Albumin Coating of a Knitted Polyester Arterial Prosthesis: An Alternative to Preclotting

Abstract

Coating a knitted polyester arterial prosthesis with cross-linked albumin fills the interstices of the graft and relieves the surgeon of the necessity to preclot. This is of particular value in patients whose blood clotting properties are hypercoagulable, or hypocoagulable. In addition, such prostheses require less handling, which can lower the risk of bacteremic colonization and shorten the operative time. The in vivo behavior of the implanted albuminated prosthesis in the thoracic aorta of dogs is similar to that of preclotted grafts, although the sequences of early healing are different. The preclotted graft develops a continuous, thick thrombotic matrix on its luminal surface during the first 4 hours of implantation. Following the initiation of the fibrinolytic mechanism 24 to 48 hours postoperatively, this thrombotic deposit quickly recedes, leaving blood cells and platelets adhering here and there to the prosthetic surface. In comparison, the albuminated coating is not associated with major early thrombotic deposits. The albumin remains visible between the filaments during the first 2 weeks of implantation. Both treated and control grafts contain numerous thrombi on their inner surface after 1 to 2 weeks. After 1, 3, and 6 months, both implants are well encapsulated and present a glistening and continuous luminal surface. This excellent healing, however, can be compromised should the graft adhere too closely to the animal's lungs. After 6 months, the cleaned, explanted prosthesis shows a well-preserved textile structure. Because of the reduced risks of postoperative hemorrhage and acute thrombosis and the ease of preparation, handling, and suturing, we believe an albumin coating provides a desirable and viable alternative to preclotting polyester prostheses.