Hemocompatibility, biocompatibility, inflammatory and in vivo studies of primary reference materials low-density polyethylene and polydimethylsiloxane: a review.

In 1984, low-density polyethylene (LDPE) and polymethylsiloxane (PDMS), two primary reference materials (PRM), were made available by the National Heart, Lung, and Blood Institute (NHLBI) as discriminatory tools for the validation of standardized and novel in vitro and in vivo tests in the evaluation of biomaterials. This article reviews the results and conclusions obtained by several studies investigating the hemocompatibility, in vitro biocompatibility, inflammatory response, and in vivo tissue reactions of these two reference materials. Variable results obtained with LDPE and PDMS in ex vivo hemocompatibility studies were attributed to the type of animal model used, the flow velocity of the circulating blood, the time of exposure, and the methodology used to measure blood cell adhesion or activation at the surface of the materials. In contrast, both the LDPE and PDMS appeared to be suitable reference materials when used in in vitro biocompatibility, inflammatory response, and in vivo studies. However, caution must be taken when interpreting the results, because gamma sterilization of these two materials as well as their origin (for example PDMS) are two critically important factors. In conclusion, we see a definite need for standardized hemocompatible parameters and better high-quality hemocompatibility studies on PRM. This review also suggests other materials as potential PRM candidates, namely, Biomer and Intramedic polyethylene.

Selection of a polyurethane membrane for the manufacture of ventricles for a totally implantable artificial heart: blood compatibility and biocompatibility studies.

Membranes made from 4 commercial poly(carbonate urethanes): Carbothane (CB), Chronoflex (CF), Corethane 80A (CT80), and Corethane 55D (CT55), and from 2 poly(ether urethanes): Tecoflex (TF) and Tecothane (TT) were prepared by solution casting and sterilized by either ethylene oxide (EO) or gamma radiation. Their biocompatibility was evaluated in vitro in terms of proliferation, cell viability, and adhesion characteristics of human umbilical veins (HUVEC), monocytes (THP-1), and skin fibroblasts, and by measuring complement activation through the generation of the C3a complex. Their hemocompatibility was determined by measuring the level of radiolabeled platelet, neutrophil, and fibrin adhesion in an ex vivo arteriovenous circuit study in piglets as well as via an in vitro hemolysis test. The results of this study showed no endothelial cell proliferation on any of the materials. The cell viability study revealed that the CB, CF, and TF membranes sterilized by EO maintained the highest percentage of monocyte viability after 72 h of incubation (>70%) while none of the gamma-sterilized membranes displayed any cell viability. The fibroblast adhesion and C3a generation assays revealed that none of the materials supported any cell adhesion or activated complement, regardless of the sterilization method. The hemolysis test also confirmed that the 4 poly(carbonate urethanes) were hemolytic while none of the poly(ether urethanes) were. Finally, the ex vivo study revealed that significantly more platelets adhered to the CB and CT55 membranes while the levels of neutrophil and fibrin deposition were observed to be similar for all 6 materials. In conclusion, the study identified the CF and TF membranes as having superior biocompatibility and hemocompatibility compared to the other polyurethanes.

Analysis of retrieved polymer fiber based replacements for the ACL.

