Derivation of neointima in vascular grafts

Vascular prostheses woven from absorbable lactide/glycolide copolymers are replaced by myofibroblast-laden tissue conduits lined by endothelium. When these prostheses are implanted in arteries of animal models, the absorption-replacement reactions are inhibited by Dacron. To determine whether these reactions resulted primarily from transanastomotic pannus ingrowth, prostheses (30 mm x 4 mm) were constructed of three 10-mm long segments with Dacron segments on both ends and a middle polyglactin 910 (PG910) segment. The prostheses were implanted in the aortas of 15 adult New Zealand White rabbits. Resultant prosthesis/tissue complexes were harvested in triplicate at 2 weeks and at 1, 2, 3, and 4 months after implantation. Explants were photographed and sectioned for light microscopy and for scanning and transmission electron microscopy, which showed 100% patency with no aneurysms or stenoses. Inner-capsule thickness in the PG910 segments increased only during the interval from 2 weeks to 2 months; this thickness was statistically greater than either Dacron segment at 1 and 2 months (p less than or equal to 0.004 and p less than or equal to 0.0001, respectively). Proximal and distal Dacron segments did not differ from each other in thickness. Inner capsules of PG910 segments at 1 month were composed predominantly of myofibroblasts, whereas inner capsules of Dacron segments were composed of fibrin coagulum beyond the initial 2 mm of endothelial pannus ingrowth. These data suggest that transanastomotic pannus ingrowth is not the primary source of cells replacing absorbable vascular prostheses.