Midterm Results of Autologous Saphenous Vein and ePTFE Pre-Cuffed Bypass Surgery in Peripheral Arterial Occlusive Disease

Donker, Jeroen M.W.; Ho, Gwan H.; Slaa, Alexander te; Groot, Hans G.W. de; Waal, J; Veen, Eelco J.; Laan, Lijckle van der

doi:10.1177/1538574411414923

Cited by 24 publications

(20 citation statements)

References 16 publications

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“…However, ePTFE grafts suffer from reductions in patency rate as vessel diameter decreases below 6mm. In fact, only 38% of ePTFE grafts remain patent after 5 years in femoropopliteal bypasses 6 , and less than 25% remain patent after 3 years in infragenicular bypass grafts 7 . As a result, ePTFE grafts see limited use in small diameter applications such as coronary or lower-limb bypass grafting.…”

Section: Introductionmentioning

confidence: 99%

In vivo evaluation of biomimetic fluorosurfactant polymer-coated expanded polytetrafluoroethylene vascular grafts in a porcine carotid artery bypass model

Bastijanic

Marchant

Kligman

et al. 2016

Journal of Vascular Surgery

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Objective To evaluate the potential for biomimetic self-assembling fluorosurfactant polymer (FSP) coatings incorporating either heptamaltose (M7-FSP) to block non-specific protein adsorption, the cell adhesive RGD peptide (RGD-FSP), or the endothelial cell-selective CRRETAWAC peptide (cRRE-FSP) to improve patency and endothelialization in small diameter ePTFE vascular graft implants. Methods ePTFE vascular grafts (4 mm diameter, 5 cm length) were coated with either M7-FSP, RGD-FSP, or cRRE-FSP by dissolving FSPs in distilled water and flowing solution through the graft lumen for 24 h. Coatings were confirmed by receding water contact angle measurements on the lumen surface. RGD-FSP and cRRE-FSP grafts were pre-sodded in vitro with porcine pulmonary artery endothelial cells (PPAECs) using a custom-designed flow system. PPAEC coverage on the lumen surface was visualized with epifluorescent microscopy and quantified. Grafts were implanted as carotid artery interposition bypass grafts in 7 pigs for 33 ± 2 days (ePTFE n=3, M7-FSP n=4, RGD-FSP n=3, cRRE-FSP n=4). Patency was confirmed immediately after implant with duplex color-flow ultrasound and at explant with contrast-enhanced angiography. Grafts were sectioned for histology and stained: Movat’s pentachrome stain to outline vascular layers; immunofluorescent staining to identify endothelial cells (anti-von Willebrand factor antibody) and immunohistochemical staining to identify smooth muscle cells (anti-smooth muscle α-actin antibody). Neoinitima:lumen area ratio was determined to evaluate neointimal hyperplasia. Results Receding water contact angle measurements on graft luminal surfaces were significantly lower (P < .05) on FSP-coated ePTFE surfaces (M7-FSP: 40 ± 16°, RGD-FSP: 25 ± 10°, cRRE-FSP: 33 ± 16°) compared to uncoated ePTFE (126 ± 2°), confirming presence of the FSP layer. In vitro sodding of PPAECs on RGD-FSP and cRRE-FSP grafts resulted in a confluent monolayer of PPAECs on the luminal surface, with similar cell population on RGD-FSP (1200 ± 187 cells/mm2) and cRRE-FSP (1134 ± 153 cells/mm2) grafts. All grafts were patent immediately after implant, and 1/3 uncoated, 2/3 RGD-FSP, 2/4 M7-FSP, and 2/4 cRRE-FSP grafts remained patent after 1 month. PPAEC coverage of the lumen surface was seen in all patent grafts. RGD-FSP grafts had a slightly higher neointima:lumen area ratio (0.53 ± 0.06) compared to uncoated (0.29 ± 0.15), M7-FSP (0.20 ± 0.15), or cRRE-FSP (0.17 ± 0.09) grafts. Conclusion Biomimetic FSP coated ePTFE grafts can be utilized successfully in vivo and have potential to support endothelialization. Grafts modified with the M7-FSP and cRRE-FSP showed lower intimal hyperplasia compared to RGD-FSP grafts.

