Performance of small diameter synthetic vascular prostheses with confluent autologous endothelial cell linings.

Autologous grafts are superior to their synthetic counter-parts for grafting arteries smaller than 6-mm diameter both in terms of acute thrombogenicity and chronic intimal hyperplasia. Endothelial cell (EC) coating of the blood contacting surface may reduce thrombogenicity of synthetic small diameter vascular prostheses. In this study, the survival of EC monolayers on synthetic 4-mm diameter arterial prostheses over short-term implantations (< or = 6 weeks) was examined. Graft types examined were expanded polytetra-fluoroethylene (ePTFE) and microporous polyurethane (PU). Lumenal coverage with ECs was achieved by culturing ovine ECs on prostheses treated by either physical adsorption or covalent binding of ovine fibronectin (Fn). An ovine carotid interposition model was used to examine the performance of EC coated ePTFE and microporous PU over implantation periods of 1, 3, and 6 weeks. Outcomes assessed at the end of each experiment were graft patency, area covered by ECs, and thrombus free surface area (TFSA). Fn concentration, cell density at the time of coating and prostacyclin production in vitro were similar for both graft types. Occlusion occurred more frequently in unseeded grafts compared with EC coated grafts over 3 and 6 week implantation periods; however, the difference was not significant (p = 0.099). In prostheses precoated with ECs, approximately 40-60% of the surface area remained covered with endothelial-like cells following the first postoperative week. Recovery of EC layers occurred rapidly thereafter with 80-90% coverage at 3 weeks. TFSA remained low in comparison to EC cover in these prostheses until between 3 and 6 weeks postoperatively, suggesting a lag phase in recovery of EC function of seeded cells. In contrast, EC cover of unseeded prostheses only achieved 10-30% at 3 weeks, primarily by pannus EC ingrowth from the adjacent artery. TFSA of unseeded grafts increased in direct proportion to EC cover over time suggesting that there was no lag phase in function of these ingrowing cells.

In vivo evaluation of polyurethanes based on novel macrodiols and MDI.

A series of novel polyurethane elastomers based on methylenediphenyl diisocyanate, 1,4-butanediol and the macrodiols, poly(hexamethylene oxide), poly(octamethylene oxide), and poly(decamethylene oxide) were implanted subcutaneously in sheep for periods of 3 and 6 months. The specimens that were subjected to 3 months of implantation were strained to 250% of their resting length, while those implanted for 6 months had no applied external strain. SEM examination of the explanted specimens revealed that the novel materials displayed resistance to environmental stress cracking. Proprietary materials, Pellethane 2363-80A, Biomer and Tecoflex EG-80A, which had been implanted under identical conditions, showed evidence of significant stress cracking. The extent of stress cracking in the 3-month strained experiment was similar to that from the 6-month unstrained experiment. Stress cracking was also observed in Pellethane 2363-55D, when implanted for 6 months (unstrained). Neither changes in molecular weight nor in tensile properties provided a clear indication of early susceptibility to degradation by environmental stress cracking.

Phagocytosis of carbon particles by macrophages in vitro.

Particles of known size ranges of carbon fibre-reinforced carbon were presented to in vitro cultures of murine macrophages. Particles of up to 20 microns diameter were phagocytosed. Larger particles were not phagocytosed but became surrounded by aggregations of macrophages, some of which migrated on to the particle surfaces. Mean rates of phagocytosis up to 2.5 particles per hour were observed. Cells presented with a large excess of particles became rounded, detached from the substrate and some underwent lysis. The implications of these findings for the fate of particulates released from implanted medical devices is discussed. It is argued that a mechanism exists where particles in the size range 8-20 microns, released from medical devices, are small enough to be phagocytosed by macrophages and transported to the lymphatics and subsequently to the vascular circulation but large enough to lodge in capillary beds of tissues remote from the implant site.