The Inert and the Living in Vascular Surgery

Since the first use of a prosthetic graft in vascular surgery in 1952, many technological improvements have been made in this field. Endovascular devices have been considerably evolving since the first use of an aortic stent-graft and are now considered as first choice treatment strategy in many pathological situations. However, the current results of prosthetic grafts are not optimal and improvements in terms of infection and thrombosis are major concerns for reseachers. A perfect vascular graft should have the following characteristics: good resistance to sepsis, low thrombogenicity, good biocompatibility, biomechanical properties close to the native arteries, low rate of long-term degradation. Two types of materials are widely used to produce vascular grafts for open surgery: microporous polytetrafluoroethylene (PTFE) and polyethylene terephtalate. To those polymeric materials, biocompatible metallical materials (nitinol, chrome cobalt, stainless steel…) have been developped in the endovascular area. These technologies have allowed treating more and more complex aortic pathologies with less invasivity (branched and fenestrated aortic stent grafts). Many protein molecules and drugs can be binded to these metallical or polymerical structures in order to improve their results: collagen, gelatin, albumin, heparin (thrombogenicity), anti-infectious agents (antibiotics, antiseptics), chemotherapy (intimal hyperplasia). We describe here the main vascular prosthetic materials and grafts. Their results and interactions with the host are also detailled.