Heparin immobilization reduces thrombogenicity of small-caliber expanded polytetrafluoroethylene grafts Jan M.M. Heyligers, MD, Hence J.M. Verhagen,

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Heparin immobilization reduces thrombogenicity of small-caliber expanded polytetrafluoroethylene grafts Jan M.M. Heyligers, MD, Hence J.M. Verhagen, MD, PhD, Joris I. Rotmans, MD, PhD, Cees Weeterings, Msc, Philip G. de Groot, PhD, Frans L. Moll, MD, PhD, Ton Lisman, PhD Journal of Vascular Surgery Volume 43, Issue 3, Pages 587-591 (March 2006) DOI: 10.1016/j.jvs.2005.10.038 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 The newly developed ex vivo perfusion system using a cuff at a constant pressure of 45 mm Hg to ensure blood flow. Blood is aspirated through the graft with a constant flow of 20 mL/min, resulting in a shear rate of 74/s. Journal of Vascular Surgery 2006 43, 587-591DOI: (10.1016/j.jvs.2005.10.038) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 Scanning electron microscopy showing platelet adhesion and fibrin deposition (arrows) on the untreated Gore-Tex expanded polytetrafluoroethylene vascular graft perfused for 6 minutes with nonanticoagulated whole blood (A) and no such adhesion or deposition on the Gore-Tex graft treated with Carmeda BioActive Surface technology (B). Representative pictures of a single volunteer are shown. Journal of Vascular Surgery 2006 43, 587-591DOI: (10.1016/j.jvs.2005.10.038) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 Heparin immobilization reduces fibrin formation during ex vivo perfusions. Perfusions were performed in 10 volunteers by using both a noncoated and heparin-bonded graft in each volunteer. Serial samples were taken during perfusion, in which levels of fibrinopeptide A (FPA) were measured by enzyme-linked immunosorbent assay. Error bars indicate SEM. ePTFE, Expanded polytetrafluoroethylene. Journal of Vascular Surgery 2006 43, 587-591DOI: (10.1016/j.jvs.2005.10.038) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 4 Progression of prothrombin fragment 1 + 2 (F1+2) levels in the perfusate over time. There was no increase in F1+2 in the perfusate over time on either type of vascular graft, thus indicating that no measurable amount of thrombin was generated. Error bars indicate SEM. ePTFE, Expanded polytetrafluoroethylene. Journal of Vascular Surgery 2006 43, 587-591DOI: (10.1016/j.jvs.2005.10.038) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 5 Progression of the percentage of P-selectin–positive platelets (pos plts) in the perfusate over time. P-selectin expression on the perfused platelets did not increase over time on either graft surface, thus indicating that no measurable number of platelets was activated. Error bars indicate SEM. ePTFE, Expanded polytetrafluoroethylene. Journal of Vascular Surgery 2006 43, 587-591DOI: (10.1016/j.jvs.2005.10.038) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions