particularly in concomitant injuries (with defect formation) to the large arterial vessels and caval organs, i.e. in a primarily infected wound.

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