What is the proper role of polytetrafluoroethylene grafts in infrainguinal reconstruction?

Whittemore, Anthony D.; Kent, K. Craig; Donaldson, Magruder C.; Couch, Nathan P.; Mannick, John A.

doi:10.1016/0741-5214(89)90445-x

Cited by 135 publications

(38 citation statements)

References 17 publications

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“…The DSs would be an ideal candidate for a vascular graft. Our histological analysis showed that the cellular components were completely removed from the DSs, leaving the porous biological three-dimensional (3-D) architecture, which could provide physiologically proper microenvironment for vascular cell repopulation (1,9). And previous studies have shown that mechanical properties such as burst strength, compliance, and suture retention strength are not significantly different between decellularized tissue matrices and native vascular tissues (5).…”

Section: Discussionmentioning

confidence: 79%

“…For reconstruction of large arteries, such as the aorta or iliac artery, the current commercial grafts made from expanded polytetrafluoroethylene (ePTFE) or Dacron are utilized satisfactorily. However, synthetic grafts are not suitable for reconstruction of smaller-diameter (internal diameter [ID] <5 mm) arteries, due to thrombosis, limited reendothelialization, and neointimal hyperplasia, owing mainly to the inherent properties of the synthetic materials (1). Therefore, physicians routinely use autologous vessels for such reconstruction procedures.…”

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confidence: 99%

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Development and Validation of Small‐diameter Vascular Tissue From a Decellularized Scaffold Coated With Heparin and Vascular Endothelial Growth Factor

et al. 2009

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To overcome shortcomings of current small-diameter vascular prostheses, we developed a novel allogenic vascular graft from a decellularized scaffold modified through heparin immobilization and vascular endothelial growth factor (VEGF) coating. The VEGF coating and release profiles were assayed by enzyme-linked immunosorbent assay, the biological activity of modified surface was validated by human umbilical vein endothelial cells seeding and proliferation for 10 days in vitro. In vivo, we implanted either a modified or a nonmodified scaffold as bilateral carotid allogenic graft in canines (n = 15). The morphological examination of decellularized scaffolds showed complete removal of cellular components while the extracellular matrix structure remained intact. After modification, the scaffolds possessed local sustained release of VEGF up to 20 days, on which the cells cultured showed significantly higher proliferation rate throughout the time after incubation compared with the cells cultured on nonmodified scaffolds (P < 0.0001). After 6 months of implantation, the luminal surfaces of modified scaffolds exhibited complete endothelium regeneration, however, only a few disorderly cells and thrombosis overlay the luminal surfaces of nonmodified scaffolds. Specifically, the modified scaffolds exhibited significantly smaller hyperplastic neointima area compared with the nonmodified, not only at midportion (0.56 +/- 0.07 vs. 2.04 +/- 0.12 mm(2), P < 0.0001), but also at anastomotic sites (1.76 +/- 0.12 vs. 3.67 +/- 0.20 mm(2), P < 0.0001). Moreover, modified scaffolds had a significantly higher patency rate than the nonmodified after 6 months of implantation (14/15 vs. 7/15, P = 0.005). Overall, this modified decellularized scaffold provides a promising direction for fabrication of small-diameter vascular grafts.

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Section: Discussionmentioning

confidence: 79%

mentioning

confidence: 99%

Development and Validation of Small‐diameter Vascular Tissue From a Decellularized Scaffold Coated With Heparin and Vascular Endothelial Growth Factor

et al. 2009

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“…Our previous study has shown that heparin-coated ePTFE grafts result in reduced platelet deposition compared with non-coated control grafts in a canine femoral artery bypass model [18]. In the current study, we tested the hypothesis that the covalent linkage of the decellularized porcine arteries with heparin would provide a non-thrombogenic surface for the graft, which would reduce platelet deposition in the xenograft because thrombosis and graft patency were still major problems in vascular graft applications [6,7,[19][20][21]. Heparin contents in treated vessels after culture did not show a significant reduction in both PBS and 70% alcohol.…”

