Biomechanics of human common carotid artery and design of novel hybrid textile compliant vascular grafts

B. S. Gupta1,* and V. A. Kasyanov1,2 1 College of Textiles, Department of Textile Engineering, Chemistry, and Science, North Carolina State University, Raleigh, North Carolina 27695-8301; 2Laboratory of Biomechanics, Riga Technical University, Riga, LV-1658, Latvia
The mechanical properties and structure of a human common carotid artery were studied in order to develop criteria for designing and manufacturing compliant textile vascular grafts. The arterial wall comprised a composite of elastin and collagen fibers with the collagen fibers crimped. This structure led to a unique pressure–circumferential stretch ratio curve, the slope of which increased with an increase in strain. The increase in slope was particularly rapid at a stretch ratio above 1.4 or pressure above 120 mmHg. Based on the knowledge gained, a criteria for the design of biomechanically compliant arterial grafts was developed. An elastomeric prestretched polyurethane monofilament yarn with a low modulus of elasticity and a bulked polyester multifilament yarn with a high modulus of elasticity were combined and used as threads in the manufacture of grafts. Tubular structures of diameters in the range 4–6 mm were made by weaving. Transverse compliance and morphological and permeability properties of these grafts were determined and compared with those of a currently available woven commercial grafts and human carotid arteries. Results indicated that the compliance values of the hybrid grafts were comparable with those of the human carotid artery. Preliminary in vivo studies in dogs showed promising results: a thin, stable neointima developed within 6 months of implantation on the flow surface. © 1997 John
Wiley & Sons, Inc.

INTRODUCTION The design and fabrication of synthetic vascular grafts has been a challenging area in vascular surgical research during the past 30 years. Large diameter grafts (diameter 6 mm) used for bypassing arteries in high flow regions such as the thoracic and abdominal aorta have generally performed well. However, the replacement with grafts of small diameter arteries, such as the coronary, renal, and carotid, has not yet been successful and continues to be a problem in reconstructive surgery. Efforts to develop vascular grafts of diameters less than 6 mm with potential for long-term patency have not yet met with success. A major cause for poor performance of such grafts has been shown to be the lack of compliance.1–4 Replacement of small arteries by rigid woven or knitted prostheses, which have little or no compliance in the circumferential direction, causes the dampening out of the higher harmonic in the pulse wave5 that leads to an increase in the pulse wave velocity and therefore to an increase in wave reflection and energy
*To whom correspondence should be addressed.

loss. The extent to which the pulse amplitude is dampened depends upon the length of the rigid part. For example, in a study by Womersly,5 a 15-cm long rigid section inserted in the femoral artery of a dog showed a reduction of the amplitude by about 13% in the first and 42% in the fourth harmonic. This problem was also noted and discussed by How and Clarke6 (1984). Baird and Abbott7 and Rittgers et al.8 showed that hemodynamic forces play an important role in the formation of thrombus and hyperplastic intima. Doo and colleagues9 determined theoretically and experimentally the differences in the behaviors of an elastic and rigid tube used as a model for an aortic arch. The resulting flow distributions examined showed a difference in the flow behaviors of the rigid and the elastic models of the arterial system. The arterial wall elasticity had an effect on the blood flow distribution; a lack of elasticity led to high turbulence. The work by Stein et al.10 showed that for a given Reynolds number the intensity of turbulence was significantly lower in compliant tubes than in rigid ones. In the latter, unfavorable flow conditions led to the formation of anastomotic aneurysm, development of hyperplastic neointima, and failure of sutures or tearing of the host artery.

Journal of Biomedical Materials Research, Vol. 34, 341–349 (1997) © 1997 John Wiley & Sons, Inc.

