Seeding human arterial prostheses with mechanically derived endothelium. The detrimental effect of smoking.

Endothelial healing of Dacron arterial prostheses can be hastened in dogs by seeding autogenous venous endothelium onto the prostheses in a single-staged operation. To determine whether this technique enhances the patency of human grafts, we studied the results of 186 operations on 161 patients performed between February 23, 1978, and December 1, 1982. Alternately allocating patients to treatment with seeded and unseeded Dacron knitted prostheses, we performed axillary-femoral and axillary-femoral-femoral bypasses in 11 patients (six seeded and five unseeded) and femoral-femoral bypasses in 28 (13 seeded and 15 unseeded). By a randomized block method of treatment allocation, femoral-popliteal grafts were installed in 147 limbs (112 vein, 18 seeded, and 17 unseeded). Patency was analyzed by the life-table method. Overall, femoral-femoral and femoral-popliteal bypasses demonstrated no difference between the seeded and unseeded grafts. Patency was somewhat better in seeded than unseeded axillary-femoral bypasses. Nevertheless, nonsmokers with seeded femoral-popliteal Dacron grafts enjoyed a significantly better graft patency than those with unseeded grafts (p = 0.035), whereas a substantial deterioration of seeded Dacron grafts was observed in those patients who smoked (p = 0.008 at 6 months). Vein grafts performed better than either seeded or unseeded Dacron prostheses (p = 0.016). Serum beta-thromboglobulin (BTG) levels varied widely and did not differ among any of the treatment groups. We concluded that endothelial seeding improved the patency of human arterial prostheses but that results were worse if the patient was a smoker. BTG was not a useful measure of the platelet activation induced by an arterial prosthesis.