Polyethyleneterephthalate provides superior retention of endothelial cells during shear stress compared to polytetrafluoroethylene and pericardium

Background

Polyethyleneterephthalate (PET) and polytetrafluoroethylene (PTFE) are polymers successfully used as large diameter arterial grafts for peripheral vascular surgery. However, these prosthetic grafts are rarely used for coronary bypass surgery because of their low patency rates. Endothelialisation of the lumenal surface of these materials may improve their patency. This study aimed to compare the endothelialisation of PET, PTFE and pericardium by examining their seeding efficiency over time and the effect of various shear stresses on retention of endothelial cells.

Methods


Ovine endothelial cells at 4 × 105 cells/cm2 were seeded onto PET, PTFE and pericardium, and cultured for 1–168 hours. Cell coverage was determined via en face immunocytochemistry and cell retention was quantified after being subjected to shear stresses ranging from 0.018 to 0.037 N/m2 for 15, 30 and 60 minutes.

Results

Endothelial cells adhered to all of the materials one hour post-seeding. PET exhibited better cell retention rate, ranging from 66.9 ± 5.6% at 0.018 N/m2 for 15 min to 44.7 ± 1.9% at 0.037 N/m2 for 60 minutes, when compared to PTFE and pericardium (p < 0.0001, three-way ANOVA).

Conclusion

PET shows superior retention of endothelial cells during shear stress compare to PTFE and pericardium.

Vascular access surveillance : the role of the access nurse in the renal dialysis unit.

Introduction
In January 2006, the Renal Dialysis Unit at Geelong Hospital appointed a Vascular Access Nurse. A Transonic Flow Qc HDO2 Ultrasound Dilution Monitor was purchased to monitor access flow and recirculation in arteriovenous fistulae in an attempt to predict AVF stenoses requiring early surgical correction.

Methods
A bi-monthly monitoring program tested all facility-based patients. 82 patients were assessed for access flow and recirculation between February and December 2006.

Results
18 (22%) had poor AVF function; 13 with access flows <500ml/minute on initial testing and 5 with an access flow decreasing >25% over a four month period. Of the 18 patients shown to have poor access flow, 2 died within one month of measurement while 5 were too frail to attempt corrective surgery. The remaining 11 proceeded to ultrasound or fistulography. A >50% stenosis was detected in all 11 cases. Of these, 4 had successful vein patch surgery and one had PTFE grafting, each with marked improvement in access flow. One had failed vein patch surgery requiring creation of a femoral AVF, one patient required cvc insertion to await AVF creation, and one had failed stenting requiring a permanent cvc. 3 died before planned surgery.

Conclusion
5 of the 82 patients that had access flow assessment, and needed further evaluation, proceeded to successful pre-emptive surgical intervention. We believe the Transonic is a useful adjunct to routine clinical AVF surveillance, in providing early evidence of AVF failure that can be avoided by pre-emptive surgery.