Abstract
Producing an early and complete prosthetic endothelialization is one of the best methods for improving performance of venous grafts. This study investigated the effect of graft material and configuration on the prosthetic endothelialization. Forty-two mongrel dogs were randomly divided into six groups. Four animals from each group were implanted with endothelial cell (EC)-seeded prostheses and 3 with unseeded ones in the inferior vena cava (IVC). ECs were harvested from autogenous omentum by enzymatic method yielding 1.65 ±0.43x106 ECs per gram of omentum. A 5-cm-long segment of IVC was resected, and an equal-dimension prosthesis was interposed. A femoral arteriovenous fistula (AVF) was created. Prostheses were explanted at ten days following surgery. All EC-seeded knitted Dacron prostheses and 3 seeded polytetrafluoroethylene (PTFE) ones were patent with complete endothelialization. All seeded woven Dacron prostheses were patent with partial endothelialization. Only 2 seeded and one control Silk prostheses were patent, and no EC lining could be detected. Light microscopy revealed that the neointima was thinner in the patent seeded PTFE grafts than that in controls (p<0.001) and in seeded knitted Dacrons (p < 0.02) . The neointima of seeded knitted Dacron grafts was thinner than that of controls (p<0.01). No marked difference was seen among the neointima formed on Meadox porous, Vascutek porous grafts (VP1200), or Vascutek sealed Gelsoft grafts. It was concluded that: (1) Excellent and early endothelialization of EC-seeded dog caval implants can be established with Vascutek VP1200, Gelsoft, Meadox knitted Dacron, and indigenous ePTFE. (2) Knitted Dacron is superior to woven Dacron in regard to EC seeding. (3) The gelatin-impregnated Gelsoft does not interfere with prosthetic endothelialization. (4) The woven Dacron, and especially the Silk prosthesis, seem unsuitable for EC seeding in the venous circuit.
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