CCC 0021-9304/97/030341-09

The initial external diameter at inner pressure p = 0 mmHg and at in situ axial length L0 was noted as D0. Animal studies conducted with the grafts showed highly promising results. Thus. 4. and to use the information in designing and constructing a compliant textile vascular graft. Specifically.K.17–21 The literature makes it clear that mechanical characteristics of vascular grafts play an important role in governing long-term patency. Diameter changes in the specimen were sensed optically with a video-dimensional analyzer coupled with a suitable lighting system for high contrast. interest in woven and knitted textile grafts continues because the latter have been successful in medium and large caliber applications. which have good biocompatibility11. Figure 1. One end of the tube was clamped to a support to which a pressure transducer (Micron Inst. pressure transducer.6. and substantial experience has been gained in their design and construction during the past four decades.A. the most important consideration to be given in designing a graft is to match the mechanical properties of the prosthesis with those of the host artery. retrieved at the autopsies of persons aged 21–35 years. An arterial sample was gradually loaded by internal pressure from 0 to 200 mmHg while maintaining the length of the sample constant at L0. displacement transducer. the specimens were stored in physiological salt solution until the mechanical tests. The pressure was elevated in 20-mmHg steps with pressure held constant in each step for 1 min. 1. The device used for these tests is shown in Figure 1. The objectives in the present work were to study the structure and mechanical behavior of a human common carotid artery (CCA). especially the dog.342 GUPTA AND KASYANOV Clearly. The sample was placed in the chamber with the physiological salt solution maintained at the temperature of 37 ± 1°C. Axial stretch was introduced by a slide mechanism to which the balance arms were fixed. problems have been encountered with the use of small diameter grafts made exclusively of this material. stepper motor. (1) = 1 × 1 . the length in situ.13–16 However. and . successful development of a small diameter vascular graft will depend not only on the use of new biocompatible materials but also on ideas of new constructions. The graft so constructed was composite in structure and characterized by nonlinear elasticity and large transverse deformation. The vessels were marked with gentian violet stain before resetting to identify the in situ axial extension ratio. Information exists in the literature on the mechanical properties of the arteries of animals. The axial deformation of the artery was measured with a specially designed inductive strain transducer connected to one of the arms of the balance. 5. The schematic of the experimental device. The diameter D was recorded at each pressure level. TV camera. more insight is needed on the structure and properties of arteries before small diameter grafts with maximum potential success can be engineered. sample in chamber with a physiological solution. 2. Special attention has been devoted in recent years to the use of polyurethanes.12 and deformational and strength properties. The polymer is found to creep. system for liquid feeding. The value of wall thickness h was calculated as follows: h = h0 × where 3 3. M-15) and a specially designed inductive force transducer were connected. 7. The changes in diameter with pressure were tracked and recorded continuously. The other end was clamped to a support to which a pressure bottle containing fluid was connected.) and his associates28–30 shed some light on the properties of human blood vessels. MATERIALS AND METHODS Mechanical properties and structure of human CCA Seven human CCAs. force transducer. 6. which leads to the development of aneurysm. were performed. 3. After resection. An artery was cannulated at both ends. were used as experimental materials. conducted within 2 h. The force transducer recorded the force necessary to maintain the vessel at its in situ length. and that of one of the present authors (V. in spite of the availability of convenient spray technology for manufacturing grafts with such elastomers.22–26 The work of Hayashi et al. 2 (2) (3) 2 = (D/D0). however.

