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The Vanguad™ endoprotheses were implanted transluminally through the femoral route and deployed at the site of surgically created aneurysms in the thoracic or abdominal aortas of dogs for prescheduled periods of implantation of 1 week, 1, 2 and 3 months. The in vivo dimensional stability of the endoprothesis was confirmed by angiography after insertion and before the sacrifice and by macroscopic observations after retrieval. Histological and scanning electron microscopic (SEM) studies were performed to assess the healing sequence of the device. Microscopic studies of the textile components and surface chemical analysis of the Nitinol wires by electron spectroscopy for chemical analysis (ESCA) were undertaken, after specimen cleaning to remove adherent tissue, to detect structural modifications to the textile structure and to evaluate the bioresilience of the Nitinol. Analysis of the angiograms after implantation and before the sacrifice revealed that morphological changes such as sliding and compression of the metal structure occurred initially after deployment and during implantation. Thrombogenicity of the luminal surface of the endoprotheses was low but the healing was still incomplete after 90 days of implantation. The lack of stability of the metal structure may explain the migration distally and the poor healing of the device. ESCA analysis showed that a physiosorbed passivation layer covered the surface of the Nitinol wires masking the nickel (Ni) component of the alloy. Ion bombardments of the surface of the wires confirmed the presence of a contaminated layer composed of carbon and other elements followed by a highly oxidized titanium (Ti) layer, and then, by the Ti/Ni alloy. Although innovative, the minimally-invasive endovascular technique for the treatment of aortic aneurysms is still in its infancy. Significant improvements are required in terms of ease of handling, effectiveness, innocuousness, biostability and healing. [Copyright &y& Elsevier]

Five polyurethane vascular grafts with three different chemistries were investigated in terms of device function, healing characteristics and material stability in a canine abdominal aorta model for prescheduled periods of 1 and 6 months. Corvita-reinforced grafts, with walls made of poly(carbonate urethane) (PCU) filaments, displayed a relatively thin, uniform and partially endothelialized inner capsule with good tissue in-growth. The external polyester mesh separated from the underlying PCU wall due to the degradation of the melt adhesive between these two layers. Three types of Thoratec access graft exhibited a high degree of thrombus and little tissue in-growth, and were non-adhesive to both the inner and external capsules as the solid layer beneath their lumens completely blocked any transmural communication. The microporous poly(ether urethane urea) degraded extensively. Pulse-Tec grafts at one month also demonstrated non-adhesive properties because the external skin served as a barrier to tissue in-growth. At 6 months, its poly(ether urethane) wall displayed the most severe degradation, damaging graft structural integrity and causing significant tissue deposition in the degradation areas. This study shows the importance of multiple factors in vascular prosthesis design and demonstrates that collective and comprehensive thinking will be key in the future development of creative and novel approaches.

Magnetic resonance imaging (MRI) and magnetic resonance (MR) relaxometry were used to assess noninvasively the tissue response of a new uncoated hybrid braided suture made from a combination of ultra-high-molecular-weight polyethylene (UHMWPE) and polyester (polyethylene terephthalate) (PET) yarns in comparison to a silicone impregnated braided 100% polyester (PET) control suture (Ticron). Both biomaterials were monitored for a period of 30 days following implantation in both incised and nonincised paravertebral rabbit muscles. In all cases, MR images and relaxometry demonstrated that the hybrid suture elicited either a milder or a similar tissue and cellular response compared to the control suture. These findings were confirmed by conventional histological analysis of the surrounding tissues. They also demonstrated that the hybrid suture promoted faster healing in terms of collagen infiltration between the yarns and individual filaments. This milder inflammatory reaction and improved biocompatibility represent a real advantage in the healing performance of sutures for cardiac and vascular surgery, and support the need for continued research and development of hybrid structures. This study also demonstrated the ability of MRI techniques to noninvasively evaluate the biocompatibility of biomaterials. By extending the capacity of MR diagnostic tools from patients to experimental animals, it is now possible to validate the healing performance of foreign materials with statistical reliability and fewer animals.

