A small arterial substitute: expanded microporous polytetrafluoroethylene: patency versus porosity

Eighty-nine grafts of expanded microporous polytetrafluoroethylene (PTFE) with a diameter of 4 mm, were placed in the carotid and femoral arteries of dogs. The animals were sacrificed at varying intervals beginning three days after operation. Four animals remain alive with patent grafts 10 months post-operatively. Twenty-four of 89 grafts were occluded, an overall patency of 73%. Fibril length (pore size) of the graft material was varied from 4 to 110 microns. Average pore size ranged from 9 to 65 microns. Wall thickness varied from 0.3 to 0.75 mm. Density ranged from 0.24 to 0.35 g/ml. Tissue ingrowth, neointimization and patency rate as compared to pore size, wall-thickness and density of expanded PTFE were observed. Pore size is the primary determinant of tissue ingrowth, neointimization and patency. Of 51 grafts with an average pore size of 22 microns or less, there were 6 occlusions, an 88% patency rate. There were 38 grafts with an average pore size of 34 microns or greater. In these 38 grafts, 18 occlusions were observed, a 53% patency rate. Patent grafts demonstrated tissue ingrowth, capillary formation an a thin neointima. Using small pore grafts, patency rates of 90% can be anticipated in the dog. Expanded microporous PTFE with its ease of handling, strength and pliability may be the vascular prosthesis of choice in man.