Biomedical subjects

M Marois

Publications and source records attributed to M Marois.

At least 37 records · Page 2Linked to original sources

PubMed1989

Comparison of processed bovine internal mammary arteries and autologous veins as arterial femoral substitutes in dogs: blood compatibility and pathological characteristics.

This study was undertaken to compare the chemically processed internal mammary artery (BIMA) and the autologous femoral vein as arterial grafts. The BIMA prosthesis was implanted as a left femoral artery bypass and the femoral vein as a right femoral artery bypass graft in 27 dogs. In groups of three dogs the grafts were implanted for predetermined durations: 4, 24 and 48 hours (short term), 1, 2 and 4 weeks (medium term) and 3, 6 and 9 months (long term). All autologous veins were patent when the dogs were killed. The patency rates of the BIMA grafts were 100% in the short-term group, 67% in the medium-term group and 29% in the long-term group. The deposition of labelled fibrinogen and platelets on flow surfaces, the structural preservation of the wall of the BIMA prosthesis and accumulation of thrombi during the period of implantation were studied.

Animals↗

PubMed1989

Expanded polytetrafluoroethylene prostheses as secondary blood access sites for hemodialysis: pathological findings in 29 excised grafts.

The popularity of expanded polytetrafluoroethylene (PTFE) arteriovenous fistulas for hemodialysis access is increasing. The low infection rate, low thrombogenicity and low body reactivity make it an important blood access for patients on routine hemodialysis. The authors examined 29 PTFE graft fistulas surgically excised from patients on hemodialysis for one or more of the following complications: infection 7, 2 with associated hemorrhage; thrombosis 9; aneurysm 11, 3 with associated thrombosis; stenosis 5, 3 with associated thrombosis; hemorrhage 4 and arterial steal 2. The explanted prostheses were reinforced Gore-tex in 20, Gore-tex thin wall in 1, Impra I in 4, Impra II in 3 and Vitagraft in 1. It was also noted that the implants failed in the short term mainly because of infection, in the medium term mainly because of thrombosis and stenosis, and in the long term usually because of aneurysm.

Adult↗

PubMed1989

Biologic and structural evaluation of 80 surgically excised human umbilical vein grafts.

Human umbilical vein is a valuable alternative to autogenous saphenous vein in lower-limb revascularization. However, the long-term patency is not as good. To understand better the reasons for this, the authors studied the biologic and structural changes occurring in 80 segments of human umbilical vein (HUV) grafts excised from 70 patients. Morphologic, histologic and scanning electron microscopy examinations were performed on each specimen. It was noted that increasing duration of implantation was associated with greater encapsulation and less surrounding inflammatory reaction. Twenty-six percent of clinically noninfected grafts were found to harbour bacteria. Bacteremic colonization was often in the folds of the luminal surface. As a result of these findings, the authors emphasize the need for complete excision of clinically infected grafts. Anastomoses between HUV segments are discouraged because they are associated with a high frequency of infection and a corresponding decrease in duration of implantation. Delamination of the wall was common, and such sites may represent areas at risk for further degradation. Continued surveillance of the biologic and structural changes occurring in excised grafts remains an important method in increasing our understanding of the evolutive complications of HUV grafts.

Adult↗

PubMed1988

Expanded PTFE prostheses as arterial substitutes in humans: late pathological findings in 73 excised grafts.

Through collaboration of surgeons, pathologists and bioengineers at five centers in Canada and France, this study analyzed the late pathology and structural changes in 73 expanded PTFE arterial prostheses harvested from patients at autopsies and reoperations. The degree of tissue encapsulation increased with the duration of implantation but was reduced by the presence of infection. In several cases, the fibrous tissue penetrated the wall of the prosthesis and partitioned off the thin outer layer, thus disrupting the delicate microporous structure of the wall. The presence of aneurysms was observed in models that had no external reinforcing layer and among grafts that apparently suffered from surgical trauma. Wrinkling of grafts was noted at areas of flexion and was often associated with thickening of the external capsule and reduced luminal diameters. Endothelialization was found within only a few millimeters of the anastomoses. The luminal surfaces were generally not well healed. The PTFE structure was usually readily visible under a thin covering of loosely adhering thrombotic deposits. Bacteria were observed in 46% of the cases, even though only 29% were considered clinically infected. The incidence of lipid or cholesterol deposits was high. Avoiding iatrogenic trauma to the external wall of the prosthesis during implantation is important. Those features where design improvements are required to provide longer term structural integrity and dimensional stability in future models of expanded PTFE prostheses should be identified.

