Thrombus-free, human endothelial surface in the midregion of a Dacron vascular graft in the splanchnic venous circuit--observations after nine months of implantation.
The addition of an endothelial cell lining to a prosthetic vascular graft may reduce the thrombogenicity of the blood-contacting surface. An endothelialized mesoatrial graft was implanted in a patient with Budd-Chiari syndrome caused by a primary inferior vena caval leiomyosarcoma. During the initial surgery a Dacron vascular graft was preclotted with plasma and then lined with microvascular endothelial cells derived from the patient's subcutaneous adipose tissue. The patient did well initially but 9 months later required resection of a mechanical stricture of the graft that occurred as it passed beneath the costochondral junction. Grossly, the luminal surface of the resected graft was free of thrombus, with a smooth, glistening, white surface. Light microscopy demonstrated a surface layer of cells morphologically consistent with an endothelial cell monolayer, a subendothelial layer composed of extracellular matrix and spindle-shaped cells, and granulation tissue around the Dacron fabric. Immunohistochemistry and electron microscopy confirmed the presence of vascular endothelium on the luminal surface. This report documents the successful achievement of a human endothelial cell monolayer that persisted for 9 months in the midportion of a Dacron vascular graft.
Park
P K
PK
Department of Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107.
Jarrell
B E
BE
Williams
S K
SK
Carter
T L
TL
Rose
D G
DG
Martinez-Hernandez
A
A
Carabasi
R A
RA
D000328:Adult; D001807:Blood Vessel Prosthesis; D006502:Budd-Chiari Syndrome / Q000601:surgery; D004730:Endothelium, Vascular / Q000166:cytology* / Q000502:physiology; D005260:Female; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006801:Humans; D008642:Mesenteric Veins / Q000601:surgery; D008854:Microscopy, Electron; D008855:Microscopy, Electron, Scanning; D011093:Polyethylene Terephthalates; D012086:Reoperation; D013927:Thrombosis / Q000517:prevention & control*; D013997:Time Factors
D011093:Polyethylene Terephthalates