Reduced Elastic Mismatch Achieved by Interposing Vein Cuff in Expanded Polytetrafluoroethylene Femoral Bypass Decreases Intimal Hyperplasia

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Abstract
Wall shear stress, arterial wall elasticity, and intimal hyperplasia are related. The aim of this study was to investigate the in vitro mechanical properties of ovine femoral arteries, jugular veins, and expanded polytetrafluoroethylene conduits, and to evaluate postoperative intimal hyperplasia. Arterial, venous, and ePTFE mechanical properties were studied in a circulating loop at isobaric systemic pressures. Histological studies of intimal hyperplasia in ePTFE-bypassed femoral arteries with and without Miller cuffs were performed at the 40th and 120th day. The incremental elastic modulus of veins was significantly higher than that of femoral arteries (P < 0.05), but significantly lower than that of ePTFE graft conduits (P < 0.05). Intimal hyperplasia was significantly less in Miller-cuff-bypassed arteries both at the 40th and 120th day (P < 0.01). The Miller cuff acts as a mechanical adapter enhancing wall shear stress and the elastic matching between ePTFE and the native artery, resulting in an early decrease of intimal hyperplasia.