Supporting, microporous, elastomeric, degradable prostheses to improve the arterialization of autologous vein grafts

Abstract

Arterial reconstructions with vein grafts fail more frequently than with arterial grafts. One of the causes of graft failure is damage due to overstretching of the graft wall. Overstretching is caused because the vein graft, which has a poorly developed medium, cannot withstand the arterial blood pressures. The aim of this study is to evaluate whether damage due to overstretching can be prevented and a gradual adaptation of the vein graft to the arterial blood pressures can be induced by applying a microporous, elastomeric, degradable prosthesis around the vein graft. Therefore, autologous vein grafts (length 1.0cm) with and without supporting prostheses (composite vein grafts and control vein grafts, respectively) were interposed into both carotid arteries of rabbits. Microporous, elastomeric, biofragmentable polyurethane-based prostheses and microporous, elastomeric, biodegradable prostheses made of poly-ε-caprolactone or a copolymer of ε-caprolactone and 3.6-dimethyl-1,4-morpholine-2,5-dione with a monomer ratio of 95.5:4.5 were prepared. The grafts were evaluated up to 6 wk after implantation. The control vein grafts showed severe destructive changes such as de-endothelialization, disruption of the media with oedema, degradation of the elastic laminae and infiltration of polymorphonuclear leucocytes into the vein graft wall, leading eventually to a fibrotic wall. In contrast, the composite vein grafts showed a preservation of the smooth muscle cell layers and the elastic laminae with only few polymorphonuclear leucocytes infiltrated into the vein graft wall. Moreover, the wall of the vein graft gradually increased in thickness by the formation of regular circularly oriented cellular layers beneath the original longitudinally oriented smooth muscle cell layers, indicating a gradual adaptation of the vein graft to the arterial conditions. It appeared that the arterialization rate depended on the degradation rate of the supporting prostheses. Microporous prostheses made of a copolymer of ε-caprolactone and 3,6-dimethyl-1,4-morpholine-2,5-dione with a monomer ratio higher than 95.5:4.5 are recommended to support the vein grafts.