In his technical report of the Hybrid Vascular Graft (Gore) for the reconstruction of the superficial femoral artery, Jean Bismuth (Houston, USA) said the graft allowed a rapid sutureless anastomosis and was highly versatile in complex situations.
Bismuth reported that the graft is the first device that has been designed to “address the ever expanding number of hybrid operations, which combine both endovascular and open surgical techniques.” He explained that it was an expanded PTFE vascular prosthesis that had a constrained nitinol section and added that it “greatly expanded” the treatment options for dialysis access, aortic debranching, and arterial bypass procedures. Bismuth commented: “The graft allows the surgeon to minimise the invasiveness of a procedure all the while benefiting from the advantages of a bypass.”
He explained that although initially the graft was launched for arteriovenous dialysis access, it now had the same indications as “any vascular graft”. For example, at his centre, where the graft has been used in 150 cases, it has been used for “a good proportion of iliofemoral bypasses and a bunch of visceral debranching as well.”
Bismuth commented: “In the femoropopliteal segment, the Hybrid graft permits access through a smaller incision to an artery which is either hard to reach behind the knee or is diseased. The nitinol reinforced segment of the graft can be introduced through a less invasive access and can take advantage of the stent to treat a stenotic segment.”
As well as reviewing the advantages of the graft, Bismuth also discussed the “pearls for success” with the device and these included the fact that “imaging was key” to successfully accessing patient anatomy—“you have to know what you are going into”, he noted. Another pearl was that correct sizing was “essential” as he said that the graft should not be oversized by more than 20%. Bismuth added that he never oversized by more than 1mm and that correct sizing could mean that sutures were not needed at all. He explained: “Gore recommends a couple of patching sutures, but I have never put any in. It is a personal choice and I have never had an issue with needing to use sutures. It is all about the sizing. If you only upsize by 1mm, you are probably not going to have any problems.” Other tips for success included not completely inserting the nitinol reinforced segment into the artery, ensuring adequate outflow and inflow, and covering all of the disease in the artery.
Bismuth concluded: “Hybrid procedures are likely to be more prevalent; the Hybrid graft allows a rapid sutureless anastomosis, particularly for difficult sites and rapid bailout. It is highly versatile in complex cases.”
