Favorable histologic findings and tensile strength at 14 years in knitted polyester aortofemoral and femoropopliteal grafts in the same patient.

Patent right and left limbs of an aortobifemoral knitted polyester graft and a patent left femoropopliteal graft, both implanted for 14 years, were removed 40 hr postmortem from a 63-year-old man. Healing studies were performed, using routine and immunocytochemistry staining scanning electron microscopy (SEM), and transmission electron microscopy (TEM) on multiple samples taken from sites sufficiently far from the anastomoses to avoid pannus healing. Evaluation by weight-elongation comparison with a fresh graft demonstrated that structural stability and strength were well preserved. Anastomoses were patent with no remarkable intimal hyperplasia. There was no thrombus on the flow surface of either graft. Histologic studies of these grafts revealed uniform through-wall tissue ingrowth and extensive patches of endothelial cells scattered over the flow surface, confirmed by factor VIII, SEM, and TEM. These findings document that long-term stable tensile strength and healing with flow surface endothelialization can be attained with knitted polyester grafts in the human.

Vascular graft healing. II. FTIR analysis of polyester graft samples from implanted bi-grafts.

FTIR-ATR analysis has shown that the 4-step process for preclotting polyester vascular grafts results in a uniform and reproducible fibrin coating of the polyester fibers. Western blot analyses have shown that FN and VEGF are also present in this fibrin coating. FTIR-ATR analyses of explanted grafts indicate that, while the in vivo healing of these preclotted polyester grafts proceed through the inflammation, proliferation, and remodeling phases of normal wound healing, these phases are modified. Because the fibrin coating provides a nonporous barrier between peri-graft tissue and the flowing blood, these molecular changes are controlled by the interactions of blood-borne constituents with the lumenal surface of the preclotted graft. Also, a well prepared preclotted polyester graft shows a minimal inflammatory response. After implantation, the fibrin preclot is more than 90% gone by the fifth day. However, the proliferation phase, involving synthesis of new protein and polysaccharide materials to replace the fibrin, appears to have begun by the third day. Detection of collagen I in the 5-day explants suggests that the overlapping remodeling phase of healing has begun. Protein and saccharide materials continue to be synthesized and remodeled, and, by the tenth day, collagen IV is detected. By 14-days post-implantation, there is an increase in collagen IV and cellular membrane lipids. Because collagen IV is an indicator of the presence of endothelial cells, some of these cellular membranes must be of endothelial origin. Thus, it appears that FTIR-ATR can be a useful tool in the study of vascular healing.