and the same polyester and a prestretched polyurethane (7. In manufacturing the former. Volgograd. which would give a more reproducible mechanical response. and dried in a Japanese Eiko-Dh-I critical point apparatus. A thin latex tube of diameter larger than those of the grafts was inserted into the specimen before the fluid was passed and the graft pressurized.) The form of the pulse wave found in the graft. In the first type (HVG-1). The artery was preconditioned before the tests by subjecting it to cyclic loading to bring it to a stable state. Russia) with a low modulus of elasticity (0. the guidelines of the Scientific Councils of the Latvian Academy of Sciences and Academy of Medicine were followed. 2). prestretched polyurethane thread combined with polyester was used as both the warp and the weft. the healing characteristics of the Figure 2. The collagen fibers were dyed using the van Gison method.8 tex linear density) were used as the weft. The dried section was coated in a vacuum chamber with 50–60 nm of gold and examined under an SEM with a ASJD-4D scanning attachment at 40-kV accelerating voltage and ×800–×30. St. which made the graft stretchable in the transverse direction. usually introduced in the longitudinal direction by the tedious process of crimping and heat setting in commercial grafts. polyester threads of 9 tex linear density were used as the warp (Fig. textile threads with two widely different deformative characteristics. This combination in the warp threads is novel in that the crimp. and radial directions. Tubular grafts of diameters 4–6 mm were made by a weaving process utilizing a foil ribbon loom. Five specimens of each type were tested. 2. and the elastin fibers were dyed using the Weigert method. dehydrated in ethanol of increasing concentration. In the second variant (HVG-2). sectioned in various directions. Eight HVG-1 hybrid grafts were also implanted in the carotid and femoral regions of mongrel dogs1 for periods of up to 1 year. For this the prepared section was fixed in 3% glutaraldehyde for 8 h. respectively. In this method. and 3 are.8 MPa) and a bulked polyester multifilament yarn (Mogilev Chemical Thread Plant. Russia) with a high modulus of elasticity (1. The stretch in the elastic thread caused the crimp to develop in the weft threads. woven structure made of 7 tex linear density polyester. The initial wall thickness h0 was measured with a cathetometer to ±0. The structure of the hybrid textile vascular grafts: (a) the polyester yarn and (b) the polyurethane yarn. During this process the vessel was pressurized from 0 to 200 mmHg in 20 mmHg steps five times with pressure held constant for 1 min at each step.0. the value of 1 (=L/L0) was 1. mechanical properties. The materials used were a polyurethane monofilament yarn (Volgograd Chemical Thread Plant. were selected. Petersburg. North.0) and then embedded in paraffin wax.31 was used. developed automatically in this graft by differential shrinkage. the procedure of Guidoin et al. (4) In these equations. postfixed in 1% osmium tetroxide for 5 h. and stained using hematoxylin-eosin. h0 is the initial thickness of the specimen wall and 1. The initial curves were markedly hysteretic. The structure of the inner layers was studied after sectioning under a JEM-100C scanning electron microscope (SEM). the samples were fixed in 10% formaldehyde (pH 7. For determining hydraulic permeability. but the third or fourth cycle gave reproducible curves with minimal hysteresis. Russia) were evaluated. For the latter.CAROTID ARTERY/BIOMECHANICS AND NOVEL VASCULAR GRAFTS 343 1 = (L/L0) = 1. Because the length of the artery was maintained constant at L0. The grafts obtained were stretchable and thus compliant in both the transverse and the longitudinal directions. . Manufacturing. The grafts were also examined under an SEM for their surface and pore characteristics.000 magnification. one nearly matching those of the elastin and the other of the collagen fibers. Two types of grafts were made.001 mm accuracy. Light microscopy (LM) was used to gain preliminary information about the constitutive elements of the connective tissue. circumferential. and structure of composite textile grafts The performances of textile composite vascular grafts designed and constructed in this work and of available commercial woven grafts (CVG)1 (6-mm diameter. the volume of water passing through the wall under a fixed hydrostatic pressure of 120 mmHg was collected for 5 min and expressed as milliliters per minute per square centimeter of water. (In performing the in vivo studies. The mechanical properties of the grafts so produced were determined at pressures ranging from 0 to 200 mmHg by following the procedure described for the carotid arteries. the stretch ratios in the axial. Mogilev.4 × 102 MPa).

the parameters Cv and Ep are not usually material constants but change with the internal pressure. In the relaxed state. is shown in Figure 3. even within the physiological pressure range.67 to 16 kPa). P is the pressure difference (120–80 mmHg) over which measurements are made. ln (P/Ps) = (D/Ds − 1). The stiffness parameter . With an increase of internal pressure the diameter of the artery increases and the degree of waviness decreases [Figs. and 5. Compliance Cv is thus the fractional change in external diameter. De. With a further increase in pressure. hybrid textile vascular graft (HVG-1). after 3 months of implantation). with change in physiological pressure. At low strain or pressure.30 The slope gradually increases with stretch ratio and becomes exceptionally high when 2 reaches a value of about 1. as the pressure is raised and the strain is increased. also shown in Figure 3. These parameters are defined as follows: Cv = (2/De) ( De/ P). P. At a pressure of 120 mmHg and the longitudinal stretch ratio corresponding to the in situ length. Some differences are noted in the values and the shapes of the curves. commercial vascular graft (CVG). Compliance and stiffness parameter The flexibility and stiffness of arteries or grafts have been frequently characterized by the values of compliance. 1.12 (or when pressure exceeds 120 mmHg). hybrid textile vascular graft (HVG-2). Ps is the mean systemic pressure (100 mmHg). respectively.42 ± 0. Ep = De ( P/ De). hybrid textile vascular graft (HVG-1.33 Ep. the collagen fibers straighten out and start to bear load. However. the collagen fibers begin to resist the circumferential strain in the artery and thus give rise to the behavior noted in Figure 3. 4. 2. the waviness of the wall elements practically disappears.32 Cv. 3. is independent of the pressure and has been used to characterize the elastic properties of polyurethane grafts. from 80 to 120 mmHg (or from 10. Because the pressure–diameter relation of an arterial wall is generally nonlinear. Results from LM and the SEM show that carotid arteries have a specific wavy structure and the tissue is a biocomposite (Figs.27 . The polyurethane and polyester threads in the former seem to play about the same roles as the elastin and the collagen fibers. most of the load is borne by the elastin fibers. The behavior of grafts HVG-1 and HVG-2. and Ds is the corresponding external diameter. the artery is highly distensible. The underlying structure of the arterial wall must be responsible for the noted mechanical behavior. however. an elastin fiber with a low modulus of elasticity (2–5 × 105 Pa) and a collagen fiber with a high modulus of elasticity (5–10 × 107 Pa). and stiffness parameter. is similar in character to that of the carotid artery. 4 and 5). (5) (6) (7) In these De is the external diameter at 80 mmHg.27.13 Figure 3. This process causes an increase in the slope. human common carotid artery. Pressure p to circumferential stretch ratio 2 relationship. the collagen fibers are slack. RESULTS A typical pressure p to circumferential stretch ratio 2 relationship for human CCA. which differs from the relationship generally found on traditional polymer materials. and therefore. A pressure of 160 mmHg or greater is needed in the grafts to straighten out the higher modulus fibers. pressure–strain elastic modulus. The p– 2 curves for the arteries are concave upward as expected. The wavy membranes consist of the elastic fibers plaited with collagen fibers.35 show that the wall tissue is made up of at least two major fibrous materials. and the coefficient is the slope of the natural logarithm (ln) pressure–diameter curve and thus represents the stiffness of the vascular wall. in the latter. Studies by Wolinsky and Glagov34 and Langewouters et al.6. 4(b) and 5(b)]. and the changes in the mechanical properties as a result of implantation were examined.344 GUPTA AND KASYANOV surface. in arteries the corre- .

the values being 2.62.18 mL/min/cm2.81 ± 1. Comparison of the Cv and Ep values shows that the deformability of the HVG-1 graft is greater than that of the carotid artery.87 ± 1. the increase in circumferential stretch ratio was 7. the circumferential stretch ratio (for the range 80–120 mmHg) decreased from 9. 9. man 34 years old. The structure of the grafts was examined with LM and an SEM before implantation and after retrieval following implantation. but the remaining two (femoral) developed a stenose of distal anastomoses.02% for the HVG-1 graft.06 ± 0. Figure 6 shows the structure of the outer and inner walls of HVG-1 before implantation. the differences in the values of the two grafts arise from the differences in their structures. 3).06% for the HVG-2 graft. Circumferential histological slice of the carotid arterial wall: (a) at zero internal pressure and (b) at internal pressure of 120 mmHg (sample 9. Six months after implantation.32% for the commercial graft.14% for the carotid arteries.62 (Fig. the stiffness coefficients being 4. These figures indicate that the healing process pro- Figure 4. Compliance values of the hybrid textile grafts compare favorably with those of the carotid arteries (Table I). . Based on the values of the stiffness parameter . indicating that a graft with the desired mechanical properties could be constructed if the structure was carefully controlled. Clearly. respectively.56 and 7. The loops noted are those of the bulked polyester yarns formed by the recovery of the polyurethane yarns. one can conclude that graft HVG-1 is more compliant than graft HVG-2. due obviously to some inward growth of the surrounding tissues. These values are about the same as obtained by others on grafts.42 ± 0. Six grafts functioned satisfactorily. and only 0. Figures 7 and 8 show typical morphology found in the six patent grafts after implantation. original magnification ×50). For the pressure range 80–120 mmHg.31 HVG-1 grafts of 4-mm internal diameter were implanted in eight mongrel dogs for periods of 1 month to 1 year. These results show that the commercial grafts used are the least distensible of all materials examined and are not biocompliant.16 and 2.02 to 2. 6.17. The results of the water permeability obtained show Figure 5. original magnification ×5000). Four were implanted in the carotid and the other four in the femoral regions. man 34 years old.CAROTID ARTERY/BIOMECHANICS AND NOVEL VASCULAR GRAFTS 345 that HVG-1 grafts are less water permeable than HVG-2 grafts. sponding pressure was lower. SEM of the circumferential slice of the carotid artery wall: (a) at zero internal pressure and (b) at internal pressure of 120 mmHg (sample 9.

In a study by Scott and Wilson40 in which blood flow behavior in the human leg was simulated with a computer model. thrombus formation. but there was no evidence of adherent thrombus (Fig.62 102.92 87.346 GUPTA AND KASYANOV TABLE I Mean Value ± SD of Human Common Carotid Artery (CCA). it was shown that a match of both the diameters and the compliances of the prosthesis and the host vessel were needed to maximize flow velocity while minimizing reflected energy losses and stresses at the suture lines.36.0132 0.78 ± 19.2. 7). In an ideal graft.00186 ± 0.0238 ± 0.0324 ± 0.64 ± 136.37 Preliminary studies show15 that compliance is a particularly important factor during the first six or so weeks of the operation.81 ± 16.23 ± 0. perigraft hematomas.86 ± 22. the two most important are the mechanical characteristics of the graft and the ability of the graft to heal. and Commercial Graft (CVG) Artery or Graft Specimen CCA HVG-1 HVG-2 CVG Wall Thickness (mm) 1.4–1.04 4. All anastomoses were intact.04 1. Cv (kPa−1) 0. 5.0078 0. The inner surface was lined with a smooth. none of the grafts showed any aneurysm formation. 8). The present work shows that in the human CCA.38 An impedance mismatch between the host and the graft leads to development of eddy currents and wave reflections. false aneurysm.54 ± 0.56 7. with occasional small foci of yellowtan staining.14. the slope of the pressure (p)–circumferential stretch DISCUSSION Although many factors affect the success of a vascular graft in surgery.18 Stiffness Parameter. and external tissue reaction was minimal. These contribute to structural fatigue. . The results of the pulse wave measured on the dogs showed that the pulse wave obtained with compliant grafts was practically of the same form as found with the carotid artery (Fig.5 times the diameter of the host artery.04 Compliance.18 ± 1.01 ± 0. amount of reflected energy can be reduced to zero if a perfect match exists between the fluid impedances of the host artery and the graft.38 61.0227 ± 0.06 6. which can lead to early occlusion of the graft.81 ± 1. Numerous studies have shown that a positive correlation exists between the matching of compliance and the patency of the graft.12 0.42 ± 0.84 gressed normally. the diameter of the graft chosen has to be 1.0005 Elastic Modulus. At retrieval. the velocity of flow is high while the stresses at the suture lines and the reflected energy losses are small. SEM examination showed that the endothelial-like cells appeared flattened with elongated nuclei (Fig.12.91 ± 16. SEM of the hybrid textile vascular grafts: (a) outside structure and (b) inside structure. For achieving minimum stress concentration and energy losses in the existing commercial grafts. or rupture.05 ± 0. 9). Textile Hybrid Vascular Grafts (HVG-1 and HVG-2).0083 0.04 1074. hyperplastic tissue growth. The hope for achieving long-term patency in 6-mm grafts lies in matching the compliance of a vascular graft with that of the artery and developing a thromboresistant surface at the luminal wall.02 ± 0.1.02 Diameter (mm) 5.92 ± 0. and atherosclerotic changes in the host artery.14.94 4. thin layer of transparent glistening tissue.39 The Figure 6.06 0.47 4. Ep (kPa) 83.27 ± 0. long-term compliance may be a negligible factor in determining the overall patency of small grafts.87 ± 1.