The present retrospective analysis of 117 surgically excised anterior cruciate ligament (ACL) prostheses was designed to elucidate the etiology and mechanisms of failure of synthetic ligamentous prostheses. They were harvested from young and active patients (26 +/- 7 yrs) at various orthopaedic centers in France between 1983 and 1993. The average duration of implantation of augmentation and replacement prostheses were 21.5 +/- 12.6 and 33.2 +/- 25.3 months, respectively. The principal causes for their excision were ruptures and synovitis. Each ACL prosthesis was examined macroscopically, histologically, and, after tissue removal, by scanning electron microscopy (SEM) to determine the model, manufacturer, surgical technique used at implantation, the extent of healing, the site of rupture, and the morphology of the damaged fibers. Fourteen types of ACL prostheses were analysed, each fabricated using a different combination of polymers, fibers and textile constructions. Consequently, they generated a variety of healing characteristics and mechanical responses in vivo. SEM observations revealed that abrasion of the textile fibers as a result of yarn-on-yarn and/or yarn-on-bone contact was a common phenomenon to almost all models, and was the primary cause of prosthetic failure. Healing inside the synthetic ACL was poorly organized, incomplete and unpredictable as the extent of collagenous infiltration into the textile structure did not increase with the duration of implantation. In fact, the collagenous infiltration into certain models appeared to be more detrimental than beneficial since it caused deterioration and fraying of the textile structure rather than serving as a reinforcing matrix around the prosthesis. In conclusion, the present study shows that three mechanisms may be involved in the failure of ACL prostheses: (1) inadequate fiber abrasion resistance against osseous surfaces; (2) flexural and rotational fatigue of the fibers, and (3) loss of integrity of the textile structure due to unpredictable tissue infiltration during healing.

Biostability, inflammatory response, and healing characteristics of a fluoropassivated polyester-knit mesh in the repair of experimental abdominal hernias.

The present study was undertaken to validate the benefits of a fluoropolymer treatment on the biostability, inflammatory response, and healing characteristics of a polyester mesh used for hernia repair, the Fluoromesh, as compared to a commercial monofilament-knit polypropylene mesh, Marlex, used as the control. Both were implanted for the repair of surgically induced abdominal hernias in piglets for prescheduled durations of implantation of 4, 15, and 60 days. The mesh and surrounding tissue were harvested at the sacrifice for the bursting strength and inflammatory response measurements in terms of alkaline and acid phosphatase secretion in the tissue, and for histological observations of the healing sequence and tissue thickness measurements by histomorphometric techniques. After cleaning to remove adherent tissue, the presence of the fluoropolymer at the surface of the mesh was detected using SEM and ESCA. The results demonstrated greater mechanical reinforcement and tissue development for the Fluoromesh than for the polypropylene mesh. The healing performance of the Fluoromesh was attributed to a more intense chronic inflammatory reaction early after implantation that stimulated significantly greater tissue ingrowth and integration. The concentration of fluoropolymer at the surface of the mesh was masked as a result of biological species adsorption. Textile analysis revealed that the Fluoromesh was dimensionally more stable in vivo than the polypropylene control mesh, which demonstrated stretching in the weft direction and shrinking in the warp direction during implantation.

In vivo magnetic resonance imaging and relaxometry study of a porous hydrogel implanted in the trapezius muscle of rabbits.

In vivo magnetic resonance imaging (MRI) and relaxometry were performed to assess noninvasively the tissue reaction and the biological integration of hydrogels made of poly[N-(2-hydroxypropyl) methacrylamide] (PHPMA) after implantation in the trapezius muscle of rabbits. The benefits of incorporating RGD peptide sequences in the polymer backbone were also investigated. The histological status of each implant was probed by the trend of their transversal relaxation times, T(2), while their biocompatibility was evaluated by analyzing the host tissue response through the evolution of the relaxation times of the adjacent muscle tissue. MR results showed the good acceptability of both hydrogels by the host tissue. The transversal relaxation curves of each implant exhibited two distinct phases as a function of implantation time: (1) a monoexponential phase, dominated by the influx of fluids inside the implants; and (2) a biexponential phase related to the infiltration of cells and the granulation tissue formation within the porous structure of each polymer. These MR findings were correlated with the results of conventional histological analyses. The present study demonstrates the effectiveness of MR methods in noninvasively monitoring the biocompatibility and histological status of implanted porous biomaterials.

Characterization of plasma proteins adsorbed onto biomaterials. By MALDI-TOFMS.