This study investigated the in vitro degradation behavior of poly(epsilon-caprolactone/polyethylene glycol/L-lactide) (PCEL) in comparison with that of three other biodegradable polymers. Polymer membranes were incubated in pancreatin solution, Ringer's solution, and distilled water at 37 degrees C for up to 20 weeks. Characterization involved measuring weight loss, observing the morphological changes by scanning electron microscopy (SEM), analyzing molecular weight using size exclusion chromatography (SEC), and studying the crystalline structure using differential scanning calorimetry (DSC). The hydrolysis in a simple aqueous solution experienced no autocatalysis, which was attributed to the high permeability of PCEL to water-soluble degradation products. Similar degradation rates were recorded for the PCEL and poly(L,L-lactide) (PLLA) test membranes. In the presence of pancreatin, the PCEL membrane experienced rapid heterogeneous surface erosion likely caused by the selective loss of its surface PEG components under enzymatic action. Pancreatin also substantially increased the even physical resorption of the other test polymers by eliminating autocatalysis. This study demonstrated that autocatalysis commonly experienced by poly(alpha-hydroxyl acid) can be reduced through chemical formulation or high enzyme activity., ((c) 2006 Wiley Periodicals, Inc)

Polyester arterial prostheses impregnated with various synthetic biodegradable materials and with gelatin were implanted subcutaneously in rats for 3-180 days. The inflammation was assessed by quantifying the activity of alkaline phosphatase and by histology. The degradation of the scaffold materials was determined by scanning electron microscopy (SEM), size exclusion chromatography (SEC), and differential scanning calorimetry (DSC). The alkaline phosphatase activity induced by the polymer-impregnated grafts was similar to that induced by the non-impregnated controls during most of the post-implantation periods. Histological studies revealed that the acute inflammatory response was moderate to mild and was similar for all types of specimens, except for the gelatin-impregnated grafts that induced a severe acute inflammation during the first 2 weeks post-implantation. At 4 and 6 months, significant disintegration of the scaffold was observed, accompanied by enhanced tissue infiltration and a reactivation of the acute inflammatory phase. Linear and exponential degradation rates of the synthetic polymers were described. The relative degradation rates of the biodegradable polymers were ranked as following: PLLACL > PDLLA > PLLA > PCEL. In conclusion, biodegradable polymers may provide an option as sealant/scaffolding materials for vascular prosthesis. It is suggested that the degradation rate of the polymer scaffolding materials should be higher to achieve early healing while without inducing strong inflammation.

Electrically conductive polypyrrole is very attractive for tissue engineering because of its potential to modulate cellular activities through electrical stimulation. However, its in vivo behaviors have not been fully studied. This paper investigates the in vivo biocompatibility and biostability of PPy-coated polyester fabrics. Three PPy-coated fabrics were prepared using phosphonylation (PPy-Phos), plasma activation (PPy-Plas), and plasma activation plus heparin treatment (PPy-Plas-HE). Virgin and fluoropassivated fabrics (F-PET) were controls. The specimens were implanted subcutaneously in the back of rats for 3-90 days, then harvested and processed for enzymatic, histological, and morphological analyses. A noninvasive MRI method was used to continuously monitor the inflammation. The level of acid and alkaline phosphatase showed a similar or a less intensive cellular reaction by the PPy-coated fabrics, when compared to the controls. Histology supported the enzymatic results and showed a fast collagen infiltration at 28 days for the PPy-Phos fabric. MRI reported an overall decrease of inflammation over time, with the PPy-coated fabrics showing a similar or mild inflammation in contrast to the non-coated fabrics. PPy clusters and excessive PPy laminary coating on the PPy-Plas and PPy-Plas-HE were lost with the implantation. This experiment suggests a similar in vivo biocompatibility of the PPy-coated and noncoated polyester fabrics and the importance of achieving a thin, uniform PPy coating.

In 1984, low-density polyethylene (LDPE) and polymethylsiloxane (PDMS), two primary reference materials (PRM), were made available by the National Heart, Lung, and Blood Institute (NHLBI) as discriminatory tools for the validation of standardized and novel in vitro and in vivo tests in the evaluation of biomaterials. This article reviews the results and conclusions obtained by several studies investigating the hemocompatibility, in vitro biocompatibility, inflammatory response, and in vivo tissue reactions of these two reference materials. Variable results obtained with LDPE and PDMS in ex vivo hemocompatibility studies were attributed to the type of animal model used, the flow velocity of the circulating blood, the time of exposure, and the methodology used to measure blood cell adhesion or activation at the surface of the materials. In contrast, both the LDPE and PDMS appeared to be suitable reference materials when used in in vitro biocompatibility, inflammatory response, and in vivo studies. However, caution must be taken when interpreting the results, because gamma sterilization of these two materials as well as their origin (for example PDMS) are two critically important factors. In conclusion, we see a definite need for standardized hemocompatible parameters and better high-quality hemocompatibility studies on PRM. This review also suggests other materials as potential PRM candidates, namely, Biomer and Intramedic polyethylene., (Copyright 2001 John Wiley & Sons, Inc.)

