Natural history of platelet deposition on Dacron aortic bifurcation grafts in the first year after implantation

Abstract

This study defined the dynamics of platelet deposition on Dacron arterial grafts up to 1 year after implantation in human subjects. Indium-111 platelet imaging was performed on 8 men 1 to 2 weeks after graft implantation and on 5 of these patients at a mean of 31 weeks (range 28 to 34) and again at 55 weeks (range 50 to 62). Serial imaging was performed at 24 to 96 hours after platelet labeling and injection in each study. Quantitative analysis was performed using a graft/blood ratio that compared background-corrected indium-111 platelet activity in the graft region to whole-blood indium-111 platelet activity. Additionally, blinded qualitative visual analysis of the images compared graft activity with the activity in adjacent native arteries. The mean of all graft/blood ratios (24, 48, 72, and 96 hours) progressively decreased from 4.4 +/- 2.1 (+/- 1 standard deviation) at 1 to 2 weeks to 3.0 +/- 1.8 at 31 weeks (p = 0.002). There was no further decrease at 55 weeks (2.8 +/- 2.0). For comparison, 12 normal subjects without grafts had a mean ratio of 1.8 +/- 0.7. Visual analysis detected platelet deposition in 7 of 8 grafts at 1 to 2 weeks, 4 of 5 at 31 weeks, and 4 of 5 at 55 weeks. Deposition decreased qualitatively in 2 of 5 patients at late study. It is concluded that there is consistent, early platelet deposition on Dacron grafts in man. Although deposition decreases over 31 weeks, it remains readily detectable in most patients at 1 year. These findings suggest absent or incomplete endothelialization of the graft flow surface in humans in the first year after implantation.