The analysis of plasma proteins adsorbed onto a polyurethane (PU) biomaterial was performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS). This article marks the first study on MALDI-TOFMS analysis of multiple proteins adsorbed from plasma, in vitro, onto the surface of a biomaterial to easily enable their characterization. Plasma standards from three different hosts were placed in contact with non-porous PU, a model biomaterial. Following the use of washing protocols developed in our laboratory, the biomaterial was analyzed, directly, with MALDI-TOFMS. Proteins with molecular weights (Mr) ranging from ca. 6.5 to 150 kDa were observed in the mass spectra and characterized upon comparison with proteins of known Mr. The proteins observed were tentatively identified as those known to adsorb onto PU, both in vitro and in vivo. In an attempt to model in vivo sorption, the PU biomaterial was exposed to freshly collected canine plasma, in vitro, for different lengths of time. Corresponding MALDI-TOFMS spectra displayed increasing protein signal for a number of different proteins with increasing times of exposure to plasma. This method provided qualitative and semi-quantitative analysis of the proteins adsorbed onto the biomaterial surface.

First-generation aortic endografts: analysis of explanted Stentor devices from the EUROSTAR Registry.

PURPOSE: To examine the structure and healing characteristics of chronically implanted Stentor endografts that were explanted due to migration, endoleak, thrombosis, or aneurysm expansion. METHODS: The devices were harvested following reoperation (n = 5) or autopsy (n = 1) with implantation times ranging from 13 to 53 months. Structural modifications to the metal components were examined using radiography, endoscopy, and magnetic resonance imaging (MRI). Specimens taken from components of the modular stent-grafts were examined histologically and with scanning electron microscopy (SEM) to assess healing behavior. Physical and chemical stability of the nitinol wires and woven polyester graft material was evaluated using SEM and electron spectroscopy for chemical analysis. RESULTS: Although the endografts were retrieved for a variety of reasons, they exhibited similar healing and structural modifications. The woven polyester sleeve showed evidence of yarn shifting and distortion, yarn damage, and filament breakage leading to the formation of openings in the fabric. The luminal surface endografts showed incomplete healing characterized by a poorly organized, nonadherent thrombotic matrix of variable thickness. Radiographic and endoscopic observations indicated that structural failure of the grafts, particularly in the main aortic component, was related to severe compaction and dislocation of the metallic frame due to suture breaks. Corrosion marks were observed on some nitinol wires in all devices. Chemical analysis and ion bombardment of the nitinol wires revealed that the surface concentrations of titanium and nickel were not homogenous. The first layer was composed of carbon or organic elements, followed by a stratum of highly oxidized titanium with a low nickel concentration; the titanium-nickel alloy lay beneath these layers. CONCLUSIONS: Although the materials selected for construction of endovascular grafts appears judicious, the assembly of these biomaterials into various interrelated structures within the device requires further improvement.

Endovascular repair of thoracic aortic aneurysm in dogs: evaluation of a nitinol-polyester self-expanding stent-graft.

PURPOSE: To validate the ease of deployment and in vivo healing performance of a nitinol-polyester self-expanding stent-graft using a canine thoracic aortic aneurysm model. METHODS: Arterial aneurysms were surgically created in 8 dogs by sewing a polyester patch onto the anterior side of the thoracic aorta. The nitinol-polyester self-expandable stent-grafts (Cragg EndoPro System 1) were implanted transluminally via the femoral route and deployed at the site of the thoracic aneurysm. Aneurysm exclusion and endograft patency were assessed by angiography after implantation and before animal sacrifice at scheduled periods ranging from 1 week to 3 months. The explanted specimens were examined with magnetic resonance imaging (MRI) to study the position of the stent-graft with respect to the aneurysmal sac. Histological analysis using light microscopy and scanning electron microscopy was performed to examine the inflammatory response and healing characteristics of the device. RESULTS: Seven of 8 stent-grafts were implanted successfully; a bend occurred within the aneurysmal sac in 1 dog, which led to continued perfusion of side branches. This endoleak sealed spontaneously within 1 week, and complete exclusion of the aneurysms in all 8 animals continued throughout implantation. At the time of explantation, all devices were structurally intact and well positioned in the aneurysmal sac. At 1 week, the luminal surface displayed a thin layer of thrombotic matrix, which was gradually replaced by a collagenous internal capsule with endothelial-like cell coverage along both ends of the stent-grafts at 2 and 3 months. No exacerbated inflammatory reaction due to either the nitinol wires or the polyester sleeve was observed after 3 months of implantation. CONCLUSIONS: This short-term in vivo study of a nitinol-polyester self-expanding endograft demonstrated the effective exclusion of thoracic aneurysms with a satisfactory healing response and no excessive tissue or inflammatory reactions.