Membranes made from 4 commercial poly(carbonate urethanes): Carbothane (CB), Chronoflex (CF), Corethane 80A (CT80), and Corethane 55D (CT55), and from 2 poly(ether urethanes): Tecoflex (TF) and Tecothane (TT) were prepared by solution casting and sterilized by either ethylene oxide (EO) or gamma radiation. Their biocompatibility was evaluated in vitro in terms of proliferation, cell viability, and adhesion characteristics of human umbilical veins (HUVEC), monocytes (THP-1), and skin fibroblasts, and by measuring complement activation through the generation of the C3a complex. Their hemocompatibility was determined by measuring the level of radiolabeled platelet, neutrophil, and fibrin adhesion in an ex vivo arteriovenous circuit study in piglets as well as via an in vitro hemolysis test. The results of this study showed no endothelial cell proliferation on any of the materials. The cell viability study revealed that the CB, CF, and TF membranes sterilized by EO maintained the highest percentage of monocyte viability after 72 h of incubation (>70%) while none of the gamma-sterilized membranes displayed any cell viability. The fibroblast adhesion and C3a generation assays revealed that none of the materials supported any cell adhesion or activated complement, regardless of the sterilization method. The hemolysis test also confirmed that the 4 poly(carbonate urethanes) were hemolytic while none of the poly(ether urethanes) were. Finally, the ex vivo study revealed that significantly more platelets adhered to the CB and CT55 membranes while the levels of neutrophil and fibrin deposition were observed to be similar for all 6 materials. In conclusion, the study identified the CF and TF membranes as having superior biocompatibility and hemocompatibility compared to the other polyurethanes.

The present study was undertaken to validate the benefits of a fluoropolymer treatment on the biostability, inflammatory response, and healing characteristics of a polyester mesh used for hernia repair, the Fluoromesh, as compared to a commercial monofilament-knit polypropylene mesh, Marlex, used as the control. Both were implanted for the repair of surgically induced abdominal hernias in piglets for prescheduled durations of implantation of 4, 15, and 60 days. The mesh and surrounding tissue were harvested at the sacrifice for the bursting strength and inflammatory response measurements in terms of alkaline and acid phosphatase secretion in the tissue, and for histological observations of the healing sequence and tissue thickness measurements by histomorphometric techniques. After cleaning to remove adherent tissue, the presence of the fluoropolymer at the surface of the mesh was detected using SEM and ESCA. The results demonstrated greater mechanical reinforcement and tissue development for the Fluoromesh than for the polypropylene mesh. The healing performance of the Fluoromesh was attributed to a more intense chronic inflammatory reaction early after implantation that stimulated significantly greater tissue ingrowth and integration. The concentration of fluoropolymer at the surface of the mesh was masked as a result of biological species adsorption. Textile analysis revealed that the Fluoromesh was dimensionally more stable in vivo than the polypropylene control mesh, which demonstrated stretching in the weft direction and shrinking in the warp direction during implantation.

Purpose: To examine the structure and healing characteristics of chronically implanted Stentor endografts that were explanted due to migration, endoleak, thrombosis, or aneurysm expansion., Methods: The devices were harvested following reoperation (n = 5) or autopsy (n = 1) with implantation times ranging from 13 to 53 months. Structural modifications to the metal components were examined using radiography, endoscopy, and magnetic resonance imaging (MRI). Specimens taken from components of the modular stent-grafts were examined histologically and with scanning electron microscopy (SEM) to assess healing behavior. Physical and chemical stability of the nitinol wires and woven polyester graft material was evaluated using SEM and electron spectroscopy for chemical analysis., Results: Although the endografts were retrieved for a variety of reasons, they exhibited similar healing and structural modifications. The woven polyester sleeve showed evidence of yarn shifting and distortion, yarn damage, and filament breakage leading to the formation of openings in the fabric. The luminal surface endografts showed incomplete healing characterized by a poorly organized, nonadherent thrombotic matrix of variable thickness. Radiographic and endoscopic observations indicated that structural failure of the grafts, particularly in the main aortic component, was related to severe compaction and dislocation of the metallic frame due to suture breaks. Corrosion marks were observed on some nitinol wires in all devices. Chemical analysis and ion bombardment of the nitinol wires revealed that the surface concentrations of titanium and nickel were not homogenous. The first layer was composed of carbon or organic elements, followed by a stratum of highly oxidized titanium with a low nickel concentration; the titanium-nickel alloy lay beneath these layers., Conclusions: Although the materials selected for construction of endovascular grafts appears judicious, the assembly of these biomaterials into various interrelated structures within the device requires further improvement.

