Implantation of in vitro endothelialized polytetrafluoroethylene grafts in human beings. A preliminary report.
To assess the impact of in vitro endothelialization on prosthetic graft patency, we performed femorotibial reconstruction in four patients. Polytetrafluoroethylene grafts (6 mm), lined with cultivated autologous endothelial cells, harvested from the veins of the forearm, were used. Autologous endothelial cells were harvested enzymatically and characterized by morphology and factor VII staining. After a cultivation period of 17 to 23 days, the cell count increased from 27 +/- 3 x 10(4) endothelial cells to 5.4 +/- 1.1 x 10(6). Endothelial cell seeding on polytetrafluoroethylene prostheses was then performed. To improve endothelial cell attachment to the graft surface, polytetrafluoroethylene grafts (60 to 70 cm; 6 mm diameter) were precoated with fibrin glue containing fibrin and fibronectin and the fibrinolysis inhibitor aprotinin. Seeding density of 49 +/- 10 x 10(3) endothelial cells per square centimeter yielded a preconfluent monolayer immediately after seeding, as demonstrated by scanning electron microscopy. A second cultivation period of 6 days, after seeding and before implantation, was necessary for establishment of a confluent monolayer and to allow for maturation of the endothelial cell cytoskeleton as well as production and excretion of extracellular matrix. Grafts endothelialized in vitro were implanted in four patients requiring femorotibial reconstruction. Scintigraphic studies with indium 111-labeled platelets demonstrated little or no platelet deposition, indicating persistent endothelialization. All grafts remained patent at 3 months after implantation.
Kadletz
M
M
II Department of Surgery, University of Vienna, Austria.
Magometschnigg
H
H
Minar
E
E
König
G
G
Grabenwöger
M
M
Grimm
M
M
Wolner
E
E
D000368:Aged; D007611:Aprotinin / Q000494:pharmacology; D001807:Blood Vessel Prosthesis; D002455:Cell Division; D002478:Cells, Cultured; D003599:Cytoskeleton; D004727:Endothelium / Q000166:cytology*; D005109:Extracellular Matrix; D005260:Female; D015718:Fibrin Tissue Adhesive; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D013997:Time Factors
D015718:Fibrin Tissue Adhesive; D011138:Polytetrafluoroethylene; D007611:Aprotinin