Section: Fig 2 Heparin Content and Stability Of Heparin-linked Porcimentioning

confidence: 96%

“…It would be desirable to have an alternative vascular prosthesis available for small-calibre reconstruction with similar or better patency rates compared with the autologous saphenous vein graft.Although the synthetic vascular prostheses, such as Dacron fabric grafts and expanded polytetrafluoroethylene (ePTFE), perform well in large-vessel reconstructions, these materials are not suitable for small-calibre arterial reconstructions [4,5]. Primary patency rates with ePTFE at 4 years for infrapopliteal and aortacoronary bypass, for instance, are only 12% and 14%, respectively [6][7][8]. The poor clinical outcome of prosthetic grafts in arterial reconstruction is mainly due to early thrombosis [6][7][8].…”

mentioning

confidence: 99%

Covalent linkage of heparin provides a stable anti‐coagulation surface of decellularized porcine arteries

Liao

Wang

Lin

et al. 2008

J Cellular Molecular Medi

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Establishing thrombosis‐resistant surface is crucial to develop tissue‐engineered small diameter vascular grafts for arterial reconstructive procedures. The objective of this study was to evaluate the stability and anti‐coagulation properties of heparin covalently linked to decellularized porcine carotid arteries. Cellular components of porcine carotid arteries were completely removed with chemical and physical means. Heparin was covalently linked to the decellularized vessels by a chemical reaction of the carboxyl end of amino acids with hydroxylamine sulphate salt and heparin‐EDC. Bound heparin contents were measured by quantitative colorimetric assay of toluidine blue staining. The average content of heparin in treated vessels was 35.6 ± 11.6 mg/cm2 tissue, which represented 6.21 ± 2.03 UPS heparin/cm2 tissue. The stability of heparin linkage was tested by incubating the heparin‐linked vessels either in PBS at 37°C or in 70% alcohol at room temperature up to 21 days, showing no significant reduction of heparin content. Anti‐coagulation property of bound heparin was determined with a clotting time assay using fresh dog blood. Standardized small pieces of non‐heparin‐bound vessels were clotted in fresh dog blood within 10 min., whereas all heparin‐bound vessels did not form clot during 1‐hr observation. In vivo platelet deposition of the vessel was determined with a baboon model of the femoral arteriovenous external shunt and 111Indium labelling of platelets. There were 1.38 ± 0.07 × 109 and 0.64 ± 0.11×109 baboon platelets deposited on the control and heparin‐linked vessels, respectively, at 60 min. These data demonstrate that covalent linkage of heparin provides an effective and stable anti‐coagulation surface of decellularized porcine carotid arteries. This study may suggest a new strategy to develop tissue‐engineered biological vascular grafts, which could be used for human coronary or low extremity artery bypasses.

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“…Unfortunately, due to age, disease, or prior usage many patients have no suitable autologous arteries or veins [7], hence synthetic materials (mainly Dacron and polytetrafluoroethylene; PTFE) are now frequently utilized for treatment of peripheral vascular disease. While these materials will act as a stopgap measure they are limited to high flow-low resistance conditions [8,9] because of low compliance, poor elasticity [10], and increased thrombogenicity of their surfaces [11]. Consequently, there is currently a great deal of interest in tissue engineering the ideal artificial arterial substitute.…”

Section: Introductionmentioning

confidence: 99%

Development of Tissue Engineered Vascular Grafts

Campbell

2007

CPB

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Vascular bypass grafting is a commonly performed procedure for ischemic heart disease and peripheral vascular disease. However, approximately one in fourteen patients do not have suitable autologous arteries or veins available for grafting. Synthetic vascular grafts were introduced in the 1960s to overcome these problems, but while they perform adequately in high-flow, large-diameter vessel settings they are generally not suited to low-flow, small-diameter vessels. Tissue engineering is a relatively new discipline that offers the potential to create replacement structures from autologous cells and biodegradable polymer scaffolds. Because tissue engineering constructs contain living cells, they may have the potential to grow, self-repair, and self-remodel. Therefore, recently there has been much interest in the use of this technique to produce low-flow small-diameter arteries. The latest and most exciting developments in this area involve the use of multipotent stem cells as a cell source for tissue engineering of vascular grafts (both in vivo and in vitro).

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What is the proper role of polytetrafluoroethylene grafts in infrainguinal reconstruction?

Cited by 135 publications

References 17 publications

Development and Validation of Small‐diameter Vascular Tissue From a Decellularized Scaffold Coated With Heparin and Vascular Endothelial Growth Factor

Development and Validation of Small‐diameter Vascular Tissue From a Decellularized Scaffold Coated With Heparin and Vascular Endothelial Growth Factor

Covalent linkage of heparin provides a stable anti‐coagulation surface of decellularized porcine arteries

Development of Tissue Engineered Vascular Grafts

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