Purpose: To validate the ease of deployment and in vivo healing performance of a nitinol-polyester self-expanding stent-graft using a canine thoracic aortic aneurysm model., Methods: Arterial aneurysms were surgically created in 8 dogs by sewing a polyester patch onto the anterior side of the thoracic aorta. The nitinol-polyester self-expandable stent-grafts (Cragg EndoPro System 1) were implanted transluminally via the femoral route and deployed at the site of the thoracic aneurysm. Aneurysm exclusion and endograft patency were assessed by angiography after implantation and before animal sacrifice at scheduled periods ranging from 1 week to 3 months. The explanted specimens were examined with magnetic resonance imaging (MRI) to study the position of the stent-graft with respect to the aneurysmal sac. Histological analysis using light microscopy and scanning electron microscopy was performed to examine the inflammatory response and healing characteristics of the device., Results: Seven of 8 stent-grafts were implanted successfully; a bend occurred within the aneurysmal sac in 1 dog, which led to continued perfusion of side branches. This endoleak sealed spontaneously within 1 week, and complete exclusion of the aneurysms in all 8 animals continued throughout implantation. At the time of explantation, all devices were structurally intact and well positioned in the aneurysmal sac. At 1 week, the luminal surface displayed a thin layer of thrombotic matrix, which was gradually replaced by a collagenous internal capsule with endothelial-like cell coverage along both ends of the stent-grafts at 2 and 3 months. No exacerbated inflammatory reaction due to either the nitinol wires or the polyester sleeve was observed after 3 months of implantation., Conclusions: This short-term in vivo study of a nitinol-polyester self-expanding endograft demonstrated the effective exclusion of thoracic aneurysms with a satisfactory healing response and no excessive tissue or inflammatory reactions.

The present study investigated the in vitro mechanism and degradation rate of polyhydroxyoctanoate (PHO). Solution-cast PHO films were incubated in either water or isoosmotic phosphate-buffered saline (PBS) for periods ranging from 1 to 24 months. Physical characterization included weight loss, water absorption, pH change, tensile strength, and scanning electron microscopy (SEM) studies. Analytical investigations including electron spectroscopy for chemical analysis, Fourier transform infrared (FTIR) spectroscopy, differential scanning calorimetry (DSC), wide-angle X-ray diffraction, and size exclusion chromatography were also performed to assess chemical and morphological changes to the structure of the PHO. The results show that the PHO-cast films incubated in either water or isoosmotic PBS underwent a simple hydrolytic degradation process characterized by water absorption, gradual molecular weight decrease, and negligible mass loss after 24 months of incubation. DSC results suggest that degradation occurred in the amorphous zone, followed by an attack in the crystalline domain. An increase in the vibration stretching of OH after 24 months of incubation, as revealed by FTIR, may indicate that the degradation process began internally, moving outwardly toward the surface of the PHO films. This process was more rapid in the films incubated in PBS than in those incubated in water. However, no significant changes in the morphology of the films were detected by SEM. This study demonstrated that the in vitro degradation of PHO in water or in PBS is a very slow hydrolytic process, exceeding 2 years. Our findings also suggest that the internal degradation mechanism is faster in PBS because of the ionic strength of the medium and that this internal process surface moves gradually toward the surface., (Copyright 2000 John Wiley & Sons, Inc.)