Adult↗

PubMed1987

[Progressive complications associated with polyester arterial prostheses. Study of 61 specimens following surgical excision].

Reports of individual surgical cases tend to be anecdotal because of the unique circumstances surrounding the patient, the surgeon, the intervention and, where applicable, the prosthetic device. To overcome this limitation the authors have taken a wider collaborative approach and report the analysis of 61 explanted polyester arterial prostheses associated with delayed complications on 53 patients reoperated upon in six different French hospitals. One advantage of such an independent and centralized retrieval programme is that the impact of centre specific factors, such as patient selection and surgical techniques, is minimized. Consequently, by following a standardized protocol for the evaluation of the morphologic, pathologic and mineralogic characteristics of the tissue surrounding the excised grafts, as well as the textile structure of the prostheses themselves, it has been possible to distinguish between iatrogenic and disease related complications and to demonstrate a number of general findings associated with the clinical performance of polyester arterial prostheses. Complications such as thromboses, infections and false aneurysms appear to occur randomly after different lengths of implantation, thicker fibrous tissue capsules are associated with velour grafts with highly textured yarns, the incidence of mineralized tissue and of endothelialized luminal surfaces is rare, weft knitted textile prostheses appear less mechanically stable and more sensitive to iatrogenic trauma than warp knitted, and the incidences of lipid and cholesterol adsorption, bacterial colonization and sterile fluid loss need further investigation. These observations lead to the recommendation that for patients with longer life expectancies surgeons should consider selecting low porosity, woven or warped knitted prostheses which contain yarns that have not been highly textured.

Adult↗

PubMed1986

New polyester arterial prostheses from Great Britain: an in vitro and in vivo evaluation.

Two models of knitted velour polyester prostheses have been developed in Great Britain, i.e. the VP1200K and the VP50K Triaxial. The evaluation of these new devices in vitro and in vivo in dogs has demonstrated that, while the first model has similar surgical, mechanical and healing characteristics in the short term to other commercial knitted velour prostheses, the second model has lower water permeability and superior strength and dimensional stability. On the basis of these results, clinical investigations can be undertaken.

Animals↗

PubMed1986

Anastomotic false aneurysms with aortic Dacron graft after twenty-five years.

One of the early diamond crimped knitted polyester (Dacron) grafts was surgically excised after implantation for 25 years in the aorto-biiliac position because of false aneurysm formation at the three anastomotic sites. The sutures were no longer visible. While the areas around the false aneurysm were poorly incorporated, the graft limbs were well encapsulated with some endothelial-like cells on the luminal surface. The integrity of the graft was well preserved despite mild fraying and the disruption of one stitch.

Adult↗

PubMed1986

Chemically fixed human umbilical cord vein grafts as arterial substitutes: potential and limits.

In spite of reported successes, synthetic fabric grafts and microporous and plain synthetic conduits have proven unsuitable for aorto-coronary bypasses and showed weaknesses below the knee. Readily available and uniform diameter vascular substitutes with biological and mechanical properties comparable to human vessels would be of paramount interest. Following reported successes with chemically fixed human umbilical veins (HUV), we have attempted to develop smaller diameter blood conduits and have improved the currently prevalent techniques of fixation, preparation and storage to generate more convenient surgical products. In vitro assessment of the processed HUV demonstrated that the HUV can be easily processed to make an arterial substitute that can be preserved either in a liquid medium or as a dry product. However, the in vivo implantations in dogs led to disappointing results for liquid-preserved or albuminated veins. Critical-point dried grafts gave better results, unfortunately they do not heal and they can only degrade after implantation.

Animals↗

PubMed1986

[Analysis of arterial microporous teflon prosthesis following surgical excision].

Twenty-one prosthetic explants were analysed after being surgically excised from 19 patients whose average age at implantation was 54.8 years. The arterial prosthesis was implanted 19 times for an advanced arteriopathy (stage III and stage IV) and twice for a stage II. The average time that the implants were in place was 14.8 months (with extremes of 19 days and 4 years). Surgical reintervention was caused by thrombosis (18 cases), infection (twice) and one case of degeneration of the prosthesis. The explanted prostheses displayed an irregular capsule, an uneven filling of the wall and a fibrous proliferation adhering to the internal surface. The role of the latter appeared essential to the prevention of the invasion of the prosthesis wall by fibrous tissues. The destruction of the structure of the microporous teflon is also prevented. Furthermore, this prosthesis seemed adversely affected when creased by flexion: the reduction in the caliber of the internal lumen caused thrombosis and a detachment of the external capsule. When such a material is implanted, everything must be done to prevent twisting or damaging the prostheses.

