Endothelial cell seeding of polytetrafluoroethylene vascular grafts in humans: A preliminary report

The importance of initial human trials with autologous endothelial seeding lies not only in the implementation of a promising idea but also in the fact that canine data are only partially applicable to humans. The surface area of jugular veins in humans is much smaller than in dogs and considerably longer grafts are needed. Moreover, the reproductive capacity of adult human endothelial cells under in vivo conditions, which probably determines the success of seeding more than the seeding density, is also uncertain. Therefore the efficiency of autologous endothelial seeding in humans was investigated in 18 patients undergoing distal femoropopliteal bypass surgery. The average surface area of the jugular veins was 4.9 ± 1.7 cm2 with an average cell yield of 32.6 ± 18.0 × 104. The mean number of seeded cells per square centimeter of graft surface was 3.1 × 103. In a follow-up extending for 14 weeks, plasma levels of platelet factor 4 and β-thromboglobulin as well as the platelet function in the whole blood aggregometer showed significantly better results in the seeded group. Plasma thromboxane B2, uptake and survival of indium 111-labeled platelets, and Doppler ultrasound investigations also favored the seeded group, but the results were statistically insignificant. No difference at all was found for the platelet dense granule compounds, releasable adenosine triphosphate and platelet serotonin. Thus our findings did not indicate the development of a closed endothelialized surface after 14 weeks, which is a period three times as long as the one required for confluent endothelial cell coverage in dogs. Disappointing in this initial human trial was the realization that the optimism raised by canine experiments did not wholly carry over into human surgery. © 1987.