The electrically conductive properties of polypyrrole (PPy) as a coating on polyester material are very attractive for the manufacture of small diameter blood conduits. However, before these PPy-coated materials can be investigated for their capacity to generate endothelialized luminal surfaces, they must first be studied for their innocuousness in a living environment. The specific goal of the present study was to investigate the in vivo interactions of PPy-coated and noncoated woven polyester materials implanted subcutaneously in rats for prescheduled periods of 2, 5, 10, 20, and 30 days. The in vivo magnetic resonance (MR) relaxation times were computed for a small area of muscle tissue adjacent to the implants. A correlation was concurrently attempted with blood monocyte activation studies as well as histological observations of the tissue-material interface. The progressive pattern of the slower transversal relaxation time (T2s) values revealed a more persistent tissue reaction for the most conductive PPy-coated materials and a shorter acute tissue response as the surface resistivity increased. Similarly, the blood monocyte activation studies indicated that the thickness of the PPy coating, which correlated with the conductivity, was directly related to tissue response. Furthermore, both the MR and biological studies showed that the PPy-coated material with a high surface resistivity displayed the lowest tissue reaction over the entire period of implantation. The results obtained from the blood monocyte activation studies and histological observations correlate well with the noninvasive MR measurements of the body's healing process. The conductive materials with high surface resistivities must be further investigated. Finally, the noninvasive nature of MR relaxometry reveals its outstanding potential for future in vivo investigations of the body's tissue interactions with polymers and nonferromagnetic biomaterials.

The present study examined the biocompatibility and degradation properties of poly (beta-hydroxy octanoate) (PHO) as an impregnation substrate on arterial prostheses. PHO-impregnated polyester grafts sterilized by ethylene oxide (EO) or gamma (gamma) radiation, and polyester Dacron(R) prostheses impregnated with fluoropolymer, gelatin, or albumin were implanted subcutaneously in rats for periods ranging from 2 to 180 days. The biocompatibility was assessed by quantifying the alkaline and acid phosphatase secretion while performing histological studies at the tissue/prosthesis interface. The degradation was determined by chemical analysis of the EO and gamma-sterilized PHO after implantation using differential scanning calorimetry (DSC), wide angle x-ray diffraction (WAXD), and size exclusion chromatography (SEC). Alkaline phosphatase activity by the sterilized PHO and by the gelatin and albumin grafts was significantly elevated early after implantation in contrast to that of the Dacron and fluoropolymer grafts that occurred later, at 7 and 5 days, respectively The peak of acid phosphatase activity for all of the grafts occurred between 5 and 10 days postimplantation, with the gamma-sterilized PHO grafts recording the greatest activity. Histological study revealed that the tissue incorporation into the graft wall was earlier and more complete for the Dacron and fluoropolymer grafts after 6 months than for the gelatin and albumin grafts, because the latter induced important inflammatory reactions during the resorption of the cross-linked protein substrates. The EO and gamma-sterilized PHO grafts exhibited a similar healing sequence characterized by the development of a collagenous tissue surrounding the prostheses. However, no infiltration of tissue into the graft wall was observed after 6 months, mainly because of the presence of the PHO. Degradation of the EO and gamma-sterilized PHO occurred preferentially by a hydrolytic mechanism as shown by a 30% molecular weight decrease after 6 months. In conclusion, PHO showed good biocompatibility in terms of enzyme activity and tissue reaction. Degradation was a slow, in vivo process controlled primarily by a random hydrolytic reaction and by a local enzymatic attack by macrophages and giant cells.

Magnetic resonance (MR) imaging and relaxation time measurements of bioresorbable implants made of polylactic acid (PLA), as well as the surrounding tissues, were carried out over a period of 6 months to monitor the implant state and the body's responses, and to determine how these processes are reflected in MR data. Twelve rabbits each received two subcutaneous PLA implants (45 x 10 x 2 mm). Changes in tissue relaxation rates demonstrated inflammation and tissue healing time courses but were not simply linear functions of the tissue water content and so provide new insight into MR characterization of inflammatory processes.

