Vascular grafts collagen coating resorption and healing process in humans

Elise Helfer; Salomé Kuntz; Delphine Dion; Frédéric Heim; Yannick Georg; Fabien Thaveau; Anne Lejay; Nabil Chakfé

doi:10.1016/j.jvssci.2022.02.001

Vascular grafts collagen coating resorption and healing process in humans

JVS Vasc Sci. 2022 Mar 25:3:193-204. doi: 10.1016/j.jvssci.2022.02.001. eCollection 2022.

Authors

Elise Helfer¹, Salomé Kuntz^{1

2

3}, Delphine Dion¹, Frédéric Heim^{1

4}, Yannick Georg^{1

3}, Fabien Thaveau^{1

3}, Anne Lejay^{1

3}, Nabil Chakfé^{1

3}

Affiliations

¹ Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire, Strasbourg, France.
² Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, Strasbourg, France.
³ Laboratoire de Physique et Mécanique Textiles, École nationale supérieure d'ingénieurs Sud Alsace, Mulhouse, France.
⁴ Department of Vascular Surgery, University Hospital, Nantes, France.

Abstract

Background: The objective of the present study was to evaluate the bioresorption rate of collagen coating (CC) sealed on textile vascular grafts (VGs) and their healing in humans using histologic analysis of explanted VGs.

Methods: A total of 27 polyester textile VGs had been removed during surgery from 2012 to 2020. The segments underwent histologic assessment. The CC bioresorption rate was assessed using morphometric analysis to determine the internal and external capsule thickness, inflammatory reaction degree, presence of neovessels, and endothelial cell layer.

Results: A total of 27 VGs were explanted from 25 patients because of infection (n = 5; 18.5%), thrombosis (n = 7; 25.9%), stenosis (n = 2; 7.4%), rupture (n = 4; 14.8%), aneurysmal degeneration (n = 3; 11.1%), revascularization (n = 4; 14.8%), or another cause (n = 2; 7.4%), with a median implantation duration of 291 days (interquartile range [IQR], 48-911 days). VGs with remaining CC (n = 7; 26%) had been explanted earlier than had those without (n = 20; 74%; 1 day [IQR, 1-45 days] vs 516 days [IQR, 79-2018 days]; P = .001). After 1 year, no remaining CC was detected on the analyzed VG sections. VGs implanted for <90 days had had a greater CC maximal thickness (63.90 μm [IQR, 0-83.25 μm] vs 0 μm [IQR, 0-0 μm]; P = .006) and a greater CC surface coverage (180° [IQR, 0°-360°] vs 0° [IQR, 0°-0°]; P = .002) than those implanted for >90 days. VGs implanted for >90 days had a greater external capsule thickness (889.2 μm [IQR, 39.6-1317 μm] vs 0 μm [IQR, 0-0 μm]; P = .002), a higher number of inflammatory mononuclear cells and giant cells (168 cells [IQR, 110-310 cells] vs 0 cells [IQR, 0-94 cells]; P < .0001) and a higher number of neovessels (4 [IQR, 0-5] vs 0 [IQR, 0-0]; P = .001) than those implanted for <90 days.

Conclusions: CC had a slow bioresorption rate in humans. Complete healing was never achieved, with no endothelial coverage observed. This finding implies that CC might not help graft healing.

Keywords: Blood vessel prosthesis; Histology; Implants; Vascular grafting.