Carbodiimide cross-linked gelatin: a new coating for porous polyester arterial prostheses

The performance of a polyester arterial prosthesis impregnated with gelatin and cross-linked with carbodiimide (Uni-graft®) was compared with its porous parent graft (Protegraft®) using a canine thoraco-abdominal bypass model. The grafts were investigated in terms of their handling characteristics, imperviousness at implantation, surface thrombogenicity and healing behaviour. Prostheses 30 cm in length were implanted for the following periods: 4, 24 and 48 h, 1, 2 and 4 weeks, 2, 3, 4, 5 and 6 months. Both types of graft had good handling characteristics. The ready-to-use impregnated graft provided satisfactory haemostasis at implantation with no blood permeating through the wall after flow was restored. Both grafts exhibited low surface thrombogenicity, as determined by the uptake of labelled fibrin and platelets, and the healing sequence of the impregnated graft after resorption of the gelatin was equivalent to that of the preclotted control. Biodegradation of the gelatin was complete within 1 month of implantation with the subsequent development of a collagenous internal capsule at both anastomoses. Endothelial cells were observed between 4 and 6 months, but were confined to small islets distributed along the luminal surface. The prostacyclin/thromboxane A2 (PGI2/TXA2) ratio, which gives an indication of the level of endothelial cell activity, was greater than 1.0 after 1 week of implantation for the control graft. For the impregnated graft it reached 1.0 only after 3 months of implantation, but remained above 1.0 for periods of up to 6 months. In conclusion, the impregnated graft experienced first a biodegradation of the gelatin coating which then gave way to a similar healing sequence to that of the preclotted prosthesis.