Macroporous Textile and Microporous Nonwoven Vascular Prostheses: Histological Aspects of Cellular Ingrowth into the Structure

  • C. R. Jerusalem
  • F. Hess
Conference paper

Summary

The trellis concept of healing is suspended by the preclotting of the porous prosthetic fabric.

The absorption of the precoagulated blood and an occasional periprosthetic hematoma does not take place as rapidly as is usually surmized. Therefore, the presence of unorganized blood coagula can inhibit the stabilization of a fibrin layer which forms an early blood flow interface and can result in thrombotic complications.

Subsequently, the development of a cellular neointima which spreads exclusively from vascular tissues at the anastomotic site is impeded.

In contrast, the coated prosthesis (UNI-GRAFT {R} DV) can be used immediately without prior preclotting, thus also in patients being heparinized or suffering from coagulopathy.

The coating effectively prevents the imbibition of the prosthetic wall with blood as well as primary and secondary bleeding into the prosthetic bed. The coating smoothes the inner surface and immediately forms a highly hemocompatible (noncollagenous) contact interface to the blood flow and promotes the formation of a dense and coherent primary fibrin layer as the “guide-rail” for a complete cellular neointima.

On the gelatine coating, the autologous fibrin film remains coherent and stable for long periods, probably indefinitly, when after clinical implantation the cellular healing of the graft remains poor or is absent.

In the absence of endothelium, a stable fibrin flow surface, the nature’s own means of covering a denuded region of the vascular wall, is superior to both the teflon/air flow surface of ePTFE, and the glutaraldehyde-fixed collageneous surface of the umbilical vein biograft.

The microporous flow surface of the experimental ffPUR prosthesis allows the firm attachment of a very thin fibrin film. Even under haemorrheologic disadvantageous conditions (loop-shaped conduit), this fibrin film forms both the athrombogenic interface to the streaming blood for many months and together the guide-rail with excellent anchoring possibilities for neointimal cells.

According to the present study, the patient’s (diseased) vessels in which a prosthesis was implanted, the flow surface consisted of fibrin rather than of endothelium.

In contrast to preclotted blood, the coating can be easily infiltrated by cells which contribute to the healing of the graft.

As a result of improved cellular immigration and penetration the UNI-GRAFT {R} DV prosthesis is better attached to the surrounding tissue and the fibrin layer is better stabilized, thus allowing a more rapid spread of endothelium and neointimal smooth muscle cells.

