Systemic effects of collagen-impregnated aortoiliac Dacron vascular prostheses on platelet activation and fibrin formation.
To minimize intraoperative blood loss a watertight knitted Dacron aortoiliac prosthesis has been developed by impregnation with bovine collagen. A potential disadvantage is that collagen may be associated with an increase in thrombus formation. We conducted a prospective randomized trial to study the systemic effects of collagen-impregnated prostheses and of aortoiliac operation as such on the coagulation mechanism during the first 10 days after operation. Forty-one patients randomly received either a collagen-impregnated (n = 20) or a nonimpregnated prosthesis (n = 21). Twelve patients who underwent cholecystectomies served as controls. Three markers of the coagulation mechanism were monitored: beta-thromboglobulin, fibrinopeptide A, and fibrin/fibrinogen degradation products. We found no significant differences in median beta-thromboglobulin, fibrinopeptide A, and fibrin/fibrinogen degradation product levels between patients in the collagen-impregnated prosthesis group and patients in the nonimpregnated prosthesis group. This indicates that collagen does not stimulate the coagulation cascade any more than conventional Dacron protheses do. In a comparison of patients who underwent aortoiliac reconstruction and patients who underwent cholecystectomies, the results indicated a significant increased platelet activation and fibrin metabolism in aortoiliac reconstruction group compared with the control group. Finally, we observed a significantly higher preoperative fibrin metabolism in patients with vascular disease than in control subjects. This difference is attributable to the high preoperative fibrin/fibrinogen degradation product values in patients with aortic aneurysms.
De Mol Van Otterloo
J C
JC
Department of Surgery, University Hospital Leiden, The Netherlands.
Van Bockel
J H
JH
Ponfoort
E D
ED
Briet
E
E
Brommer
E J
EJ
Hermans
J
J
Daha
M R
MR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001807:Blood Vessel Prosthesis; D003094:Collagen; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005337:Fibrin / Q000378:metabolism*; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005344:Fibrinopeptide A / Q000032:analysis; D006083:Graft Occlusion, Vascular; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation; D011093:Polyethylene Terephthalates; D001620:beta-Thromboglobulin / Q000032:analysis
D005338:Fibrin Fibrinogen Degradation Products; D011093:Polyethylene Terephthalates; D001620:beta-Thromboglobulin; D005344:Fibrinopeptide A; D005337:Fibrin; D003094:Collagen