Mechanism and rate of degradation of polyhydroxyoctanoate films in aqueous media: A long-term in vitro study.

The present study investigated the in vitro mechanism and degradation rate of polyhydroxyoctanoate (PHO). Solution-cast PHO films were incubated in either water or isoosmotic phosphate-buffered saline (PBS) for periods ranging from 1 to 24 months. Physical characterization included weight loss, water absorption, pH change, tensile strength, and scanning electron microscopy (SEM) studies. Analytical investigations including electron spectroscopy for chemical analysis, Fourier transform infrared (FTIR) spectroscopy, differential scanning calorimetry (DSC), wide-angle X-ray diffraction, and size exclusion chromatography were also performed to assess chemical and morphological changes to the structure of the PHO. The results show that the PHO-cast films incubated in either water or isoosmotic PBS underwent a simple hydrolytic degradation process characterized by water absorption, gradual molecular weight decrease, and negligible mass loss after 24 months of incubation. DSC results suggest that degradation occurred in the amorphous zone, followed by an attack in the crystalline domain. An increase in the vibration stretching of OH after 24 months of incubation, as revealed by FTIR, may indicate that the degradation process began internally, moving outwardly toward the surface of the PHO films. This process was more rapid in the films incubated in PBS than in those incubated in water. However, no significant changes in the morphology of the films were detected by SEM. This study demonstrated that the in vitro degradation of PHO in water or in PBS is a very slow hydrolytic process, exceeding 2 years. Our findings also suggest that the internal degradation mechanism is faster in PBS because of the ionic strength of the medium and that this internal process surface moves gradually toward the surface.

Tissue reactions to polypyrrole-coated polyesters: A magnetic resonance relaxometry study.

The electrically conductive properties of polypyrrole (PPy) as a coating on polyester material are very attractive for the manufacture of small diameter blood conduits. However, before these PPy-coated materials can be investigated for their capacity to generate endothelialized luminal surfaces, they must first be studied for their innocuousness in a living environment. The specific goal of the present study was to investigate the in vivo interactions of PPy-coated and noncoated woven polyester materials implanted subcutaneously in rats for prescheduled periods of 2, 5, 10, 20, and 30 days. The in vivo magnetic resonance (MR) relaxation times were computed for a small area of muscle tissue adjacent to the implants. A correlation was concurrently attempted with blood monocyte activation studies as well as histological observations of the tissue-material interface. The progressive pattern of the slower transversal relaxation time (T2s) values revealed a more persistent tissue reaction for the most conductive PPy-coated materials and a shorter acute tissue response as the surface resistivity increased. Similarly, the blood monocyte activation studies indicated that the thickness of the PPy coating, which correlated with the conductivity, was directly related to tissue response. Furthermore, both the MR and biological studies showed that the PPy-coated material with a high surface resistivity displayed the lowest tissue reaction over the entire period of implantation. The results obtained from the blood monocyte activation studies and histological observations correlate well with the noninvasive MR measurements of the body's healing process. The conductive materials with high surface resistivities must be further investigated. Finally, the noninvasive nature of MR relaxometry reveals its outstanding potential for future in vivo investigations of the body's tissue interactions with polymers and nonferromagnetic biomaterials.

