J.Jpn. Surg. Soc.. 78(6): 473-494, 1977
Original article
A HISTOPATHOLOGICAL STUDY OF THE SYNTHETIC VASCULAR PROSTHESES RECOVERED FROM THIRTY-TWO CLINICAL CASES
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Department of Thoracic Surgery, Faculty of Medicine, University of Tokyo Katsuo Fuse |
The following results were obtained :
1) The internal surfaces of all the prostheses showed fibrin or collagenous layers and no endothelial coverings through the entire length of the graft.
2) As compared with healing processes of three kinds of the vascular prostheses, the knitted dacron graft showed rather thin and most stable healing structures. The woven teflon graft showed unsatisfactory results with unstable organization of the neointima. In cases of the knitted teflon graft, wide differences on the pore size of the prostheses were observed, and in specimens with large pore size, healing patterns were similar to the knitted dacron graft. According to the present ovservations, it was postulated that these different findings were not due to graft materials, but the pore size of prostheses.
3) In 4 cases, recurrent mural thrombus formations were observed on the neointima, suggesting possibilities of late occlusions of the grafts or dislodgements of the mural thrombi causing distal embolizations.
4) Very thin neointimas were observed in 2 cases that had been implanted into the thoracic aortas, which suggests that flow velocity plays an important role on the healing process.
5) As regard to the atherosclerotic changes of inner layer, 2 cases of calcification and 2 cases of cholesterin deposits were observed. These changes were only seen in atherosclerotic disease and not seen in inflammatory disease.
6) The “intimal crevasses” at the suture lines were observed in 2 cases, suggesting that physical factors such as vibrations and shearing forces along the suture lines may cause the small hollows which lead to the development of anastomotic aneurysms.
7) Anastomotic aneurysms following the insertion of the knitted graft were rather small in shape and localized at the suture portions, while those of the woven teflon graft were large and included the entire length of the graft. These extensive dissections in the latter graft were supposed to be due to unsatisfactory organization between the prostheses and outer fibrous capsules.
8) On the basis of these observations, it was concluded that the woven teflon graft seemed unsuitable for the replacement of main arteries except for unavoidable circumstances, e.g. the reconstruction under the cardio-pulmonary bypasses.
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