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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2001 August;42(4):537-42

lingua: Inglese

In vivo evaluation of ammonia plasma modified ePTFE grafts for small diameter blood vessels replacement. A preliminary report

Sipehia R., Liszkowski M., Lu A.

From the Artificial Cells and Organs Research Centre Faculty of Medicine, McGill University Drummond, Montreal, Quebec, Canada


Background. Today, saph­e­nous ­veins are ­most fre­quent­ly ­used to recon­struct occlud­ed or dis­eased ­small diam­e­ter ves­sels (≤6 mm in diam­e­ter). However, ­these ­veins are unavail­able in 30-40% of ­patients. In ­such a sit­u­a­tion, pros­thet­ic ­grafts pro­vide the ­only alter­na­tive. Since an endo­the­lial ­cell (EC) lin­ing, impor­tant for main­tain­ing a “haem­os­tat­ic-throm­bot­ic” bal­ance, ­does not devel­op ­onto the inti­ma of implant­ed ­grafts in ­humans, ­these ­grafts ­occlude with­in a ­short peri­od of ­time. The fail­ure of vas­cu­lar ­grafts is attrib­ut­ed to ­their char­ac­ter­is­tics ­which are non­con­du­cive ­towards endo­the­lial ­cell adhe­sion, spread­ing and ­growth. In ­order to exam­ine wheth­er the paten­cy of vas­cu­lar ­grafts can be ­improved by the sur­face mod­ifi­ca­tion of ­grafts’ inti­ma, ­small diam­e­ter ­grafts ­were mod­i­fied by a nov­el ammo­nia plas­ma treat­ment to ­enhance ­their inter­ac­tions ­with EC.
Methods. Through lap­a­rot­o­my, ammo­nia plas­ma treat­ed ePTFE (4 mm in diam­e­ter) ­grafts (n=3) and con­trol untreat­ed ­grafts (n=6) ­were implant­ed ­into the dis­tal infra­ren­al aor­ta of rab­bits. At appro­pri­ate ­time, ­grafts and adher­ent tis­sue ­were ­removed, ­fixed, ­stained and embed­ded in Poly/Bed 812. Light micro­scop­ic exam­ina­tion of ­thin sec­tions cut ­from the prox­i­mal and dis­tal anas­to­mat­ic and mid­por­tion seg­ments of explant­ed ­grafts was car­ried out.
Results. In con­trol ­group stud­ies, all ani­mals devel­oped low­er ­limb par­a­ple­gia with­in sev­en ­days of implan­ta­tion. Light micro­scop­ic exam­ina­tion of explant­ed con­trol ­grafts ­showed ­that con­trol ­grafts ­were obstruct­ed by throm­bo­sis/inti­mal hyper­pla­sia. However, ammo­nia plas­ma mod­i­fied explant­ed ­grafts, ­after one ­month of trans­plan­ta­tion, ­revealed an endo­the­lial ­cell-­like lin­ing ­that cov­ered the ­grafts’ ­inner sur­fac­es. Accordingly, ­these ­grafts ­remained pat­ent in ani­mals.
Conclusions. The ­grafts’ sur­fac­es ­that are ­made con­du­cive to EC adhe­sion and pro­life­ra­tion and ­host ­response may influ­ence endo­the­lial regen­er­a­tion. It is ­hoped ­that the com­bi­na­tion of angio­gen­ic mole­cules (i.e. endo­the­lial ­cell spe­cif­ic ­growth fac­tors ­such as ­VEGF) ­with ammo­nia plas­ma mod­i­fied ­grafts may pro­vide fur­ther ­insight ­into the devel­op­ment of ­ideal ­small diam­e­ter pros­the­sis.

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