In vivo biocompatibility and degradation studies of polyhydroxyoctanoate in the rat: a new sealant for the polyester arterial prosthesis.

The present study examined the biocompatibility and degradation properties of poly (beta-hydroxy octanoate) (PHO) as an impregnation substrate on arterial prostheses. PHO-impregnated polyester grafts sterilized by ethylene oxide (EO) or gamma (gamma) radiation, and polyester Dacron(R) prostheses impregnated with fluoropolymer, gelatin, or albumin were implanted subcutaneously in rats for periods ranging from 2 to 180 days. The biocompatibility was assessed by quantifying the alkaline and acid phosphatase secretion while performing histological studies at the tissue/prosthesis interface. The degradation was determined by chemical analysis of the EO and gamma-sterilized PHO after implantation using differential scanning calorimetry (DSC), wide angle x-ray diffraction (WAXD), and size exclusion chromatography (SEC). Alkaline phosphatase activity by the sterilized PHO and by the gelatin and albumin grafts was significantly elevated early after implantation in contrast to that of the Dacron and fluoropolymer grafts that occurred later, at 7 and 5 days, respectively The peak of acid phosphatase activity for all of the grafts occurred between 5 and 10 days postimplantation, with the gamma-sterilized PHO grafts recording the greatest activity. Histological study revealed that the tissue incorporation into the graft wall was earlier and more complete for the Dacron and fluoropolymer grafts after 6 months than for the gelatin and albumin grafts, because the latter induced important inflammatory reactions during the resorption of the cross-linked protein substrates. The EO and gamma-sterilized PHO grafts exhibited a similar healing sequence characterized by the development of a collagenous tissue surrounding the prostheses. However, no infiltration of tissue into the graft wall was observed after 6 months, mainly because of the presence of the PHO. Degradation of the EO and gamma-sterilized PHO occurred preferentially by a hydrolytic mechanism as shown by a 30% molecular weight decrease after 6 months. In conclusion, PHO showed good biocompatibility in terms of enzyme activity and tissue reaction. Degradation was a slow, in vivo process controlled primarily by a random hydrolytic reaction and by a local enzymatic attack by macrophages and giant cells.

Endothelial cell behavior on vascular prosthetic grafts: effect of polymer chemistry, surface structure, and surface treatment.

When implanting any vascular prosthetic grafts, one important goal to ensure long-term patency is achieving complete endothelialization of the luminal surface, a process that has rarely been observed clinically in humans. Seeding vascular grafts with endothelial cells has been seen as an attractive approach but has not been clinically convincing. A determining factor may be the type of polymer and surface structure. Using organotypic culture assays, the present investigation studied the effect of different polymers, surface structures, and surface treatments on endothelial cell behavior. The materials tested were polyester (PET), polytetrafluoroethylene (PTFE), polyesterurethane (PESU), and polyetherurethane (PETU) grafts with different surface structures. The surface treatments on the PET grafts included impregnation with cross-linked albumin, collagen, and gelatin, and treatments with fluoropolymer and electrically conducting polypyrrole polymer. Low density polyethylene (LDPE) and polydimethylsiloxane (PDMS) sheets (smooth surface, plain wall) were used as controls. After incubation for 7 days at 37 degrees C, cell adhesion and migration on the different polymers and structures were as follows: woven and knitted PET (high porosity) > PTFE, PESU, PETU hydrophobic (low porosity) > PETU hydrophilic, LDPE, PDMS (no porosity). Cell density results showed no difference between polymers and porous structures and a higher cell density on smooth nonporous surfaces. Compared with the nonimpregnated PET structures, knitted PET treated with albumin, collagen, or gelatin showed slight decreases of cell adhesion. No differences in cell migration and density were reported between any of the PET grafts, except for one polyester graft with a different chemistry than Dacron, which exhibited greater cell migration and lower cell density. Polyester grafts with a fluoropolymer treatment showed lower cell adhesion and migration and higher cell density than the nontreated PET. Finally, the woven PET grafts treated with electrically conducting polypyrrole exhibited contrasting cell behavior depending on the conductivity involved.

