Heparin-bonded expanded polytetrafluoroethylene vascular graft for femoropopliteal and femorocrural bypass grafting: 1-year results

Bosiers, Marc; Deloose, Koen; Verbist, Jürgen; Schröe, Herman; Lauwers, Geert; Lansink, Wouter; Peeters, Patrick

doi:10.1016/j.jvs.2005.10.037

Cited by 119 publications

(76 citation statements)

References 24 publications

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“…Also, Bosiers and colleagues 7 reported good results in terms of early graft thrombosis and limb salvage with the examined graft, with a 30-day amputation rate of 4%, similar to the rate reported in our series. This modified graft seems to affect surface thrombotic processes, preventing graft thrombosis during the initial high-risk period for thrombotic failure; the mechanism of modulation of initial thrombus accumulation has been explained with a reduced platelet deposition on the graft surface, specifically correlated with the immobilized high antithrombin-affinity heparin fraction.…”

Section: Discussionsupporting

confidence: 90%

“…Results at 24 months were satisfactory in our experience, with 2-year patency and limb salvage rates similar to those reported at 1-year follow-up by Bosiers et al; 7 particularly in below-knee bypasses, our 24-month 80% primary patency compares favorably with the reported 24-month rate of 48.2% in a recent meta-analysis on infrainguinal ePTFE grafts. 2 It could be supposed that prolonged heparin bioactivity on the graft surface can somehow influence the formation of anastomotic myointimal hyperplasia; particularly, longterm patency rates may be significantly affected by reduced thrombus accumulation in the first several months after implant.…”

Section: Discussionsupporting

confidence: 89%

“…5 Recently, a new bioactive PTFE graft with covalent end-point attachment of heparin to the graft surface, enabling maintenance of functional heparin bioactivity, has been developed; and its effectiveness in terms of improvement of early graft patency has been demonstrated in an experimental study; 6 recently, data from a multicenter study 7 demonstrated promising results in terms of early patency and limb salvage, even if follow-up was limited to 1 year. Moreover, we reported in a previous experience 8 initial satisfactory results with this modified graft in below-knee revascularizations compared with those obtained with standard expanded PTFE (ePTFE).…”

Section: Introductionmentioning

confidence: 99%

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Lower Limb Revascularization with a New Bioactive Prosthetic Graft: Early and Late Results

Dorigo

Carlo

Troisi

et al. 2008

Annals of Vascular Surgery

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The aim of the study was to evaluate the immediate and long-term results of femoropopliteal bypasses performed with a new bioactive heparin-treated expanded polytetrafluoroethylene (ePTFE) graft in a single-center experience. From March 2002 to April 2006, 51 patients underwent lower limb revascularization with a new bioactive ePTFE prosthetic graft with covalent endpoint attachment of heparin to the graft surface. Data concerning preoperative assessment, intraoperative strategy, drug administration, and follow-up surveillance program were prospectively collected in a dedicated database; early results were analyzed in terms of graft patency, amputation rate, and deaths. Follow-up consisted of clinical and duplex scan examination at 1, 6, and 12 months and yearly thereafter. Midterm results in terms of primary and secondary patency, limb salvage, and survival were analyzed. Patients were predominantly male (35 patients, 71%), with a mean age of 71 years (SD ¼ 9.05). Indications for surgical revascularization were critical limb ischemia in 36 patients and severe intermittent claudication in 15 patients. Interventions were performed for occlusion of a native vessel in 35 cases, whereas 12 patients had late thrombosis of a femoropopliteal bypass; the remaining four patients were operated on for an occluded popliteal artery aneurysm. Intervention consisted of below-knee bypass in 34 patients, while the other 17 had an above-knee revascularization. No perioperative deaths occurred. Cumulative 30-day graft patency was 88%, with an amputation rate of 4% (two cases). Results were similar in above-and below-knee revascularizatons. Mean duration of follow-up was 18 months (SD ¼ 7). Cumulative estimated 24-month survival and primary patency rates were 97% and 80.2%, respectively; the corresponding limb salvage rate was 85.7%. Long-term results did not significantly differ in above-and below-knee revascularizatons. In our experience, the use of a modified ePTFE graft with covalent end-point linkage of heparin molecules on the graft surface provides good early and midterm results, with low rates of graft thrombosis and amputation.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lower Limb Revascularization with a New Bioactive Prosthetic Graft: Early and Late Results

Dorigo

Carlo

Troisi

et al. 2008

Annals of Vascular Surgery

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“…Firstly, we did not investigate whether the scaffolds were still fully covered by autologous ECs in vivo after 24 weeks of implantation, thus the actual role of pre-endothelialization on patency rate remained to be confirmed. Secondly, intimal hyperplasia is an important cause of poor patency rate in small-diameter vascular grafting, particularly in the anastomotic area; 27 we did not, however, evaluate intimal hyperplasia after scaffold implantation. Besides this, both PLLA and PCL are known to be biodegradable materials; 20 unfortunately, the extent of scaffold degrading and the alteration of mechanical properties following 24 weeks of implantation were not determined by us.…”

Section: Discussionmentioning

confidence: 97%

Fabrication of small-diameter vascular scaffolds by heparin-bonded P(LLA-CL) composite nanofibers to improve graft patency

