Platelet Adhesion in Polytetrafluoroethylene (PTFE) Vascular Grafts In Vivo and the Influence of Increased Intramuscular Pressure-An Experimental Model

Summary

Thrombogenicity of graft material is involved in early graft failure in small diameter grafts. The frequently seen postoperative swelling of the leg after distal revascularization may cause an increased intramuscular pressure and early graft failure.

Pairs of 4 mm polytetrafluoroethylene (PTFE) grafts were implanted. Autologous platelets were labeled with mIn-oxine. Platelet adhesiveness onto the grafts were analyzed from gamma camera images. Intramuscular pressures were measured with wick technique. Blood flow was measured. One graft served as control the other as test graft. Ninety minutes after declamping the i. m. pressure was increased in the test-leg to 30 mmHg, and later to 60 mmHg.

In the control-graft platelet uptake increased to a maximum 60 min after declamping. Blood flow and i.m. pressure remained uneffected. The test-grafts were initially similar but when i.m. pressure was increased to 30 mmHg activity in the grafts increased significantly. Blood flow decreased with 12% of initial flow. When i. m. pressure was raised to 60 mmHg platelet uptake continued to increase.

An increased intramuscular pressure of 30 mmHg or more significantly increase the amount of platelets adhering onto PTFE grafts, emphasizing the need for measuring intramuscular pressures after lower limb vascular revascularizations.

Keywords

Intramuscular pressure - ¹¹¹In-oxine - Platelet adhesion - Arterial grafts

• References

• 1 Ashton H. The effect of increased tissue pressure on blood flow. Clin Orthop 1975; 113: 15-25
• 2 Bom G, Cross M. The aggregation of blood platelets. J Physiol (London) 1963; 168: 178-195
• 3 Bunting RW, Callahan RJ, Fankelstein S, Strauss HW. Labeling human platelets with In-lll-oxine using an albumin density gradient separation. J Nucl Med 1980; 21: 42-43
• 4 Callow AD. Current status of vascular grafts. Surg Clin North Am 1982; 62: 501-513
• 5 Christenson JT, Megerman J, Hanel KC, L’ltalien GJ, Strauss HW, Abbot WM. The effect of blood flow rates on platelet deposition in PTFE arterial by pass grafts. Trans Am Soc Artif Intern Organs 1981; 27: 188-191
• 6 Darling RC, Linton RR. Durability of femoropopliteal reconstruc-tions. Endarterectomy versus vein by pass grafts Am J Surg 1972; 123: 472-479
• 7 DeWeese JA. Early failures in arterial reconstruction. Arch Surg 1962; 85: 901-904
• 8 Edwards WH, Mulherin JL. The role of graft material in femorotibial by pass grafts. Ann Surg 1980; 191: 721-726
• 9 Evans G, Irvine WT. Long-term arterial-graft patency in relation to platelet adhesiveness, biochemical factors and anticoagulant therapy. Lancet 1966; 1: 353-356
• 10 Friedman LI, Leonard EF. Platelet adhesion to artificial surfaces: Consequences to flow, exposure time, blood conditions and surface nature. Fed Proc 1971; 30: 1641-1649
• 11 Grabowski EF, Didisheim P, Lewis JC, Franta JT, Stropp JQ. Platelet adhesion to foreign surfaces under controlled conditions of blood flow: Human v.s rabbit, dog, sheep, pig, macaque and baboon. Trans Am Soc Artif Intern Organs 1977; 23: 141-148
• 12 Hallet JW, Brewster DC, Darling RD. The limitations of polytetrafluoroethylene in the reconstruction of femoropopliteal and tibial arteries. Surg Gynecol Obstet 1981; 152: 819-821
• 13 Hargens AR, Akeson WH, Mubarak SJ, Owen CA, Evans KL, Garetto LP, Gonzalues MR, Schmidt DA. Fluid balance within the canine anteriolateral compartment and its relationship to compart-ment syndromes. J Bone Joint Surg 1978; 60 A 499-505
• 14 Matsen FA, Mayo KA, Krugmire RB, Sheridan GW, Kraft GH. A model compartment syndrome in man with particular reference to the quantification of nerve function. J Bone Joint Surg 1971; 59 A 648-653
• 15 Mubarak SJ, Hargens AR, Owen CA, Akeson WH, Garetto LP. The wick catheter technique for measurement of intramuscular pressure: A new research and clinical tool. J Bone Joint Surg 1979; 58-A: 1016-1020
• 16 Nordenson N. Klinisk morfologisk hematologi. Scandinavian University Books; Stockholm: 1961
• 17 Pathman DR. Compartmental syndromes in peripheral vascular surgery. Clin Orthop 1975; 113: 103-110
• 18 Qvarfordt P, Eklof B, Ohlin P. Reference values for intramuscular pressure in the lower leg in man. Clin Physiol 1982; 2: 427-434
• 19 Qvarfordt P, Christenson JT, Eklöf B, Ohlin P. Intramuscular pressure after revascularization of the popliteal artery in severe ischemia. Br J Sing 1983 in press
• 20 Reneman RS, Staaf DW, Lindbom L, Tangelder GJ, Arfors KE. Muscle blood flow disturbances produced by simultaneously elevated venous and total muscle tissue pressure. Microvasc Res 1980; 20: 307
• 21 Sauvage LR, Walker MW, Berger K, Robel SB, Lischko MM, Yates SG, Logan GA. Current arterial prosthesis. Arch Surg 1979; 114: 687-691
• 22 Thakur ML, Welch MJ, Joist JH, Coleman RE. Indium-111-labeled platelets: Studies on preparation and evaluation of in vitro and in vivo function. Thromb Res 1976; 9: 345-357
• 23 Weisel RD, Johnston KW, Baird RJ, Drezner AD, Oates TK, Lipton IH. Comparison of conduits for leg revascularization. Surgery 1981; 88: 8-15