by varying the sizes and properties of the individual yarns. Future research must additionally focus on development of improved inner surface coatings. The LM and SEM analyses show that the arterial wall is a biocomposite of elastin and collagen fibers and has a specific crimped character. renders the heat setting process for crimping unnecessary. The interior is lined with a thin layer of transparent glistening tissue without thrombus. Kambic et al.18 for the human carotid artery (see Table I). the structure and properties of vascular grafts could be effectively and conveniently engineered to suit the application. on the other hand. Our results show a value of 5. the work of Lee and Wilson37 showed a marked increase in circumferential stiffness after 3 months of implantation.15 A difficult problem faced in matching compliance is a change in the mechanical properties of the graft that is induced by tissue ingrowth. the longitudinal stiffness had increased but the circumferential stiffness had not changed. they remained compliant during the first week after insertion and adapted their diameter to the flow conditions of the arteries that were bypassed.42 working with woven Dacron or Teflon grafts. 3). found that 3 weeks postimplantation. the mechanical compliance alone does not guarantee success in vivo. which may minimize tissue reaction and undesirable cellular events at the anastomoses.25 for the human CCA and 19. All commercial grafts are crimped by one or two heat-setting processes. The novel hybrid textile vascular grafts produced in this work have elastic properties that match those of the human carotid artery. The materials used in their construction were polyurethane and polyester yarns that allowed the hybrid textile grafts to have a compliance value in the circumferential direction 10 or more times those of the currently available commercial grafts. which differs from that of the traditional polymer materials. This structure. The water permeability value of the hybrid grafts is at the same level as found in the commercial prostheses. Studies on spandex prostheses in dogs indicated18 that while these grafts lost some circumferential stretchability after becoming infiltrated with unyielding collagenous tissue. Endothelium cells on the flowing surface of the HVG-1 graft. Hasegava and Azuma. On the other hand. The in vivo test results on the grafts of this study are encouraging. However. The spandex grafts usually adjust their diameter in response to changing flow Figure 8. Examination of the HVG-1 grafts after 6 months of implantation indicated that the healing process progressed normally. the grafts were still fairly compliant. there was no transmural or ‘‘through’’ growth of the tissues. Moreover. .CAROTID ARTERY/BIOMECHANICS AND NOVEL VASCULAR GRAFTS 347 Figure 7. indicating that at 3 months the connective tissue ingrowth was organized and played a significant role in increasing wall stiffness. After 9 months of implantation in mini-pigs. The value of compliance measured on human carotid arteries coincides with the values obtained by Hayashi et al. A gelatin coating was used to provide a bloodcompatible graft with a smooth nonpseudoneointima generating surface that does not promote cell ingrowth at the anastomoses. It was also found43 that although both neointima and adventitia cells were closely attached to the polyurethane fibers near the surface.27 who found that the stiffness parameter had a value of 5. ratio ( 2) curve increases with pressure and becomes exponential at pressures greater than 120 mmHg (Fig. as explained earlier. Some loss of compliance was noted due to tissue ingrowth into the wall.41 showed that no one material satisfies the requirements for by- pass of all small caliber arteries. Hybrid vascular graft HVG-1 after 6 months of implantation.17 The procedure used in manufacturing the hybrid textile prostheses. leads to the unusual mechanical behavior noted above.84 for the femoral artery. These grafts rapidly lose crimp and longitudinal compliance upon implantation. The combination of prestretched polyurethane yarns with polyester in the warp threads led to the development of a stable crimp in the longitudinal direction.

