Compliance of Textile Vascular Prostheses Is a Fleeting Reality

Abstract

Compliance is considered to be a major property influencing the long term performances of synthetic vascular substitutes that could play a role in anastomotic false aneurysm and intimal hyperplasia stenosis onset. Over the last decades, manufacturers have tried to develop substitutes that mechanically mimic arterial properties and avoid a compliance mismatch at the anastomoses in particular. However, data are missing about how initial compliance properties could change with time. The goal of this study was to evaluate how the compliance of vascular grafts evolves under cyclic loading conditions invitro. The compliance of three different models of commercially available textile polyethylene terephthalate (PET) grafts was evaluated. Tests were performed with and without their original coating. Compliance was assessed with a specific device dedicated to measure the deformations undergone by a graft under cyclic pressure loading conditions, using image analysis software. In each experiment, image analysis was performed under 60 and 140mmHg pressure loading conditions at loading start (H0) and after three, six, and 24h (H3, H6, H24) loading time. Average radial, longitudinal, and volumetric compliance was calculated from the obtained images. Twenty-four samples were tested. Results demonstrate that all values decreased significantly within only a few hours. On average, the loss of compliance after 3h of cyclic loading ranged on average from 35% for longitudinal compliance to 39% for radial compliance and 37% (p<.050) for volume compliance. After 24h, the loss of radial, longitudinal and volume compliance was respectively 63±3%, 60.5±2% and 61±7%. In this invitro model, PET graft compliance has already decreased significantly within 3h. The rapid loss of compliance identified in this experimental study helps explain the mismatch mentioned in clinical observations.