Nerve conduit using fascia-wrapped fibrocollagenous tube

The purpose of this study was to evaluate the application of autogenous fascia as a framework of a fibrocollagen tube for a nerve conduit in Japanese white rabbits. The fascia was wrapped with a double layer around a silicone rod 3.0 mm in diameter. After the implantation of the fascia-wrapped silicone rod into a subcutaneous pocket for 2 weeks, a 3.0 x 30-mm fascia-wrapped fibrocollagen (FFC) tube was prepared. With microvascular techniques, the tube was interposed into a right sciatic nerve gap which was 25 mm long. The results of nerve regeneration in the FFC tube group, in particular, the formation of epineurium, were able to stand comparison with the results of a control group under both histologic and electron micrographic examination.     

Rabbit model for evaluation of a long small-caliber vascular graft.

We developed an experimental method for evaluating the properties and healing process of a long, small-caliber vascular graft in a small animal. Eight rabbits were used. A left thoracotomy was performed and the thoracic aorta was isolated. The aorta was clamped and excised in the middle without a temporary shunt. A 15-cm-long by 4.0-mm-ID segment of a vascular graft was implanted end to end. After the blood flow of the aorta was restarted, the long graft remained in a big loop shape in the thoracic cavity and showed no tension. The major advantage of this technique is that, although it is simple, we are still able to evaluate a long, small-caliber vascular graft in a small animal.     

小口径猪血纤维蛋白血管支架内皮化的研究

明体外培养7 d内皮细胞在血管支架内表面就已形成较完整的内皮细胞单层,内皮细胞覆盖率达(99.2±0.5)%(n=4).结论 犬静脉内皮细胞在小口径血管支架内表面能较好地生长增殖.     

Experimental studies on application of small-caliber vascular prosthesis produced by polyurethane.

It has been suggested that a microporous structure enhances fast and complete endothelialization. For long-term patency, antithrombogenicity and microporous structure are very important factors. In this paper, we have developed a new technique to give a micro-porous structure to small-caliber vascular prosthesis produced by polyurethane which has favorable antithrombogenecity. A mixed solution (tetrahydrofuran: dimethylformamide = 1:1) containing 13 wt% of segmented polyurethane and a variable amount of calcium carbonate (mean particle size of 8 mm in diameter) was dip-coated on a glass mandril of 3 mm and 6 mm in diameter and placed into distilled water for 24 hours. After the glass mandrill was removed, this polyurethane tube was placed into 1 mmol hydrochloric acid for 1 hour, and a microporous polyurethane vascular prosthesis of 20 mm in length was completed. These prostheses of 3 mm and 6 mm in diameter were implanted into the femoral and the carotid arteries, and the abdominal aorta of the dogs, respectively. Patency was recognized by arteriography and Duplex scanning and the removed grafts were inspected macro- and microscopically. Greater hydraulic permeability of this graft was obtained with an increase in the quantity of calcium carbonate mixed with polyurethane. In elasticity, this graft was more similar to the canine jugular vein than the polytetrafluoroethylene graft. Patency was observed 8 weeks after implantation on the arteriogram, and neointima was observed microscopically on the smooth and lustrous lumen. The new polyurethane vascular prosthesis we developed might provide a potential prosthesis for small-caliber vascular reconstruction.     

New small-caliber antithrombotic vascular prosthesis: experimental study

Vascular prostheses with the inner diameter smaller than 1 mm were implanted to the common carotid artery of rats, and their patency was examined. Four types of tubes were prepared for this purpose in Experiment 1: polyethylene (PE), poly-(acrylic acid)-grafted polyethylene (PE-AA), polyacrylamide-grafted polyethylene (PE-AAm), and poly(vinyl alcohol) (PVA) tubes. Comparative studies made using nonsuture anastomosis revealed that the PE-AAm and PVA tubes were antithrombotic, although disconnection was noted at the anastomotic sites within 1 week and 1 month, respectively. Thereafter in Experiment 2, the PVA tubes were implanted to the common carotid artery of 20 rats using conventional anastomosis. Neither anticoagulants nor fibrinolytic agents were used in both series of experiments. Patency of the PVA tubes was 80% after 1 week and 70% after 1 month. In patent cases after 1 month, the luminal surfaces of the prostheses and the host arteries were examined using scanning electron microscopy. The lumen of the arteries and anastomotic sites was covered with endothelial cells, while the lumen of the PVA tubes was free from thrombi and there was no neointima formation. So far, there has been reported no manmade material that has completely antithrombotic property in vivo. However, our studies disclosed that PVA is antithrombotic and one of the most promising materials for the inner surface of small vascular prostheses.     

