Arterial prostheses

The analysis of microporous Teflon-based arterial prostheses, which were retrieved along autopsies or along revision surgeries, confirmed the excellent biostability of these devices insofar as they had been carefully implanted. Few ruptures or tears were observed but had been likely caused either by a bad handling or by fibrosis expansion, the latter being more frequent for non-sheathed devices (Formichi et al. [22,23]). Taking into account the lack of stability of the prosthesis wall, the two major makers made tremendous efforts to improve this situation. W.L. Gore chose to fit their prostheses with a very thin external sheath, made also of microporous PTFE but almost impervious (Fig. 6). 

Considering the second requirement, that is, good dynamic mechanical properties ePTFE-based arterial prostheses must satisfy to improve their functional patency, there are not so many ways to reach this goal. Unfortunately, and due to the intrinsic mechanical characteristics of PTFE, the mechanical behaviour of these prostheses cannot be easily modified. However, different ways have been explored on the one hand, an optimisation of the design of the prostheses... 

J. Couture, R. Guidoin, M. King, M. Marois, Textile Teflon arterial prostheses How successful are they, Can. J. Surg. 27 (1984) 575. 

Granegger S, Flores J, Widhalm K, Sinzinger H (1988) Increased low-density lipoproteins (LDL) negatively affect human labelling. Folia Haematol 115 451-453 Harker LA, Slichter SJ, Sauvage LR (1977) Platelet consumption by arterial prostheses the effects of endothelialization and pharmacologic inhibition of platelet function. Ann Surg 186 594-601 Hawker RJ, Hawker LM, Wilkinson AR (1987) Indium-labelled human platelets. Optimal method. Clin Sci 58 243-248... 

Large arterial prostheses Replacement of deficient large arteries, e.g. aorta or femoral artery Flowing blood high shear rate low ratio of contacted surface/blood volume Woven or knitted PET for 0 > 6 mm expanded PTFE for 0 > 4 mm... 

Small arterial prostheses Replacement of deficient coronary arteries Flowing blood high shear rate high ratio of contacted surface/blood volume Currently none... 

M. W. King, R. Guidon, P Blais, A. Garton and K. Gunasekera, Degradation of polyester arterial prostheses a physical or chemical mechanism , in Corrosion... 

R. Guidon, M. King, P. Blais, M. Marois, C. Gosselin, P. Roy, R. Courbier, M. David and H. Noel, A biological and structural evaluation of retrieved Dacron arterial prostheses , in NBS Special Publication 601 - Implant Retrieval ... 

Abstract The chapter discusses the advantages and limitations of arterial prostheses (or vascular grafts) in terms of their biocompatibility, biofunctionahty and biostabUity. Criteria for biomaterials selection and prosthesis design that have enabled patients to recover more rapidly without any device-related complications are reviewed, and developments are considered that may lead to future improvements in healing and clinical outcomes for the next generation of vascular prostheses. 

This is the undisputed material of choice for the replacement of medium- and large-diameter arteries. The prostheses are available in straight and bifurcated designs (Fig. 15.7). In fact the technology associated with the design and fabrication of arterial prostheses has spread across the world over the past 40 years. So it is fair to say that these woven (Fig. 15.8) and knitted (Fig. 15.9) tubular structures are now a mature medical product. 

Over the years a series of different concepts have influenced the innovation and design requirements for polyester arterial prostheses. 

Sixth Concept Bicomponent prostheses. For arterial prostheses to provide hemostasis at implantation, yet encourage tissue infiltration and promote luminal surface endothelialization, they need to contain two dissimilar components, a permanent component and a resorbable component. A coated or impregnated graft provides an impervious wall at implantation, thanks to the biodegradable matrix of albumin, collagen, - and/... 

Couture J, Guidoin R, King M and Marois M.Textile Teflon arterial prostheses how successful are they Can. J. Surg. 27 575-582,1984. 

Sauvage LR, Berger K, Nakagawa Y, Wood SJ and Mansfield PB. An external velour surface for porous arterial prostheses. Surgery 70 940-953,1971. 

Guidoin R, King M, Marois Y, Ukpabi P, Deng X, Zhang Z, Yang C, Badour B, Laroche G, Martin L. Polyester arterial prostheses recent developments from the Czech Repubhc and Poland. ASAIO J. 43 69-83,1997. 

King M, Guidoin R, Gunasekera K, Martin L, Marois M, Blais P, Maarek JH and Gosselin C. An evaluation of Czechoslovakian polyester arterial prostheses. ASAIO J. 7 114-133,1984. 

Guidoin R, Marois Y, Deng X, Chakfd N, Marois M, Roy R, King MW, DouviUe Y. Can collagen impregnated polyester arterial prostheses be recommended as small diameter blood conduits ASAIO J. 42 974-983,1996. 

Herring MB, Dilley R, Jersild Jr RA, Boxer L, Gardner A, Glover J. Seeding arterial prostheses with vascular endothelium - The nature of the lining. Ann. Surg. 190 84-90,1979. 

Clarke JM, Pittilo RM, Nicholson LJ, Woolf N, Marston A. Seeding Dacron arterial prostheses with peritoneal mesothelial cells a preUminary morphological study. Br. J. Surg. 71 492-494,1984. 

Herring M, Gardner A and Glover J. Seeding human arterial prostheses with mechanically derived endothelium. The detrimental effect of smoking. J. Vase. Surg. 1 279-289,1984. 

Magnen JF and Kretz JG, Impregnated polyester arterial prostheses performance and prospects , of Vascular Surgery, 13 (5), 1999, pp 509-523. 

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