Clinical experience with a collagen impregnated woven Dacron graft

Vascular grafts continue to evolve. Recent developments have been aimed at decreasing porosity, increasing strength of prosthesis, increasing ease of handling and suturing and optimising flow characteristics. This study describes results with a recently developed collagen impregnated polyester prosthesis Hemashield Woven Double Velour, which does not require pre-clotting. Between January 1988 and December, 1991 such prostheses were used in 90 patients at Papworth Hospital. Fifty-eight, were used to replace the ascending aorta, 10 for the arch of the aorta and 28 for the descending aorta seven of whom were for coarctation and four for traumatic transections. In 60 cases the underlying disease was a dissected or ruptured aorta requiring emergency operation. There were 66 survivors with X-ray and CT follow-up of 6-52 months. Median blood loss was 630 ml range 380-1800 ml. There was no leakage from any of the grafts during surgery despite full perioperative heparinisation. For emergency/elective operations (N = 60/30) early mortality was 25%/10% (15/3) and late mortality 5%/6.6% (3/2). Of 15 patients who had interposition grafts for Type A dissection CT scans at 5-47 months showed one with chronic dissection proximal to the repair and 11 with persistent distal dissection. There was no evidence of late bleeding, seroma impaired healing or thickened neointima formation. It is concluded that there are no clinical disadvantages associated with collagen impregnation to set against the notable convenience of initial impermeability.