IN-VITRO ENDOTHELIALIZATION OF A MESOSYSTEMIC SHUNT - A CLINICAL CASE-REPORT

The existence of a confluently covering endothelium that is free of an y thrombotic appositions can be proved 30 days after clinical implanta tion of an in vitro endothelialized expanded polytetrafluoroethylene g raft, The recipient of the mesosystemic H-graft was a 69-year-old man who had a thrombosed portal vein following pancreatitis. Autologous en dothelial cells were obtained from the external jugular vein under foc al-anesthesia, applying the in situ cannulation technique. After low-d ensity plating, first-passage mass cultures of 1.22 x 10(6) endothelia l cells were obtained 14 days after vein excision. After precoating wa s accomplished with fibrinolytically inhibited fibrin glue, a 10 mm ex panded polytetrafluoroethylene graft was confluently lined with the au tologous endothelial cells at a seeding density of 1.2 x 10(5) cells/c m(2). After a maturation period of an additional 9 days and the microb iologic exclusion of a possible infection, an 11 cm graft segment was implanted between the superior mesenteric vein and the inferior vena c ava. In spite of a patent shunt the patient had a repeat bleeding epis ode, needed parenteral nutrition, and died of sepsis on day 30. Immedi ately after the graft had been taken out, specimens were processed by scanning electron microscopy and light microscopy for the immunohistoc hemical proof of the endothelial nature of the surface-covering cell l ayer. The entire graft surface displayed a confluent cell lining that was free of any thrombotic appositions. A strongly positive stain resu lt for both factor VIII-related antigen and the fixation-resistant CD3 4 molecule identified these cells as endothelial. No alpha-actin-posit ive cells could be detected. The underlying protein matrix was well pr eserved and unaltered in thickness and appearance, compared with preim plantation samples. None of the specimens showed any evidence of infec tion. This human demonstration of an intact endothelium on a patent ve nous prosthesis further establishes in vitro lining as a method that a ctually creates a persistent and functioning endothelium on a syntheti c graft surface.