Polyurethane vascular prostheses decreases neointimal formation compared with expanded polytetrafluoroethylene Marc G. Jeschke, MD, Valentin Hermanutz,

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Polyurethane vascular prostheses decreases neointimal formation compared with expanded polytetrafluoroethylene Marc G. Jeschke, MD, Valentin Hermanutz, PhD, Steven E. Wolf, MD, Gerhard B. Köveker, MD Journal of Vascular Surgery Volume 29, Issue 1, Pages 168-176 (January 1999) DOI: 10.1016/S0741-5214(99)70358-7 Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Electron microscopic picture of an untreated, not implanted, open porous PU prosthesis. The prosthesis demonstrates a nonwoven microporous structure without any preferred orientation of the fibers. The prosthesis is very resistant against hydrolase activity and demonstrates noncarcinogenic characteristics. Journal of Vascular Surgery 1999 29, 168-176DOI: (10.1016/S0741-5214(99)70358-7) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Complete implanted vascular graft (P) into the abdominal aorta of the rat (A). A single stitch was used to suture the graft to the aorta. The clamps were released to reestablish blood flow. Journal of Vascular Surgery 1999 29, 168-176DOI: (10.1016/S0741-5214(99)70358-7) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Longitudinal section of a PU graft 6 months after implantation. Positive reaction with antibodies against von Willebrand factor (arrow). The luminal surface of the graft was covered by endothelial cells. L, Graft lumen; P, prostheses. Magnification, ×40. Journal of Vascular Surgery 1999 29, 168-176DOI: (10.1016/S0741-5214(99)70358-7) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Longitudinal section of a PU graft 4 weeks after implantation. Identification of smooth muscle cells with antibodies against a-smooth muscle actin (up arrow). Smooth muscle cells were covered by endothelial cells, which showed no positive reaction (down arrow). L, Graft lumen; P, prostheses. Magnification, ×100. Journal of Vascular Surgery 1999 29, 168-176DOI: (10.1016/S0741-5214(99)70358-7) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Electron microscopy of the lumen of a PU graft 2 weeks after implantation. Neointimal cells migrated from the bordering intrinsic vessel onto the luminal surface of the prostheses with the identification of the “growing edge” (arrow). 1, Neointimal cells; 2, acellular luminal graft coverage. Journal of Vascular Surgery 1999 29, 168-176DOI: (10.1016/S0741-5214(99)70358-7) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Migration of neointimal cells on the luminal surface of PU or ePTFE prostheses, dependent on the implantation time. PU prostheses are completely covered with neointimal cells at 28 days after implantation. Expanded PTFE were completely covered at 6 months after implantation (*P < .01). Data presented are mean ± SEM. Journal of Vascular Surgery 1999 29, 168-176DOI: (10.1016/S0741-5214(99)70358-7) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Neointimal thickness at the anastomoses in PU and ePTFE grafts 6 months after implantation. Neointimal thickness was significantly smaller in PU grafts compared with ePTFE grafts (*P < .05). Data are presented as mean ± SEM. Journal of Vascular Surgery 1999 29, 168-176DOI: (10.1016/S0741-5214(99)70358-7) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Proliferation rate of neointimal cells in PU and ePTFE prostheses (BrdU index). Seven days after implantation, neointimal cells in both materials had a proliferation rate of nearly 100%. This rate decreased beginning after 28 days throughout the whole study period. At 6 months after implantation, the mitogenic activity of neointimal cells in PU prostheses approached the physiologic activity in normal arterial blood vessels (0.05%). Data presented are mean ± SEM (*P < .001). Journal of Vascular Surgery 1999 29, 168-176DOI: (10.1016/S0741-5214(99)70358-7) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions