Suitable vein is not always available and in this situation PTFE should be used. It can be used in conjunction with vein as a composite graft. Neointimal hyperplasia at the distal anastomosis can be reduced by the incorporation of a segment of vein as either a Millar Cuff or Taylor Patch to improve the long-term patency of the grafts. The most common cause of graft infection is contamination at the time of surgery. Eradication of infection with the graft in situ is difficult and it may require removal.
Anastomotic aneurysms result from partial or total disruption of the anastomosis.
They usually result from infection or disruption of the suture line. Most are asymptomatic but some cause symptoms as a result of local pressure . If they are superficial they can usually be easily palpated. Treatment requires a short segment bypass graft to remove the risk of rupture. Most aorto-enteric fistulae present months or years after the initial vascular surgery.