Vena cava replacement with a peritoneum-lined vascular graft.
The use of the peritoneum as a venous conduit was analyzed because of the inherent fibrinolytic properties of the mesothelium. A canine model in which the infrarenal inferior vena cava was replaced with interposition grafts (2 cm) of either a peritoneal tube, polytetrafluoroethylene (PTFE), or PTFE lined with peritoneum (lined graft) was studied. Venograms were performed 1 and 6 weeks after graft implantation for the percent area reduction of the lumen. Grafts were explanted at 6 weeks for light and scanning electron microscopy. The percent area reduction at 1 week for all grafts was found to be predictive of graft clotting by 6 weeks. At 6 weeks, one of three peritoneal tube grafts (33%), six of seven PTFE grafts (86%), and four of seven lined grafts (57%) were patent. Histologic studies demonstrated that stenosis of PTFE grafts was due to intraluminal thrombus formation, whereas lined grafts stenosed due to granulation tissue growth between the mesothelium and PTFE. A cellular circumferential intraluminal lining was found in four of four lined grafts, but in none of six PTFE grafts (p < 0.01). Furthermore, none of four lined grafts had intraluminal thrombus, but all of six PTFE grafts did (p < 0.01). Peritoneum-lined PTFE grafts maintain a continuous circumferential cellular lining, but have no improvement in short-term patency compared to PTFE alone.
Theuer
C J
CJ
Department of Surgery, University of Louisville School of Medicine, Kentucky, USA.
Bergamini
T M
TM
Theuer
H H
HH
Burns
C D
CD
Proctor
M L
ML
Garrison
R N
RN
D000704:Analysis of Variance; D000818:Animals; D001672:Biocompatible Materials / Q000378:metabolism; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D004285:Dogs; D006083:Graft Occlusion, Vascular; D006085:Graft Survival; D008854:Microscopy, Electron; D010537:Peritoneum / Q000378:metabolism; D010690:Phlebography; D011138:Polytetrafluoroethylene / Q000378:metabolism; D011182:Postoperative Care; D013927:Thrombosis; D014684:Venae Cavae / Q000601:surgery*
D001672:Biocompatible Materials; D011138:Polytetrafluoroethylene