Disturbances in the haemostatic function of blood platelets, plasma clotting system and fibrinolysis after implantation of polyester prostheses into the aorta.
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Biomedical subjects
Publications and source records attributed to K Worowski.
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In the intima of a vein grafted into the aorta, the thromboplastic activity during the first 4 months after the operations is higher than in the artery and vein. At the same time, the plasminogen activator activity of the venous graft is also higher than that of the artery but lower than that of the vein. In the later post-operative period, both activities of the intima of the venous graft closely approaches those of the intima of the normal vein. In the media the thromboplastic activity is lower in the graft and the plasminogen activator content is higher than in the artery and vein. However, the thromboplastic and fibrinolytic activity in the adventitia of the venous graft, artery, and vein did not change significantly during the 36-month observation period of the experiment.
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Autogenous veins and polyester prostheses were implanted in the abdominal aorta of dogs. The venous or polyester grafts were removed together with sections of the normal arteries and veins 1 month, 4 months, and 3 years after the operation. This material was then dissected into the intimal, medial, and adventitial layers, and homogenized after which their cathepsin D activity was determined. It was found that the cathepsin D activity was far higher in all the layers of the venous grafts, particularly in the polyester grafts, than in the corresponding layers of the normal arteries and veins.
The distribution and variation of thromboplastic and fibrinolytic activity were studied in various layers of polyester grafts in the dog aorta. One, four and 36 months after implantation, these grafts were removed together with segments of normal arteries and veins and dissected into three layers. The thromboplastic and plasminogen activator activities in these layers were then determined. It was found that in the early post-operative period, the thromboplastic activity in the Dacron graft neointima is very high, whereas that of the plasminogen activator is relatively low. With the passage of time the thromboplastic activity decreases and plasminogen activator activity increases. Similarly the thromboplastic activity in the neomedial and neoadventitial layers of the graft falls as time elapses after the implantation and the fibrinolytic activity gradually increases. These changes in thromboplastic and fibrinolytic activity increase the danger of graft thrombosis in the early post-operative period whereas in the later period they are favourable to maintenance of graft patency.
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Histones form insoluble complexes with heparin and neutralize its anticoagulant action. The plasmin degradation products of histones do not possess these properties. Plasmin also digests histones in complexes with heparin. Breakdown of the histones in these complexes causes release of heparin from them.
The potato inhibitors of proteases inhibit the activation of trypsinogen, chymotrypsinogen, proelastase, procarboxypeptidase A and B induced by trypsin. These inhibitors do not inhibit the activation of trypsinogen induced by enterokinase. Potato inhibitors have no influence on pepsinogen autoactivation and on pepsin activity.
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Native LDL are degraded by the protease of the lysosomal extract but they are not sensitive to isolated cathepsin D. Protamine increases the sensitivity of LDL to the effect of lysosomal protease and makes them sensitive to the effect of cathepsin D. Degradation of LDL by lysosomal protease is most intensive between pH 4.0 and 4.5 but in case of LDL bound with protamine it is most intensive at pH 4.5--5.0.
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An 8 cm long Dallon prosthesis was implanted into defects of the abdominal aorta of dogs, and the following changes were found: the blood flow through the vascular prosthesis induced a shortening of the blood clotting time and the heparin-thrombin time and a slight increase in the prothrombin consumption. It has a favourable effect of the sealing of pores in the prosthesis and covering its internal surface with a fibrin membrane.
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The potato inhibitor of proteolytic enzymes was found to inhibit the plasma clotting and fibrinolytic systems in the dog. The anticoagulative action of potato inhibitor consists in a prolongation of clotting time, inhibition of thromboplastin generation, reduction of prothrombin consumption and of the retractility of the blood clot. The potato inhibitor prolongs the euglobulin fibrinolysis time and causes a rise in the plasma antiplasmin level.