Aortic replacement surgery has become a well-established procedure. Many substances have been used as vessel substitutes. The picture is slowly clearing; some substances have been tried and rejected; others continue to show promise.
Regardless of the type of graft available, the problem of proper size and shape remains. All too often an otherwise ideal procedure must be partially compromised by the necessity of adapting the graft available to the host's remaining vessels. Complicated plastic tailoring of the graft or host vessel becomes necessary to accomplish a functional anastomosis.
This is particularly true when homografts are used. The diseased aorta is often dilated and the diameter of the homograft, selected because of its lack of disease, is significantly smaller.
Our investigations have indicated that polyvinyl formalinized (Ivalon) sponge is superior to homografts for large-caliber vessels not traversing flexion creases. In this respect, we are in agreement with the recent excellent presentation