Keywords

Permeability Porosity Formaldehyde Migration Albumin 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Ashley, S., Brooks, SG., Latif, AB., Gehani, AA., Rajah, SM., Kester, RC.: The influence of collagen and gelatine coating on the thrombogenicity of Dacron vascular grafts. Abstr. subm. XIX World Congr. Int. Soc. Cardiovasc. Surg. Toronto 1989.Google Scholar
  2. Benslimane, S., Guidoin, R., Roy, PE., Friede, J., Hébert, J., Domurado, D., Sigot-Luizard, MF.: Degradability of cross-linked albumin as an arterial polyester prosthesis coating in vitro and in vivo rat studies. Biomaterials, 7, 268–272, 1986.CrossRefGoogle Scholar
  3. Benslimane, S., Guidoin, R., Marceau, D., King, M., Merhi, Y., Rao, TJ., Martin, L., Lafreniere-Gagnon, D., Gosselin,C.: Albumin-coated polyester arterial prosthesis: is xenogenic albumin safe? Biomat. Art. Cells Org. 15, 435–481, 1987.Google Scholar
  4. Benslimane, S., Guidoin, R., Merhi, Y., King, M., Domurado, D., Sigot-Luizard, MF.: An in vivo evaluation of polyester arterial grafts coated with albumin: the role and importance of cross-linking agents. Eur.Surg.Res. 20, 66–67, 1988.CrossRefGoogle Scholar
  5. Berger, K., Sauvage, L.R., Rao, A.M., Wood, S.J.: Healing of arterial prostheses in man. Ann. Surg. 178, 18–27, 1972.Google Scholar
  6. Bibby, SR., Crow, MJ., Sheehan, SJ., Kester, RC.: Should pre-clotted Dacron grafts still be used? Abstr. p. 29. Ann. meeting Vase. Surg. Soc. Great Brit. Ireland. 26/27 nov. 1987.Google Scholar
  7. Blakemore, AH., Voorhees, AB. Jr.: Use of tubes constructed from vinyon “N” cloth in bridging arterial defects: Experimental and clinical. Ann.Surg. 140, 324–334, 1954.CrossRefGoogle Scholar
  8. Braun, B., Grande, P., Lehnhardt, F.-J., Jerusalem, C., Hess, F.: Herstellung und tierexperimentelle Untersuchung einer kleinlumigen mikroporösen Polyurethangefässprothese. Vasa, Suppl. 22, 1–38, 1988.Google Scholar
  9. Carrel, A.: Results of the transplantation of blood vessels, organs and limbs, abstracted. JAM 51, 1662–1667, 1908.CrossRefGoogle Scholar
  10. Carrel, A., Guthrie, CC.: Uniterminal and biterminal venous transplantations. Surg.Gynicol. Obst. 2, 266–286, 1906.Google Scholar
  11. Edwards, WS.: Progress in synthetic graft development: An improved crimped graft of teflon. Arch. Surgery. 45, 298–309, 1959.Google Scholar
  12. Edwards, WS.: Arterial grafts. Arch. Surg. 113, 1225–1233, 1978.CrossRefGoogle Scholar
  13. Edwards, WS., Tapp, JS.: Chemically treated nylon tubes as arterial grafts. Surgery, 38, 61–70, 1955.Google Scholar
  14. Graf, W.: Der Erlanger Ciliatentest. Ein in vitro Verfahren zur Ermittlung von Zellverträglichkeit und Zytotoxizität. GIT Fachz. Lab. 6, 601–614, 1985.Google Scholar
  15. Gross, RE., Hurwitt, ES., Bill, AH. Jr.: Preliminary observations on the use of human arterial grafts in the treatment of certain cardiovascular defects. N. Engl. J. Med. 293, 578–579, 1948.CrossRefGoogle Scholar
  16. Guidoin, R., Couture, J., Assayed, f., Gosselin, C.: New frontiers of vascular grafting. Int. Surg. 73, 241–249, 1988.Google Scholar
  17. Harrison, JH.: Synthetic materials as vascular prostheses: II. A comparative study of Nylon, Dacron, Orion, Ivalon sponge and Teflon in large blood vessels with tensile strength studies. Am. J. Surg. 59, 16–14, 1958.CrossRefGoogle Scholar
  18. Hess, F., Braun, B., Jerusalem, C., Van Det, R., Steeghs, S., Skotnicki, S., Grande, P.: Endothelialization of polyurethane vascular prostheses implanted in the dog carotid and femoral artery. J. Cardiovasc. Surg. 29, 458–463, 1988.Google Scholar
  19. Hess, F., Jerusalem, C., Braun, B., Grande, P.: Significance of the inner surface structure of small calibre prosthetic blood vessels in relation to the development, presence and fate of a neointima. A morphological evaluation. J. Biomed. Mater. Res. 18, 745–755, 1984.CrossRefGoogle Scholar
  20. Hess, F., Jerusalem, C., Braun, B., Grande, P.: Patency and neointima development in 10 cm long microvascular polyurethane prostheses implanted in the rat aorta. Thorac. Cardiovasc. Surgeon 32, 283–287, 1984.CrossRefGoogle Scholar
  21. Hess, F., Jerusalem, C., Braun, B., Grande, P.: The inner prosthetic surface structure and re-endothelialization: an experimimental study using two types of microvascular prostheses for aortic implantation Microsurgery, 7, 29–37, 1986.Google Scholar
  22. Hess, F., Steeghs, S., Jerusalem, C., Wijn, P., Skotnicki, S.: Determination of the patency of vascular prostheses implanted in the rat aorta by means of ultrasonic blood flow measurement. Microsurgery 8, 5–10, 1987.CrossRefGoogle Scholar
  23. Hess, F., Steeghs, S., Jerusalem, C., Braun, B., Grande, P.: Implantation of 20 cm long polyurethane vascular prostheses in the femoral artery of the dog priliminary results. Thorac. Cardiovasc. Surgeon. 36, 348–350, 1988.CrossRefGoogle Scholar
  24. Jerusalem, C., Hess, F., Werner, H.: The formation of a neointima in textile prostheses implanted in the aorta of rats and dogs. Cell Tissue Res. 248, 505–510, 1987.CrossRefGoogle Scholar
  25. Kogel, H., Vollmar, JF., Cyba-Ayunbay, S.: Ingrowth of microvessels into vascular grafts, a prerequisite for complete endothelial lining/animal experiments. Thorac. Cardiovasc. Surgeon, 37, Suppl. I, 82, 1989.Google Scholar
  26. Merhi, Y., Guidoin, R., Forest, J-C.: Fate of poyester arterial prostheses implanted as thoraco-abdomonal bypass in dogs: Haematology, pathology and biiochemistry. Clin.Invest.Med. 11, 403–416, 1988.Google Scholar
  27. Julien, S., Gill, S., Guidoin, R., Guzman, R., Charara, J., Roy, P-E., Marois, G., Batt, M., Roy, P., Serise, J-M., Marois, D.: Biologic and structural evaluation of 80 surgically excised human umbilical vein grafts. CJS 32, 101–1017, 1989.Google Scholar
  28. Pugatch, EMJ.: The growth of endothelium and pseudoendothelium on the healing surface of rabbit ear chambers. Proc. Roy. Soc. B, 160, 412–422, 1964.CrossRefGoogle Scholar
  29. Sauvage, L.R., Berger, K., Wood, S.J., Rittenhausen, E.A., Davis, C.C., Smith, I.C., Hall, D.G., Mansfield, P.B.: Grafts for the 80’s. Monograph from the Bob Hope International Heart Research Institute, Seatle, Washington 1980.Google Scholar
  30. Szilagyi, DE., McDonald, RT., Smith, RF.: Biologic fate of human arterial homografts. Aarch. Surg. 75, 506–529, 1957.CrossRefGoogle Scholar
  31. Voorhees, A.B., Jaretzki, A., Blankenase, A.H.: The use of tubes constructed from vinyon-N cloth in briding arterial defects. Ann. Surg. 135, 332–336, 1952.CrossRefGoogle Scholar
  32. Wesolowski, SA., Fries, CC., Karlson, KE., Debarkey, MC., Sawyer, PN.: Porosity: primary determinant of ultimate fate of synthetic vascular grafts. Surgery 50, 91–96, 1964.Google Scholar
  33. Wesolowski, SA., Fries, CC., Henningar, G., Fox, LM., Sawyer, PN., Sauvage, LR.: Factors contributing to long-term failures in human vascular prosthethic grafts. J. Cardiovasc. Surg. 5, 544–576, 1964.Google Scholar
  34. Wesolowski, SA., Fries, CC., Martinez, A., McMahon, JD.: Arterial prosthetic materials. Annals NY Acad.Sc. 146, 325–344, 1968.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • C. R. Jerusalem
    • 1
  • F. Hess
    • 1
  1. 1.Dept. of Cell BiologyK.-University of NijmegenNijmegenThe Netherlands

Personalised recommendations