Significance of the inner-surface structure of small-caliber prosthetic blood vessels in relation to the development, presence, and fate of a neo-intima. A morphological evaluation.

Microvascular prostheses with three different inner surface structures were examined morphologically 1-18 months after implantation to evaluate the presence and structure of the neo-intima. Fibrous polyurethane tubes (length: 5-10 mm, inner diameter: 1.5 mm) were implanted in the rat abdominal aorta in group A with a fibrillar inner structure (pore sizes 20-50 microns), and in group B the inner fibrillar structure was coated with an impermeable continuous silicon sheet. Expanded polytetrafluorethylene vascular prostheses (length: 40 mm, inner diameter: 4 mm) were implanted in the dog carotid artery (group C). The specimens were examined by light microscopy and scanning electron microscopy. A continuous and permanent neointima was only found in the prostheses with the porous fibrillar inner structure (group A). The thin new lining sheet was well attached to the prosthetic wall by cellular protrusions. In the silicon-coated prostheses (group B) also a continuous neo-intima had developed which, however, was irregular, thicker, and not anchored to the prosthetic wall. The expanded polytetrafluorethylene prostheses (group C) showed also after 1 year only incomplete lining with a neo-intima. Fresh blood cell deposits could be observed in the unlined prosthetic wall. It is concluded that a continuous lining of vascular grafts with a thin neo-intima is only achieved if the cells invading the prostheses from the anastomotic areas can anchor their cytoplasmic protrusions onto an appropriately structured inner surface. If these anchoring facilities are not provided, the unattached neo-intima will thicken, interfering with the patency of these microvascular prostheses, or fragments of the neo-intima or alternatively mural thrombi may constantly strip off and embolize.