Zusammenfassung
Gestrickte und gewebte Dacronprothesen mit kommerzieller Vorbeschichtung aus bovinem Kollagen, Gelatine oder humanem Albumin wurden bei 35 Schweinen End-zu-Seit zwischen infrarenaler Aorta und der Bifurkation implantiert. Die Prothesen wurden nach 4, 8 und 12 Wochen explantiert und mit 6 unbeschichteten gestrickten Dacronprothesen verglichen. Unbeschichtete Dacronprothesen entwickelten rasch eine fest haftende Neointima mit Endothelauskleidung, wobei die thrombusfreie Fläche gegenüber beschichteten Prothesen signifikant größer war (P<0,05). Die verlangsamte Albuminresorption führte zu einer verzögerten und inkompletten Neointimaausbildung sowie zu einer ausbleibenden Protheseneinheilung. Obwohl das bovine Kollagen nur schwach vernetzt war, war auch bei gewebten beschichteten Dacronprothesen die Neointimaausbildung verzögert, wobei noch nach 12 Wochen die Neointima nur locker mit der Prothese verbunden war. Das identische Kollagen sowie die bovine Gelatine waren bei gestrickter Prothesenstruktur bereits nach 4 Wochen resorbiert und die Prothesen waren komplett eingeheilt. Diese beiden Prothesentypen zeigten jedoch nach 8 bzw. 12 Wochen konstant einen organisierten thrombotischen Verschluß. Hier wies die Histologic eine Hyperplasie glatter Muskelzellen innerhalb der verdickten distalen Anastomosenregion nach. Diese Ergebnisse zeigen, daß die zeitgerechte Wiederkehr der Porosität unverzichtbar ist für die regelrechte Entwicklung sowie für die Aufrechterhaltung einer intakten Neointima. Hier sind sowohl die Struktur der Prothese als auch die Art der Beschichtungsverarbeitung entscheidende Parameter, die die Resorptionsrate der Imprdgnierung beeinflussen.
Summary
Knitted and woven Dacron grafts commercially coated with bovine collagen, gelatin and human albumin were implanted end-to-side between the infrarenal aorta and the bifurcation in 35 growing pigs. Grafts were explanted after 4, 8 and 12 weeks and compared to 6 uncoated knitted prostheses preclotted with blood that served as a control. Uncoated grafts rapidly developed a firmly attached neointima lined with endothelium. Compared with coated grafts the thrombus-free area of uncoated grafts was significantly larger (P < 0.05). The slow resorption of albumin resulted in a delayed and incomplete neointimal healing and failing graft incorporation. Although the bovine collagen was only minimally cross-linked by formaldehyde, healing of the neointima was compromised in a thin woven graft that demonstrated peeling of the inner capsule even after 12 weeks. The identical collagen as well as bovine gelatin were quickly degraded in knitted grafts and both types showed transprosthetic infiltration at 4 weeks. All knitted grafts coated with either collagen or gelatin, however, were occluded after 8 and 12 weeks. Light microscopy revealed hyperplasia of smooth-muscle cells within the thickened distal anastomotic region. These results demonstrate that a timely return of porosity is mandatory for the development and maintenance of an intact neointima. Both the structure of the fabric as well as the method of preparing the coating are crucial variables to determine the rate of biodegradation.
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Hake, U., Gabbert, H., Iversen, S. et al. Evaluation of the healing of precoated vascular dacron prostheses. Langenbecks Arch Chir 376, 323–329 (1991). https://doi.org/10.1007/BF00186423
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DOI: https://doi.org/10.1007/BF00186423