Twenty-two cases of vascular graft failures (thrombosis, pseudoaneurysm, dilation, infection) were investigated by means of physicochemical, histological, and ultrastructural studies. A general decrease of mechanical resistance to stress of the prostheses was observed. Its magnitude ranged from 2 to 75% of the values of identical virgin prostheses and there was no relation with the duration of implantation. In addition to the breakage of yarn filaments (SEM), migration of fiber debris (histology) was observed in 7 cases. The structure of the polyester molecule had evolved after implantation. A decrease of crystallinity (x-ray diffraction and differential scanning calorimetry) was noted. These observations raise the question of the established stability of vascular prostheses and emphasize the need for further investigations in human graft retrieval programs.
Among 212 vascular prostheses collected in a vascular explant retrieval program, 50 exhibited one or more criteria of graft infection i.e., (a) clinical evidence of graft infection, (b) positive bacteriological analyses of the graft, and (c) presence at the blood-prosthetic interface of characterized microorganisms. Whereas each of these criteria was noted respectively in 25, 26, and 20 cases, there was no complete overlapping among the three criteria, but their combination led us to consider 50 cases of infected vascular grafts among the 212 collected. These results, and the occurrence in two cases among six investigations for viral infection, suggest that extensive bacteriological investigations of vascular explants should be included in an implant retrieval program, and that infection may represent a high risk in graft failure.
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