Denucleation promotes neovascularization of ePTFE in vivo

Expanded polytetrafluoroethylene (ePTFE) implants are being increasingly used as vascular prostheses and other devices. However the tissue response associated with this and other polymer implants continues to limit any long-term function. One of the major approaches currently being investigated to improve biocompatibility involves surface modification of the base polymer. In this report, we attempted to alter the healing characteristics of ePTFE by denucleation, a process which removes air trapped within the interstices of the material. Additionally, adsorption of extracellular proteins on the denucleated polymer was also tested. After 5 weeks implanted in subcutaneous and epididymal fat sites of rats, the material was explanted and the healing around the implant evaluated histologically. We found that in skin implants, denucleation alone resulted in a substantial reduction in the fibrous capsule which has been previously reported for untreated ePTFE, and an increase in blood vessel development around and within the polymer. Absorption of extracellular matrix proteins prior to implantation resulted in a reduced vascularity of the implants compared with denucleation-only implants. Implants in fat tissue, regardless of treatment, showed very little tissue reaction, either in the number of inflammatory cells, development of a fibrous capsule or neovascularization. These results suggest that the presence of air nuclei within porous material may contribute to the inappropriate healing response associated with these polymers. In addition, they confirm earlier reports that healing around implanted polymers is tissue-specific.