The healing characteristics, durability, and long-term complications of vascular prostheses

Arterial and venous autografts remain the materials of choice to replace diseased or damaged blood vessels. However, because of their limited supply, there is an increasing need to develop arterial substitutes that are durable, are readily incorporated by host tissues, possess a non-or hypothrombogenic flow surface, have compliance characteristics that closely approximate the native vessel, are resistant to infection, and are easily sutured (1, 2). Although none of the currently available prostheses manifests all of the desired characteristics of the ideal arterial replacement, large-diameter Dacron grafts used to replace the abdominal aorta have proved adequate, with 5-year cumulative patency rates of 85-90% (3-5). Late patency rates of 74 and 70% at 10 and 15 years, respectively, have been reported by Nevelsteen et al. (5). Unfortunately, the longevity of small-diameter prosthetic grafts (6 mm in internal diameter or less) is limited by the development of anastomotic intimal hyperplasia and consequent thrombosis of the grafts. When small-diameter prosthetic grafts such as those fabricated from polytetrafluoroethylene or Dacron are placed above the knee, cumulative patency rates range from 37.9 to 71%; below the knee, they range from 30 to 57% (6-9).