The effect of pancreatopeptidase E (elastase) on anastomotic intimal thickness in two types of vascular prosthesis.

To determine the effects of pancreatopeptidase E (elastase) on anastomotic intimal thickness in vascular prostheses, expanded polytetrafluoroethylene (ePTFE) and Dacron grafts were implanted in the infrarenal aortas of 28 adult mongrel dogs, divided into four groups of seven dogs each according to the type of graft used and whether or not elastase was given. Thus, group E received ePTFE grafts without elastase; group D received Dacron grafts without elastase; group E + Ela received ePTFE grafts with concomitant oral elastase, 8 mg/kg per day; and group D + Ela received Dacron grafts with elastase given at the same dosage as in group E + Ela. Each graft was harvested 4 months following surgery for histologic examination. It was clearly observed that elastase suppressed intimal growth at the proximal and distal anastomoses in the ePTFE grafts (P < 0.05), but not in the Dacron grafts. Furthermore, when we measured the smooth muscle cell percent extinction (%E) on microspectrophotometry in the intima within 2 mm of the proximal and distal anastomoses, it was found that elastase reduced intimal smooth muscle proliferation at the anastomosis of the ePTFE grafts, but not the Dacron grafts (P < 0.05). These data suggest that elastase suppresses intimal growth by inhibiting smooth muscle cell migration and proliferation in the vascular prostheses of low but not of high porosity.