In vivo time course studies of the tissue responses to resorbable polylactic acid implants by means of MRI.

Magnetic resonance (MR) imaging and relaxation time measurements of bioresorbable implants made of polylactic acid (PLA), as well as the surrounding tissues, were carried out over a period of 6 months to monitor the implant state and the body's responses, and to determine how these processes are reflected in MR data. Twelve rabbits each received two subcutaneous PLA implants (45 x 10 x 2 mm). Changes in tissue relaxation rates demonstrated inflammation and tissue healing time courses but were not simply linear functions of the tissue water content and so provide new insight into MR characterization of inflammatory processes.

Effect of sterilization on the physical and structural characteristics of polyhydroxyoctanoate (PHO).

The present study examined the potential applicability of poly(beta-hydroxy octanoate) (PHO), a bacterial polyester, as a candidate for biomaterial applications, by investigating the effect of sterilization on the physical and structural characteristics of PHO. PHO-cast films were sterilized by either ethylene oxide (EO) gas at 38 degrees C or gamma radiation (2.5 Mrad) in air at room temperature. The physical characteristics of the EO and gamma-sterilized PHO were determined by scanning electron microscopy (SEM) and tensile strength analyses. In addition, various analytical methods were used to detect modifications in the chemical and morphological structure of PHO, namely, electron spectroscopy for chemical analysis (ESCA), Fourier transform infrared (FTIR) spectroscopy, differential scanning calorimetry (DSC), wide angle X-ray diffraction (WAXD), and size exclusion chromatography (SEC). The results show that EO sterilization did not modify the chemical and physical characteristics of PHO, however, significant modifications in both the structural and tensile properties were observed with gamma-sterilized PHO. These changes accounted for decreases in both the weight average, number average and melting temperature, and increases in the heat of fusion and tensile strength. No residual EO was detected following sterilization as revealed by head-space chromatography. The physical and structural properties of PHO were shown to be well preserved following EO sterilization, whereas gamma radiation caused random chain scission and physical cross-linking, a frequent phenomenon observed with organic polymers.

Hydrolytic and enzymatic incubation of polyhydroxyoctanoate (PHO): a short-term in vitro study of a degradable bacterial polyester.

The present study examined the degradation behaviour of poly(beta-hydroxy octanoate) (PHO), a bacterial poly(beta-hydroxy alkanoate), following incubation under hydrolytic or enzymatic conditions in vitro. Solution-cast PHO films were incubated in a citrate buffer solution with and without acid phosphatase and in an acetate buffer with and without beta-glucuronidase for periods ranging from 7 to 60 days. The physical characterization of the PHO films was analyzed by SEM and tensile strength studies. In addition, various analytical methods were used to detect modifications in the chemical and morphological structure of the PHO, namely, ESCA, FTIR, DSC, X-ray diffraction, and SEC. The results indicate that the enzymatic conditions selected in the present study induced no significant surface morphological or chemical modifications, and no significant weight loss was observed after 60 days of incubation. However, as revealed by weight average molecular weight Mw and number average molecular weight Mn decreases, changes in the bulk structure of the PHO were observed with acid phosphatase at 28 and 60 days, in contrast to smaller Mw and Mn decreases recorded in both the buffers and the beta-glucuronidase. The tensile properties had decreased following incubation, yet showed no difference under all of the selected conditions. With no weight loss or surface changes, the PHO films incubated in acid phosphatase showed only a chemical hydrolytic process characterized by Mw and Mn decreases with time of incubation. The present study demonstrated that the degradation of PHO films is one of slow, chemical hydrolysis only, perhaps requiring several months of incubation. The hydrophobic nature of the long alkyl pendent chain in PHO may be responsible for this slow process. The inability of enzymes to degrade PHO may be attributed to the latter's poor adsorption capacity, due to its hydrophobic nature, and to a lack of specificity in the catalytic activity of these enzymes.

