Cardiovascular Pathology
Volume 20, Issue 4 , Pages 213-221, July 2011

Pathology of explanted polytetrafluoroethylene vascular grafts

  • Rupal I. Mehta

      Affiliations

    • Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA 90095, USA
    • Corresponding Author InformationCorresponding author. 10833 Le Conte Avenue, 18-126 CHS, Los Angeles, CA 90095, USA. Tel.: +1 310 825 0544; fax: +1 310 206 8290.
    • ,
  • Arnob K. Mukherjee

      Affiliations

    • Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095, USA
    • C-Link Micro Imaging, Inc., Los Angeles, CA 90035, USA
    • ,
  • Tyler D. Patterson

      Affiliations

    • Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA 90095, USA
    • ,
  • Michael C. Fishbein

      Affiliations

    • Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA 90095, USA

Received 14 December 2009; received in revised form 26 May 2010; accepted 3 June 2010. published online 12 July 2010.

Abstract 

Introduction

Graft occlusion is a well-documented etiology for arteriovenous fistulae failure. However, there is little morphologic information elucidating why synthetic vascular grafts fail. The purpose of this study was to examine the tissue responses occurring within and adjacent to explanted polytetrafluoroethylene grafts that were utilized during cardiovascular procedures and subsequently removed.

Methods

Forty explanted polytetrafluoroethylene grafts (including 32 failed vascular grafts) originating from 18 females and 22 males who ranged in age from 6 to 82 years (mean age, 36 years) were evaluated. Duration of engraftment varied from 1 to 255 months (mean engraftment period, 64 months).

Results

In addition to neointimal hyperplasia, foreign body reaction, and thrombosis, an unexpected finding was calcification involving the graft material, as well as luminal thrombus and adjacent soft tissues. Twenty-seven of forty cases (68%) showed evidence of calcification, either within or adjacent to polytetrafluoroethylene grafts. Histologic examination revealed variable degrees and patterns of calcification within and adjacent to explanted polytetrafluoroethylene membranes and conduits (arterial, arteriovenous, or cardiac grafts). A significantly longer duration of engraftment (P=.015) was identified in calcified versus noncalcified polytetrafluoroethylene materials. Patient age, serum calcium, creatinine level, and blood urea nitrogen level showed no statistically significant differences between patients with calcified grafts and patients without calcified grafts.

Conclusions

Interstitial calcification is frequently found within explanted polytetrafluoroethylene grafts and is associated with graft disruption. These findings suggest that calcification of polytetrafluoroethylene biomaterials may play a role in eventual graft failure. A better understanding of the process of polytetrafluoroethylene graft calcification may lead to novel therapies that aid in the prevention of polytetrafluoroethylene vascular graft failure.

Keywords: Polytetrafluoroethylene (PTFE), Calcification, Arteriovenous graft, Vascular graft, Graft failure

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 Disclosure of interest: the authors have no conflicts of interest to disclose.

 This work was supported through generous funds from the Oppenheimer Program Clinical Translational Seed Grant (R.I.M.), and the Piansky Family Trust (M.C.F.).

PII: S1054-8807(10)00077-3

doi:10.1016/j.carpath.2010.06.005

Cardiovascular Pathology
Volume 20, Issue 4 , Pages 213-221, July 2011

Article Tools

* Image Usage & Resolution