Effectiveness of fragmented autologous adipose tissue as a sealer of porous textile grafts: Effect on endothelial development

Abstract

Purpose: This study is designed to develop a sealing method for fabric vascular prosthesis with chopped tissue fragments.Methods: A highly porous fabric vascular prosthesis was invaginated, and a suspension of chopped autologous adipose connective tissue fragments was injected repeatedly until the pores were enmeshed with the fragments. Small tissue fragments oozed out from and firmly anchored within the interstices of the fabric, which made the outer surface smooth. The graft was then invaginated to bring the smooth surface into the luminal side.Results: No blood leakage was observed in an extracorporeal in vivo shunt load test with heparin (total 1400 IU/kg, actinomycin > 1500), whereas a continuous bleeding was seen in a preclotted control graft (400 IU/kg, actinomycin 657 ± 341). The sealed grafts were implanted in the descending thoracic aorta of 40 dogs, and an equal number of control grafts was used. The grafts were removed at selected time intervals up to 738 days. No bleeding was observed with the sealed grafts, and a thin layer of neointima was observed at 30 postoperative days. Eight (20%) of the control dogs bled to death within 24 hours of implantation. The neointima in the control animals extended from the anastomotic sites slowly with complete healing observed at 217 postoperative days.Conclusions: The autologous adipose tissue fragments could reliably seal the highly porous fabric prosthesis while allowing rapid and complete neointima healing in dogs.