Nonpenetrating vascular clips for small-caliber anastomosis

In the search for better anastomosing techniques, an improved vascular stapler device (VCS clip applier system(R)) has been introduced. The system uses nonpenetrating clips to approximate everted vessel walls. The objective of this study was to determine the effects of nonpenetrating vascular clips on endothelial wound healing. Aortic end-to-end anastomoses were performed in male Wistar rats. A comparison was made between clipped (n = 12) and conventional hand-sewn (n = 6) anastomoses. Patency rates were verified at different time intervals (after 1, 4, and 8 weeks), after which the anastomotic sites were removed. Morphological evaluation was carried out using scanning electron microscopy. All rats survived the procedure. Closure with clips took less time than closure with conventional sutures, with decreasing aortic clamping times for the clipped procedures during the course of the experiments. Patency rates were 100% in both the "clipped" and "sutured" groups. Microscopic examination showed favorable endothelial healing at the clipped anastomotic sites, with less inflammatory reaction at 1 week, and a more complete endothelial regeneration at 4 and 8 weeks follow-up, as compared with the sutured anastomoses. The clip applier holds the promise of a useful device in anastomosing small-caliber vessels, since clip closure takes less time than suturing, while patency rates are identical, and morphological results are favorable. Training is mandatory to obtain technical skills and to achieve optimal results.     

Development of a small caliber vascular graft using a connective tissue tube with temporary antithrombogenicity

A connective tissue tube containing collagen fibrils and capillary blood vessels is an ideal material for artificial artery, since the collagen fibrils compose an excellent supporting framework for cell migration and proliferation and the endothelial cells of the capillary can be the origin of the endothelialization of the graft. However, its thrombogenicity has remained a problem. This experiment was designed to develop a small caliber (3mm) vascular graft using an autogenous connective tissue provided with temporary antithrombogenicity. A tube knitted of ultra-fine polyesters was implanted subcutaneously in the back of mongrel dogs for three weeks. Thus accomplished connective tissue grafts were heparinized ionically in vitro, using cross-link agents. Then the treated grafts, 5-6 cm in length and 3mm in diameter, were segmentally replaced with bilateral carotid arteries. During the follow-up period up to 55 days, 7 of 8 grafts (88%) were patent. Histological examinations revealed that there was no thrombus and the neointima formation with a lining of endotherial cells was completed, extending overall length of the grafts. Thus, newly devised hybrid type of connective tissue graft is thought to be usefull for a replacement for arteries with a small caliber.     

Experimental study of vascularized nerve graft: evaluation of nerve regeneration using choline acetyltransferase activity

A comparative study of nerve regeneration was performed on vascularized nerve graft (VNG) and free nerve graft (FNG) in Fischer strain rats. A segment of the sciatic nerve with vascular pedicle of the femoral artery and vein was harvested from syngeneic donor rat for the VNG group and the sciatic nerve in the same length without vascular pedicle was harvested for the FNG group. They were transplanted to a nerve defect in the sciatic nerve of syngeneic recipient rats. At 2, 4, 6, 8, 12, 16, and 24 weeks after operation, the sciatic nerves were biopsied and processed for evaluation of choline acetyltransferase (CAT) activity, histological studies, and measurement of wet weight of the muscle innervated by the sciatic nerve. Electrophysiological evaluation of the grafted nerve was also performed before sacrifice. The average CAT activity in the distal to the distal suture site was 383 cpm in VNG and 361 cpm in FNG at 2 weeks; 6,189 cpm in VNG and 2,264 cpm in FNG at 4 weeks; and 11,299 cpm in VNG and 9,424 cpm in FNG at 6 weeks postoperatively. The value of the VNG group was statistically higher than that of the FNG group at 4 weeks postoperatively. Electrophysiological and histological findings also suggested that nerve regeneration in the VNG group was superior to that in the FNG group during the same period. However, there was no significant difference between the two groups after 6 weeks postoperatively in any of the evaluations. The CAT measurement was useful in the experiments, because it was highly sensitive and reproducible.     