Comparison of healing in fresh and preserved arterial allografts in the dog.

The use of aortic allografts for the management of vascular prosthetic infections has recently been reintroduced. Impressive results have been obtained; however, the possibility of late degeneration remains a major concern. The healing behavior of aortic allografts, either fresh or preserved, in antibiotic-supplemented nutrient medium at 4 degrees C for 1 week and used as thoracic aorta substitutes in dogs was investigated after 6 months of implantation. Four dogs received a fresh aortic allograft from four different donors, and four dogs received a preserved allograft from two different donors. Autografts in two dogs were performed as controls. The in vivo investigation was conducted to describe (1) the histological characteristics of the arterial wall, (2) the macroscopic and thrombogenic aspect of the luminal surface, (3) the integrity of the endothelial lining by scanning electron microscopy, and (4) its biochemical function by prostacyclin (PGI2) and thromboxane A2 (TXA2) secretion. Immune-mediated reactions directed toward the grafts were measured by sequential screening of donor-specific serum antibody development. All donor-recipient pairs of dogs were major histocompatibility complex (MHC)-incompatible according to a mixed lymphocyte reaction (MLR) assay. From the results of this study we concluded that although preserved arterial allografts exhibited similar surface characteristics as those of fresh allografts in terms of re-endothelialization and long-term graft function, an elicited immune response, a degenerative process in the media, and a hyperplasic reaction in the intima could not be prevented using this method of preservation.

Theoretical prediction of the hemodynamic performance of slow resorbing polyester protein impregnated arterial prostheses after implantation: a plea for fast resorption of the coating.

The clinical literature cites cases where slow, incomplete, or nonuniform protein resorption from protein impregnated arterial prostheses produces undesirable localized internal capsule proliferation leading to a significant reduction of the internal diameter of the prosthesis. In an attempt to describe the hemodynamic response to this phenomenon, the blood flow in such stenotic regions was simulated and characterized numerically using FIDAP computational fluid dynamics software to determine the Navier-Stokes and continuity equations for simple channel flow. To simulate various stages of internal capsule development, numeric computations were made in an idealized tubular expansion at stenosis ratios ranging from 0.9 to 0.5 and stenosis length ratios from 10 to 40. The results indicated that a triangular annular ring vortex was formed immediately distal to the stenosis at all Reynolds numbers (Re) studied. The size of the vortex increased almost linearly with the Reynolds number. The pressure drop through the stenosis was affected by blood flow rate, severity, and stenosis length. When the stenosis ratio was low, the pressure drop through the stenosis increased gradually and almost linearly with blood flow rate. In a severe stenosis, the pressure drop was no longer a linear function of flow rate, but increased significantly with increasing flow rate. In conclusion, satisfactory healing of the internal capsule requires fast resorption of any impregnated protein. If the resorption is slow, incomplete, or nonuniform, there is a tendency for the lumen to narrow, causing stenosis, an increased pressure drop through the narrowed graft and disturbed flow distal to the stenosis. This phenomenon therefore constitutes a major limitation for using this type of graft in small diameter arterial reconstruction.

Mechanical characteristics of the canine thoracic duct: what are the driving forces of the lymph flow?

This study is designed to better understand the mode of lymph transport, particularly through the extrinsic pumping by external compression of the lymph vessel. The pressure-diameter relationship of lymphatic segments isolated from the canine thoracic duct was examined using a laser optical micrometer measurement system. Results revealed that the thoracic duct displayed a high extensibility or compliance in the physiological pressure range, yet became progressively less so with increasing internal pressure. The calculated incremental circumferential modulus of the thoracic duct under physiological pressure (range of 2 to 6 cm H2O) showed values ranging from 1.2 x 10(4) to 3.61 x 10(5) dyn/cm2. At a pressure of 35 cm H2O, the modulus reached a limiting value of approximately 6.0 x 10(6) dyn/cm2. In the physiological pressure range, the relative wall thickness (h/R0) of the canine thoracic duct was approximately 3.5%, which was much lower than that reported for canine arterial segments and similar in value to that of the canine jugular vein. In conclusion, the pressure-diameter curve of the canine thoracic duct was shown to resemble that of venous vessels. However, the circumferential elastic modulus of the thoracic duct wall was lower than the moduli of veins, proving that lymphatics are more compliant than veins. This suggests lymph flow in the thoracic duct may be better promoted by external compression of the lymphatic vessel.