Wang¹,

Mo²,

Jiang³

et al. 2013

IJN

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Abstract:The poor patency rate following small-diameter vascular grafting remains a major hurdle for the widespread clinical application of artificial blood vessels to date. Our previous studies found that electrospun poly(L-lactide-co-epsilon-caprolactone) (P[LLA-CL]) nanofibers facilitated the attachment and growth of endothelial cells (EC), and heparin incorporated into P(LLA-CL) nanofibers was able to release in a controlled manner. Hence, we hypothesized that heparin-bonded P(LLA-CL) vascular scaffolds with autologous EC pre-endothelialization could significantly promote the graft patency rate. To construct a small-diameter vascular scaffold, the inner layer was fabricated by heparin-bonded P(LLA-CL) nanofibers through coaxial electrospinning, while the outer layer was woven by pure P(LLA-CL) nanofibers. Except dynamic compliance (5.4 ± 1.7 versus 12.8 ± 2.4 × 10 −4 /mmHg, P , 0.05), maximal tensile strength, burst pressure, and suture retention of the composite, scaffolds were comparable to those of canine femoral arteries. In vitro studies indicated that the scaffolds can continuously release heparin for at least 12 weeks and obtain desirable endothelialization through dynamic incubation, which was confirmed by EC viability and proliferation assay and scanning electronic microscopy. Furthermore, in vivo studies demonstrated that pre-endothelialization by autologous ECs provided a better effect on graft patency rate in comparison with heparin loading, and the united application of pre-endothelialization and heparin loading markedly promoted the 24 weeks patency rate of P(LLA-CL) scaffolds (88.9% versus 12.5% in the control group, P , 0.05) in the canine femoral artery replacement model. These results suggest that heparin-bonded P(LLA-CL) scaffolds have similar biomechanical properties to those of native arteries and possess a multiporous and biocompatible surface to achieve satisfactory endothelialization in vitro. Heparin-bonded P(LLA-CL) scaffolds with autologous EC pre-endothelialization have the potential to be substitutes for natural small-diameter vessels in planned vascular bypass surgery.

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“…Por estas e outras razões, faz-se necessária a opção de um substituto sintético, o que sustenta o interesse da pesquisa neste campo da cirurgia vascular 10,11 .…”

Section: Discussionunclassified

Prótese vascular derivada do látex

et al. 2007

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ResumoContexto: O desenvolvimento de prótese vascular tem sido vital para os avanços e realizações da cirurgia vascular reconstrutora durante as últimas 5 décadas.Objetivos: Desenvolver um novo modelo de prótese vascular microperfurada, confeccionada em tecido recoberto com um composto derivado do látex natural da seringueira (Hevea brasiliensis) e avaliar sua perviedade, trombogenicidade, biocompatibilidade e o processo de cicatrização, além de algumas propriedades mecânicas (adaptabilidade, elasticidade, impermeabilidade e possibilidade de sutura), utilizando como controle a prótese de politetrafluoretileno expandido no mesmo animal. Métodos:Quinze cães foram separados em três grupos de cinco animais. Implantou-se a prótese de tecido e látex microperfurada e, no membro pélvico contralateral, a prótese de politetrafluoretileno expandido em todos os cães. O seguimento pós-operatório foi de 4, 8 e 12 semanas. A apreciação dos resultados foi feita segundo as avaliações clínicas dos pulsos, complicações (coleção líquida, deiscência, granuloma e infecção), arteriografias, análise macroscópica e elétron-micrografias de varredura. Resultados:Os testes estatísticos aplicados não evidenciaram diferenças significativas (p > 0,05) em relação às complicações pós-operatórias e perviedade dos enxertos. Ambas as próteses integraram-se adequadamente aos tecidos circunvizinhos, com um tecido de incorporação formado por fibras colágenas. Constatou-se a presença de neoíntima recoberta por endotélio em toda a extensão da superfície luminal da prótese de tecido e látex microperfurada. Ao contrário, na prótese de politetrafluoretileno expandido, o desenvolvimento endotelial sobre a superfície neointimal limitou-se às regiões próximas às anastomoses.Conclusões: A prótese de tecido e látex microperfurada demonstrou qualidades estruturais (adaptabilidade, elasticidade, impermeabilidade e possibilidade de sutura) satisfatórias como substituto vascular. Estimulou o crescimento endotelial além das regiões de contato com a artéria nas anastomoses e foi biocompatível no sistema arterial do cão, apresentando adequada integração tecidual. Palavras-chave:Prótese vascular, látex, politetrafluoretileno, endotélio, porosidade, artéria femoral. AbstractBackground: The development of vascular grafts has been crucial for advances and achievements in reconstructive vascular surgery over the past 5 decades.

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Heparin-bonded expanded polytetrafluoroethylene vascular graft for femoropopliteal and femorocrural bypass grafting: 1-year results

Cited by 119 publications

References 24 publications

Lower Limb Revascularization with a New Bioactive Prosthetic Graft: Early and Late Results

Lower Limb Revascularization with a New Bioactive Prosthetic Graft: Early and Late Results

Fabrication of small-diameter vascular scaffolds by heparin-bonded P(LLA-CL) composite nanofibers to improve graft patency

Prótese vascular derivada do látex

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