血管脱细胞细胞外基质制备的实验研究

目的 :研究脱除犬血管细胞获取完整血管基质的方法。方法 :采用不同浓度的去垢剂和蛋白酶 ,以及不同温度和时间的效果比较 ,并通过组织学检查 ,确定犬血管脱细胞细胞外基质的较好方法。结果 :经低渗 /高渗溶液加去垢剂和蛋白酶抑制剂处理 ,犬血管的细胞全部脱除 ,细胞外基质保持完好。结论 :制备血管脱细胞细胞外基质时去垢剂脱细胞的效果最佳     

The tissue-engineered vascular graft using bone marrow without culture

OBJECTIVE: To overcome the shortcomings of current vascular grafts, tissue-engineering methods have been applied to cardiovascular regions. We previously reported the creation of a tissue-engineered vascular graft by using vascular mixed cells. However, the cost and manpower for harvesting and culturing the cells was too burdensome. To overcome these drawbacks, we have developed a new method for creating a tissue-engineered vascular graft by using bone marrow cells, which can be obtained easily and used immediately, without cell culture. METHODS: Biodegradable polymers seeded with different types of cells (group V, cultured venous cells; group B, bone marrow cells without culture; and group C, non-cell-seeded graft [as control]) were implanted into the inferior venae cavae of dogs. The grafts were explanted at 4 weeks and assessed histologically and biochemically. RESULTS: In the histologic examination, a regular layer of Masson-staining collagen fiber and a layer of factor VII-stained endothelial and ant-alpha-smooth muscle cell antigen-immunoreactive cells stained in groups V and B like native vascular tissue, whereas no such stained regular lining was detected in group C. A 4-hydroxyproline assay in group C showed significantly lower levels than in groups V and B or native tissue ( P < .05). The DNA content of the tissue-engineered vascular graft tended to be higher in group C than in groups V and B or in native tissue. CONCLUSIONS: In the creation of tissue-engineered vascular grafts, the method of using bone marrow cells seems to be useful and superior to that of using vascular cells because bone marrow cells can be used directly, without culture.     

Multicenter evaluation of a polyurethaneurea vascular access graft as compared with the expanded polytetrafluoroethylene vascular access graft in hemodialysis applications

Objectives: The purpose of this study was to compare in a randomized, prospective, and controlled study, the performance of a multilayered, self-sealing polyurethane vascular access graft (PVAG) and expanded polytetrafluoroethylene (ePTFE) vascular access grafts in hemodialysis applications. Performance measures included graft survival, complications, time to early cannulation, and hemostasis times after cannulation. Study Design: A total of 142 patients were randomized equally to receive one of the two grafts after meeting all eligibility requirements. All patients were followed up prospectively to 12 months or to the end of secondary patency. Specifically, this study documented the performance of the PVAG and ePTFE grafts by determining the patencies and complications for both grafts. Results: Patient characteristics between the two groups were similar with respect to risk factors and demographic characteristics (P >.05). Life-table patencies from the date of first dialysis were primary patency: PVAG 55% versus ePTFE 47% (6 months) and PVAG 44% versus ePTFE 36% (12 months) and secondary patency: PVAG 87% versus ePTFE 90% (6 months) and PVAG 78% versus ePTFE 80% (12 months). None of these differences were significant (P >.05). Both primary and secondary patencies were also not significantly different when the date of implantation was the starting point. Adverse events and complications were similar for the two groups, except the PVAG group had a higher incidence of technical complications manifested by graft kinking when compared with the control cohort (P <.05). Additionally, there was no significant difference in complication rates between these two groups with regard to infection and bleeding. When the time to hemostasis after cannulation was compared at 5 minutes or less, there were more PVAG cannulation sites that achieved hemostasis compared with ePTFE sites, and this difference was significant (P <.0001). When time to first dialysis access was compared between the two grafts, 53.9% of all PVAG grafts were cannulated before 9 days versus none with the ePTFE grafts (P <.001). However, long-term graft survival was not significantly different when PVAG patients were stratified into early (< 9 days) and the late access (9 ≥ days) groups (P =.29). Conclusions: The PVAG graft allows for early access without compromising long-term performance. Both PVAG and standard ePTFE grafts have similar long-term outcomes, despite early access with the PVAG vascular access grafts. (J Vasc Surg 2001;34:465-73.)     