Aged↗

PubMed1986

Pathologic features of surgically excised human umbilical vein grafts.

This article describes the pathologic changes in 31 human umbilical vein grafts excised from 23 patients after implantations ranging from 24 hours to 5 years. Gross morphologic examination, light microscopy, and scanning electron microscopy demonstrated that the umbilical vein grafts appeared to be fragile and easily delaminated. Bacteremic colonization on the luminal surface was present in the grafts removed because of infections but in two instances had extended into the wall. The presence of lipid on the surface and in the subintimal layer was observed in five grafts, three of which had been implanted for less than 1 month. We concluded that human umbilical vein grafts pathologically exhibit fragility, biodegradation, lipid accumulation, and bacterial colonization in infected cases, and these characteristics may adversely affect the durability and long-term success of the prosthesis.

Adult↗

PubMed1985

A compound arterial prosthesis: the importance of the sterilization procedure on the healing and stability of albuminated polyester grafts.

In response to the demand for a vascular prosthesis which achieves reliable haemostasis without preclotting, a new compound albumin/polyester prosthesis has been developed. In order to optimize the sterilization procedures for this device, two series of implantations in the thoracic aorta of dogs were undertaken to compare the effects of ethylene oxide (EtO) and gamma-radiation. Preclotted polyester prostheses were implanted in two additional control series. Pathological analysis of the explanted grafts indicated that gamma-radiation is to be preferred over EtO because it results in faster rates of healing. While the albumin coating delayed the thrombotic response and fibrinolytic activity, the extent of healing of the radiation sterilized graft was equivalent to that achieved by preclotted polyester prostheses in the medium and long term. Measurements of the strength and dimensional changes of the graft demonstrated that, in addition to reducing the risks of acute thrombosis and postoperative haemorrhage, the albumin coating improves the dimensional stability of the knitted structure.

Albumins↗

PubMed1985

The fate of human umbilical vein grafts as an infrarenal aortic substitute in monkeys.

The literature contains conflicting reports about the potential value of the processed human umbilical vein graft as an arterial substitute. With a view to a better understanding of the ultimate fate of this device, a series of long-term implantation was undertaken with a nonhuman primate model. Dardik Biografts were implanted as an infrarenal aortic substitute in 13 monkeys. Nine were put to death following complications after post-operative periods ranging from 3 months to 3 years, while four animals remain alive. No calcification or lipid infiltration was found, presumably because the animals were healthy. The patency rate was poor because of complications associated with thrombotic deposits and thinning of the graft wall after implantation, which led to stenosis and fibrous hyperplasia along the anastomoses. The external polyester mesh was found to encourage external tissue proliferation, which could not prevent the graft from dilating since it contained neither elastin nor smooth muscle cells. Because the places where the graft had been damaged before or during processing were the sites of thrombotic accumulation and initial collagen degeneration, it is essential to use only defect-free material. As a consequence the long-term durability of this graft continues to be questioned.

Animals↗

PubMed1985

[Physical characteristics of stripping veins preserved at 4 degrees C and usable as artery substitutes].

The mechanical behavior of varicosis veins harvested during stripping and preserved at 4 degrees C has been investigated by measuring the compliance, the yield strain, the yield stress and the longitudinal Young's modulus. No relationship has been demonstrated between those parameters and external factors such as age, sex, storage duration and bacteremic contamination. The mechanical behavior of such veins is unpredictable. Therefore, it is mandatory to proceed through individual and non-destructive quality control tests to obtain a selection of grafts suitable for implantation. Moreover, implantation should be oriented towards patients who are able to visit the hospital frequently since the healing capacity of the venous homograft is unpredictable.

Arteries↗

PubMed1985

[Stripped veins for secondary vascular access in hemodialysis. Pathologic study of the grafts after surgical excision].

The suitability of stripping vein homografts as AV fistulae for intermittent hemodialysis has been evaluated. Microscopic investigation of stored veins indicated the superiority of cryopreservation over refrigeration. A systematic study of 12 venous homograft fistulae surgically excised from hemodialysis patients revealed that the homograft walls are the sites of both connective tissue proliferation and of mural degeneration. It was also noted that the implants failed in the short term (less than 1 yr) mainly due to stenosis, in the medium term (1 yr-3 yrs) mainly due to aneurysmal dilatation and for a variety of reasons beyond 3 years. It was concluded that when suitably selected, handled and stored, stripping vein homografts are a viable alternative to treated human umbilical or bovine heterografts as blood access fistulae if no autograft is available.