Experimental modifications to a canine infrarenal aortic aneurysm model for the validation of endovascular stent-grafts: an exploratory study.

The intraluminal elastase perfusion model has been proven to be potentially effective in producing abdominal aortic aneurysms (AAA) in rodents, yet has produced unpredictable results in larger animals. The purpose of this study was to explore different variations to an existing elastase perfusion model in the dog in the hopes of producing a consistent AAA for endovascular graft validation. The elastase perfusion canine model was modified as follows: (1) inflation of a balloon catheter in the infrarenal aorta (IA) of 3 dogs following elastase perfusion with doses of 2800 U for 40 min; (2) perfusion of the IA of 5 dogs with various elastase doses ranging from 2800 U to 8400 U for 2 h; and (3) perfusion of the IA of 2 dogs with elastase and collagenase for 2 h. The dogs were sacrificed at 4, 7, and 29 weeks. Prior to sacrifice, the treated aortic segments were either examined in vivo by x-ray angiography or by ultrasonography to measure aneurysmal dilation. The aortas were examined macroscopically postmortem to assess the luminal surface characteristics, and under light microscopy and scanning electron microscopy to reveal any pathological injuries induced by the various treatments on the aortic wall. Perfusion of the aorta with 2800 U elastase for 40 min followed by balloon catheter inflation either immediately or 3 weeks after perfusion produced no dilation. Perfusion for 2 h with either elastase alone or in combination with collagenase showed an increased aortic diameter averaging 65.6+/-20.8%, with an irregular dilation of the aortic wall. Histological examination revealed partially digested elastic network of the intima, media, and adventitia, as well as a reduction in the number of smooth muscle cells. An intimal hyperplasic reaction was observed in some of the dogs. Located sparingly within the intima were extravasated erythrocytes associated with recent hemorrhages, intramural thrombi in reorganization, and occasional necrotic lesions. The various modifications brought to the elastase perfusion model failed to produced an aneurysmal dilation with enough expansion to make it a reliable model for endovascular graft validation.

Characterization of abnormalities responsible for immediate rejection of porcine aortic valves for the manufacture of bioprostheses.

Gross observation at the slaughterhouse determines the primary selection of porcine aortic valves for the manufacture of bioprostheses. This step is critical because only valves with significant abnormalities are rejected. The present study validated this selection process by investigating the pathological characteristics of one series of accepted valves and one series of rejected valves. Macroscopy, x-ray examination, light microscopy, and scanning electron microscopy (SEM) were performed on 5 initially rejected valves, 3 leaflets from 3 other initially rejected valves, and 6 valves that successfully passed this first step in the selection process. Abnormalities were macroscopically visible only on the rejected valves and were described as thick white areas, heavy white striations, thin spots, white plaques, and nodules. Individual variability in the structure of each leaflet was more significant in the rejected valves than in the valves that had passed the first inspection. The leaflets of the rejected valves were also irregularly thick with a lack of consistency in the position and prominence of the different layers. The formation of nodules and the presence of white plaques in the inner fibrosa layer were among the pathological features. The initially accepted valves considered defect free under gross observation continued to display some weaknesses, and not all of the valves selected during the first step of the process were suitable to become bioprostheses. Because the manufacturer carries out further quality control inspections at every step of preparation resulting in additional rejections, it is therefore anticipated that all valves with defects will be rejected. None of the rejected valves were defect free, and rejection was fully justified.