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New prostheses for venous substitution.

H Kogel1, J F Vollmar, P Proschek

  • 1Department of Vascular, Thoracic and Cardiac Surgery, University of Ulm, Germany.

The Journal of Cardiovascular Surgery
|May 1, 1991
PubMed
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Optimized artificial vascular grafts, specifically e-PTFE and polyurethane, demonstrated superior tissue integration and patency in canine inferior vena cava replacements. These advanced grafts may eliminate the need for additional protective measures in future clinical applications.

Area of Science:

  • Biomaterials Science
  • Vascular Surgery
  • Regenerative Medicine

Background:

  • Inferior vena cava (IVC) replacement presents challenges in vascular surgery.
  • Current artificial vascular grafts often require adjunctive measures like an arteriovenous (AV) fistula for optimal patency.
  • Endothelialization is crucial for successful vascular graft integration and long-term patency.

Purpose of the Study:

  • To evaluate the efficacy of different artificial vascular graft materials for IVC substitution in a canine model.
  • To assess the tissue incorporation, endothelialization, and patency rates of various expanded polytetrafluoroethylene (e-PTFE) and polyurethane grafts.
  • To determine if optimized grafts can achieve successful outcomes without the need for an AV fistula.

Main Methods:

Related Experiment Videos

  • 81 Beagle dogs underwent end-to-end replacement of 6 cm IVC segments using artificial vascular grafts.
  • Grafts included various e-PTFE (30-90 microns fiber length) and polyurethane materials with differing porosities.
  • Grafts were implanted without AV fistulas or anticoagulant drugs, with a 12-month follow-up period.

    • Main Results:

    • e-PTFE (75 microns fiber length) and increased porosity polyurethane grafts showed excellent tissue incorporation and complete endothelialization.
    • These optimized grafts achieved high patency rates of 80-85% at 12 months.
    • Complete endothelialization was observed as early as 6-12 weeks, outperforming other tested grafts.

    Conclusions:

    • Optimized e-PTFE and polyurethane vascular grafts demonstrate superior performance for large venous substitution.
    • These advanced prostheses facilitate rapid and complete endothelialization, leading to high patency rates.
    • The findings suggest that adjunctive AV fistulas may become unnecessary for these improved vascular grafts in clinical practice.