Arteriovenous Shunt, Surgical↗

PubMed1984

[Mechanical fatigue of an arterial prosthesis].

This case study reports the analysis of a knitted polyester arterial prosthesis that was implanted in an 18-year old patient for five years following a bicycle accident which injured the left external iliac artery. In spite of the prosthesis, the patient continued to participate in competitive cycling. The graft became dilated and stretched by tension from the hypertrophic psoas muscle, and because the patient presented with pain and claudication, a second surgical operation was performed. The central region of the prosthesis was badly kinked. A segment was resected and analyzed in terms of pathological, textile and chemical properties. The analysis showed a poorly healed graft that had suffered from mechanical and chemical degradation. The findings point to the wisdom of implanting woven rather than knitted grafts in young patients and also suggest that in this particular case, where mechanical deterioration was accompanied by chemical degradation, it would have been preferable to remove the whole prosthesis.

Adolescent↗

PubMed1984

Cytocompatibility of albuminated polyester fabrics.

An alternative to the usual technique of preclotting porous textile vascular prostheses prior to surgical implantation is to render them impermeable to blood by impregnation with a cross-linked albumin filler matrix. This material subsequently becomes the foundation for cellular development. The compatibility of such impregnated fabrics with newly formed endothelial cells has been evaluated by an in vitro organotypic culture method. This technique enables the characterization and numeration of cells that develop on blood contact surfaces and enables determination of their rate of development. Woven, knitted, and velour fabrics were evaluated following coating with albumin and either storage in Tyrode solution or 40% ethanol or desiccation by critical point drying. Preclotted cardiovascular repair fabrics prepared according to conventional surgical protocol served as controls. The identification of the newly formed cells was confirmed histologically. The most extensive and rapid cellular development was observed on the woven fabric and is believed may have resulted from the smoother surface topography of this substrate. Good cellular development was noted particularly on fabrics which had been stored in Tyrode solution. Ethanol had a deleterious effect on the apparent compatibility.

Albumins↗

PubMed1984

Albumin coating of a knitted polyester arterial prosthesis: an alternative to preclotting.

Coating a knitted polyester arterial prosthesis with cross-linked albumin fills the interstices of the graft and relieves the surgeon of the necessity to preclot . This is of particular value in patients whose blood clotting properties are hypercoagulable, or hypocoagulable . In addition, such prostheses require less handling, which can lower the risk of bacteremic colonization and shorten the operative time. The in vivo behavior of the implanted albuminated prosthesis in the thoracic aorta of dogs is similar to that of preclotted grafts, although the sequences of early healing are different. The preclotted graft develops a continuous, thick thrombotic matrix on its luminal surface during the first 4 hours of implantation. Following the initiation of the fibrinolytic mechanism 24 to 48 hours postoperatively, this thrombotic deposit quickly recedes , leaving blood cells and platelets adhering here and there to the prosthetic surface. In comparison, the albuminated coating is not associated with major early thrombotic deposits. The albumin remains visible between the filaments during the first 2 weeks of implantation. Both treated and control grafts contain numerous thrombi on their inner surface after 1 to 2 weeks. After 1, 3, and 6 months, both implants are well encapsulated and present a glistening and continuous luminal surface. This excellent healing, however, can be compromised should the graft adhere too closely to the animal's lungs.+2

Albumins↗

PubMed1984

[The Sparks-Mandril arterial prosthesis. An ingenious concept, a total failure. What can we learn from it?].

In spite of its ingenuity, the Sparks-mandril concept has failed to generate a satisfactory arterial substitute. Pathological analysis of prostheses retrieved from humans and explanted from dogs as part of a controlled laboratory study has demonstrated that the tissue laid down during the autogenous generation stage contains neither elastin fibers nor smooth muscle cells capable of providing the required dimensional stability of a blood vessel. The supporting polyester mesh tube has been found to stretch in vivo, resulting in dilation and lengthening of the prosthesis and the formation of aneurysm and thrombosis. It is recommended that the use of devices relying on the Sparks-mandril concept not to be reintroduced until such time as the mechanism of growth promoting factors for angiogenesis are fully understood.

Adult↗