Multicenter evaluation of a polytetrafluoroethylene vascular access graft as compared with the expanded polytetrafluoroethylene vascular access graft in hemodialysis applications

OBJECTIVES: The purpose of this study was to compare in a randomized, prospective, and controlled study, the performance of a multilayered, self-sealing polyurethane vascular access graft (PVAG) and expanded polytetrafluoroethylene (ePTFE) vascular access grafts in hemodialysis applications. Performance measures included graft survival, complications, time to early cannulation, and hemostasis times after cannulation.Study Design: A total of 142 patients were randomized equally to receive one of the two grafts after meeting all eligibility requirements. All patients were followed up prospectively to 12 months or to the end of secondary patency. Specifically, this study documented the performance of the PVAG and ePTFE grafts by determining the patencies and complications for both grafts. RESULTS: Patient characteristics between the two groups were similar with respect to risk factors and demographic characteristics (P >.05). Life-table patencies from the date of first dialysis were primary patency: PVAG 55% versus ePTFE 47% (6 months) and PVAG 44% versus ePTFE 36% (12 months) and secondary patency: PVAG 87% versus ePTFE 90% (6 months) and PVAG 78% versus ePTFE 80% (12 months). None of these differences were significant (P >.05). Both primary and secondary patencies were also not significantly different when the date of implantation was the starting point. Adverse events and complications were similar for the two groups, except the PVAG group had a higher incidence of technical complications manifested by graft kinking when compared with the control cohort (P <.05). Additionally, there was no significant difference in complication rates between these two groups with regard to infection and bleeding. When the time to hemostasis after cannulation was compared at 5minutes or less, there were more PVAG cannulation sites that achieved hemostasis compared with ePTFE sites, and this difference was significant (P <.0001). When time to first dialysis access was compared between the two grafts, 53.9% of all PVAG grafts were cannulated before 9 days versus none with the ePTFE grafts (P <.001). However, long-term graft survival was not significantly different when PVAG patients were stratified into early (< 9 days) and the late access (9 >/= days) groups (P =.29). CONCLUSIONS: The PVAG graft allows for early access without compromising long-term performance. Both PVAG and standard ePTFE grafts have similar long-term outcomes, despite early access with the PVAG vascular access grafts.     

Prosthetic vascular graft

Since the first application of the prosthetic vascular graft for the operation of aneurysm of the abdominal aorta, surgeries with prosthetic grafts were carried out among 573 patients, that is, 445 with aortic diseases, 48 with diseases of the periferal arteries and 75 with congenital heart diseases, respectively. In this paper, our clinical experiences of using the prosthetic grafts during last 25 years were described at first, and then, some problems of the prosthetic graft in the present and future were discussed.     

The effect of predetermined thrombotic potential of the recipient on small-caliber graft performance

This study was designed to establish the influence of the recipient's thrombotic potential on the patency of small-caliber prostheses and to evaluate the subsequent improvement of graft performance by medicinally altering the prostaglandin balance in subjects predisposed to graft occlusion. Mongrel dogs were pretested and classified as low and high responders according to their thrombotic potential, measured as prostaglandin metabolite balance and platelet aggregability. High responders were randomly divided into two groups. Those assigned to serve as the medicated subjects were pretreated 1 week before surgery with a single oral daily administration of combined dazmegrel (UK-38, 485) and aspirin in equal dosages of 3 mg/kg. Medication was continued throughout the experiment. Dacron grafts were implanted bilaterally in the carotid artery site in all subjects. Following a 3-week implantation period, the patency rate for the group with low thrombotic potential was 100%. In the animals with high thrombotic potential the patency rate was 10% for nonmedicated subjects and 100% for medicated subjects. These data support the concept that the thrombotic potential largely determines the capacity of the recipient's blood to thrombose small-caliber prostheses. Effective medicinal alteration of prostaglandin balance results in exceptionally increased patency of synthetic grafts. (J VASC SURG 1986;3:311-21.)     

Apicoaortic bypass using a vascular graft with a bioprosthetic valve

We report a case of 75-year-old man who underwent an apicoaortic bypass for severe aortic stenosis. The patient had a porcelain aorta accompanied by a severely calcified aortic annulus. We used a woven polyester vascular graft instead of a rigid apical connector because the latter material cannot be obtained in Japan. Postoperative examination showed no compression or stenosis in the apical outflow. A woven polyester vascular graft is therefore considered suitable for an apicoaortic bypass.