Structural failure of Dacron arterial grafts

The ultimate test of a Dacron (polyethylene terephthalate or PET) arterial prosthesis depends on its ability to retain sufficient strength and durability to function properly for the life of the patient. Because graft recipients appear to be living longer, primarily because of improved medical and surgical treatment of cardiovascular disease, strength and durability of arterial prostheses have become increasingly important. From the time of implantation, all PET prostheses are continuously subjected to the cyclic stresses of pulsatile blood flow with mechanical fatiguing of yarns, as well as chemical and physical alterations associated with biodegradation. Notwithstanding the overall successful use of currently available prostheses, structural failure continues to occur sporadically and is especially noteworthy because of its potentially serious nature and usual occurrence 5 or more years after implantation, when the diagnosis may be overlooked or delayed. A review of the subject is provided based on the premise that timely recognition and appropriate management require a basic understanding of PET prostheses with respect to various fabric constructions and physical properties, graft healing, postoperative dilation, and known causes of structural failure.