R. . 15. Mater. Doo. 34. Beahan and D. Maxwall. K. 7. 9. Gunasekera. Takamizawa. The above results thus indicate that by choosing appropriate materials and controlling the structure. ‘‘Experience in vivo 130 polytetrafluoethylene grafts. 11. ‘‘Design and in vivo testing Figure 9. the structure was infiltrated with organized fibrous tissue. Rittgers. Saito. Biol. W. 115. Organs. N. Surg. Kidson and W. 8. 16. I. M. ‘‘A study of the interface between a fibrous polyurethane arterial prosthesis and natural tissue. Rosenberg. Wildevuur.’’ Circ.’’ Am. G. 275–281 (1980). R. Soc. Surg. Am. F. 19. ‘‘The elastic properties of a polyurethane arterial prosthesis. 17.’’ J. S. 217–226 (1983).. phase-inversion process.. Biomed. A. Artif. 113 (1992). R. Intern. Walden. 3. D. S. Soc. R. E. B. J. ‘‘Wall distensibility effect on arterial flow distribution.. ‘‘Designing polyester vascular prostheses for the future. Blick.. 597– 608 (1984). Walburn. microporous. Cardiovasc. M. ‘‘Keynote lecture. Sci. this knowledge is needed before an optimally useful graft can be designed. C. and if the size was greater than about 50 m. E. W. 58. Hayashi. Jedruch. T. Hayashi. and J. 2. A. G. ‘‘Oscillatory flow in arteries. Organs. van der Lei and Ch. fibrohistiocytic tissues grew. R. Med. compliant polyurethane vascular graft. Intern. 17. Surg. ‘‘The effect of porosity and biomaterial on the healing and long-term mechanical properties of vascular prostheses. 10. Am. I. 9. G. Womersly. N. Res. Biomech. Intern. compliant. 5–10 (1989). M. 2. 3.1–1. 1047–1050 (1989). Kennedy. ‘‘Low compliance and arterial graft occlusion. and pressure conditions. Technol. 5. nonprofit institution. Clarke. and E. An important question still remains. Clearly. and C.’’ Lancet. Abbott. N. Shaw. White4 showed that if the pore size was less than 15 m. and R.348 GUPTA AND KASYANOV References 1.’’ Tissue Eng. 337–347 (1989). 229–244 (1989). Biomech. and (c) hybrid vascular graft HVG-1. Goddard. H. Rodkiewicz. 17. J. ‘‘Polyurethane small artery substitutes. Abbot. K.’’ Thorac.’’ Trans. Soc.. Baird and W.. (b) commercial graft. Mater. K. Guy. J. Megerman. 94–100 (1988). 1. Med. Kambic. P.. 17.’’ J. P. J. V.’’ J. and develop a thin. Shape of the pulse waves: (a) dog carotid artery. 141. 106. 23. K. however: Should the properties of the host be matched by those of the virgin prostheses or those of the prostheses after they have been at the site for some length of time?45 To address this question. Hostetler. Kondo. E. How and R. ‘‘Elastic properties and strength of a novel small-diameter. almost transparent. Brown. 42. Artif. Sladen and T. M. ‘‘A circumferential elastic prostheses: three-year studies of a dacron-spandex graft in the dog. 16.. a textile graft can be engineered that has the desired compliance and the potential for attaining the needed tissue ingrowth. J. I’Ltalien..’’ Trans. Gosselin. 37. J. R.’’ Med. and C. Chu and L. King. 14. ‘‘Matching elastic properties and successful arterial grafting. 792–801 (1978). H. Galletti.. biodegradable smallcaliber vascular graft to a new artery. 6. E. Sasken. G. Karayannacos. J. Am. Tissue incorporation and healing of synthetic grafts are related to this property. Hull. ‘‘Damping effect of distensible tubes on turbulent flow: implication in cardiovascular system.. 643 (1984). M. M. 7–16 (1983). F.’’ Phys. G. Soldani. neointima on the flow surface.4 (1978).’’ Trans. J. Mater. Organs. Mater. 18. and P. Surg. K. T. R. M. 13. Nerem. C.’’ Biorheology. Vasko. Guidoin. ‘‘Small diameter polyurethanepolydimethylsiloxane vascular prostheses made by a spraying. it is necessary to know what changes take place in the properties of a graft with time in situ and how these affect the function of the product. B. F. M.’’ J. K. Biomed.’’ J. 14. Appl. M. G. 12. if it was greater than 15 m but less than about 45 m. 545–548 (1981). 2. 827–838 (1982). Res.44 The pore size affects the type of tissue grown through the wall. R. and K. 313–323 (1958). Progr. J. Abbott. or other organization with which the authors are associated. The benefits accruing to the authors from a commercial or industrial party will be applied to a research fund. 4. H. particularly the former. R. ‘‘Pulsatile blood flow in arterial grafts.’’ Arch. minimal tissue ingrowth took place. Hiramatsu. F. ‘‘Velocity distribution and initial proliferation in autogenous vein grafts in dogs. Panol. Artif. Lecaroz. P. E.. Simpson. Res.4 Working with polyurethane grafts. ‘‘From a synthetic. M. White. H. Kira. II: The reflection of the pulse wave at junction and rigid inserts in the arterial system. 34. P. 1166–1169 (1980). Another important parameter that determines the success of a graft in bypass application is porosity. 948–950 (1976).. Biomechanical approach to the design of vascular prostheses. Stein. and W.’’ J. G. Biomater. 34. Res. Adams.

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