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Section: Introductionmentioning

confidence: 99%

In vivo evaluation of biomimetic fluorosurfactant polymer-coated expanded polytetrafluoroethylene vascular grafts in a porcine carotid artery bypass model

Bastijanic

Marchant

Kligman

et al. 2016

Journal of Vascular Surgery

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“…donker and colleagues performed 110 lower extremity bypass operations using precuffed ePtFe grafts. 19 the cumulative 3-year patency rates for supragenicular, infragenicular and femorocrural ePtFe grafts were 45%, 24%, and 24%, respectively. the cumulative 3-year patency rates using aGsv for supragenicular, infragenicular, and femorocrural bypass were 94%, 74%, and 52%, respectively.…”

Section: Structural Graft Modificationsmentioning

confidence: 98%

Bypass Surgery in Limb Salvage: Polytetrafluoroethylene Prosthetic Bypass

Naoum

Arbid

2012

Methodist DeBakey Cardiovascular Journal

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Polytetrafluoroethylene (PTFE) grafts have proven to be an adequate alternative conduit for peripheral bypass operations. Whether or not one uses PTFE depends on several factors: surgeon preference, individual patient circumstances, or when autologous greater saphenous vein is not available or adequate. These conventional grafts have evolved and undergone modification. The intraluminal surface has been coated with carbon or bonded with heparin. The structure of grafts has been modified with the creation of a hood or cuff, with the incorporation of a stent-graft segment for a sutureless anastomosis, or the fusion of PTFE with an outer polyester layer to minimize suture hole bleeding. This evolution intends to limit graft thrombogenicity, ameliorate the formation of intimal hyperplasia, decrease complications, and improve overall graft patency.

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“…These bypasses demonstrated patency rates comparable to those of ePTFE grafts refined with venous cuffs. 7,8 As mentioned in an earlier report from our clinic, 9 we preferably use ASV grafts for peripheral bypass surgery in patients with peripheral arterial disease (PAD). If that is not applicable, a precuffed ePTFE Dynaflo graft (Bard Peripheral Vascular Inc, Tempe, Ariz) is used in supragenicular femoropopliteal bypass reconstructions, and a precuffed ePTFE Distaflo graft (Bard Peripheral Vascular Inc) is used in infragenicular femoropopliteal bypass and femorocrural bypass reconstructions.…”

mentioning

confidence: 98%

“…2 Our previous report demonstrated acceptable midterm results of precuffed ePTFE grafts with respect to limb salvage. 9 However, the long-term results of precuffed ePTFE grafts are lacking. The aim of this study was to analyze long-term results up to 5 years of precuffed ePTFE and ASV grafts in patients with moderate to severe PAD, with special attention to limb salvage and adverse events.…”

mentioning

confidence: 99%

The current position of precuffed expanded polytetrafluoroethylene bypass grafts in peripheral vascular surgery

Slegt

Steunenberg

Donker

et al. 2014

Journal of Vascular Surgery

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Midterm Results of Autologous Saphenous Vein and ePTFE Pre-Cuffed Bypass Surgery in Peripheral Arterial Occlusive Disease

Cited by 24 publications

References 16 publications

In vivo evaluation of biomimetic fluorosurfactant polymer-coated expanded polytetrafluoroethylene vascular grafts in a porcine carotid artery bypass model

In vivo evaluation of biomimetic fluorosurfactant polymer-coated expanded polytetrafluoroethylene vascular grafts in a porcine carotid artery bypass model

Bypass Surgery in Limb Salvage: Polytetrafluoroethylene Prosthetic Bypass

The current position of precuffed expanded polytetrafluoroethylene bypass grafts in peripheral vascular surgery

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