When implanting any vascular prosthetic grafts, one important goal to ensure long-term patency is achieving complete endothelialization of the luminal surface, a process that has rarely been observed clinically in humans. Seeding vascular grafts with endothelial cells has been seen as an attractive approach but has not been clinically convincing. A determining factor may be the type of polymer and surface structure. Using organotypic culture assays, the present investigation studied the effect of different polymers, surface structures, and surface treatments on endothelial cell behavior. The materials tested were polyester (PET), polytetrafluoroethylene (PTFE), polyesterurethane (PESU), and polyetherurethane (PETU) grafts with different surface structures. The surface treatments on the PET grafts included impregnation with cross-linked albumin, collagen, and gelatin, and treatments with fluoropolymer and electrically conducting polypyrrole polymer. Low density polyethylene (LDPE) and polydimethylsiloxane (PDMS) sheets (smooth surface, plain wall) were used as controls. After incubation for 7 days at 37 degrees C, cell adhesion and migration on the different polymers and structures were as follows: woven and knitted PET (high porosity) > PTFE, PESU, PETU hydrophobic (low porosity) > PETU hydrophilic, LDPE, PDMS (no porosity). Cell density results showed no difference between polymers and porous structures and a higher cell density on smooth nonporous surfaces. Compared with the nonimpregnated PET structures, knitted PET treated with albumin, collagen, or gelatin showed slight decreases of cell adhesion. No differences in cell migration and density were reported between any of the PET grafts, except for one polyester graft with a different chemistry than Dacron, which exhibited greater cell migration and lower cell density. Polyester grafts with a fluoropolymer treatment showed lower cell adhesion and migration and higher cell density than the nontreated PET. Finally, the woven PET grafts treated with electrically conducting polypyrrole exhibited contrasting cell behavior depending on the conductivity involved.

The use of aortic allografts for the management of vascular prosthetic infections has recently been reintroduced. Impressive results have been obtained; however, the possibility of late degeneration remains a major concern. The healing behavior of aortic allografts, either fresh or preserved, in antibiotic-supplemented nutrient medium at 4 degrees C for 1 week and used as thoracic aorta substitutes in dogs was investigated after 6 months of implantation. Four dogs received a fresh aortic allograft from four different donors, and four dogs received a preserved allograft from two different donors. Autografts in two dogs were performed as controls. The in vivo investigation was conducted to describe (1) the histological characteristics of the arterial wall, (2) the macroscopic and thrombogenic aspect of the luminal surface, (3) the integrity of the endothelial lining by scanning electron microscopy, and (4) its biochemical function by prostacyclin (PGI2) and thromboxane A2 (TXA2) secretion. Immune-mediated reactions directed toward the grafts were measured by sequential screening of donor-specific serum antibody development. All donor-recipient pairs of dogs were major histocompatibility complex (MHC)-incompatible according to a mixed lymphocyte reaction (MLR) assay. From the results of this study we concluded that although preserved arterial allografts exhibited similar surface characteristics as those of fresh allografts in terms of re-endothelialization and long-term graft function, an elicited immune response, a degenerative process in the media, and a hyperplasic reaction in the intima could not be prevented using this method of preservation.

This study is designed to better understand the mode of lymph transport, particularly through the extrinsic pumping by external compression of the lymph vessel. The pressure-diameter relationship of lymphatic segments isolated from the canine thoracic duct was examined using a laser optical micrometer measurement system. Results revealed that the thoracic duct displayed a high extensibility or compliance in the physiological pressure range, yet became progressively less so with increasing internal pressure. The calculated incremental circumferential modulus of the thoracic duct under physiological pressure (range of 2 to 6 cm H2O) showed values ranging from 1.2 x 10(4) to 3.61 x 10(5) dyn/cm2. At a pressure of 35 cm H2O, the modulus reached a limiting value of approximately 6.0 x 10(6) dyn/cm2. In the physiological pressure range, the relative wall thickness (h/R0) of the canine thoracic duct was approximately 3.5%, which was much lower than that reported for canine arterial segments and similar in value to that of the canine jugular vein. In conclusion, the pressure-diameter curve of the canine thoracic duct was shown to resemble that of venous vessels. However, the circumferential elastic modulus of the thoracic duct wall was lower than the moduli of veins, proving that lymphatics are more compliant than veins. This suggests lymph flow in the thoracic duct may be better promoted by external compression of the lymphatic vessel.

The clinical literature cites cases where slow, incomplete, or nonuniform protein resorption from protein impregnated arterial prostheses produces undesirable localized internal capsule proliferation leading to a significant reduction of the internal diameter of the prosthesis. In an attempt to describe the hemodynamic response to this phenomenon, the blood flow in such stenotic regions was simulated and characterized numerically using FIDAP computational fluid dynamics software to determine the Navier-Stokes and continuity equations for simple channel flow. To simulate various stages of internal capsule development, numeric computations were made in an idealized tubular expansion at stenosis ratios ranging from 0.9 to 0.5 and stenosis length ratios from 10 to 40. The results indicated that a triangular annular ring vortex was formed immediately distal to the stenosis at all Reynolds numbers (Re) studied. The size of the vortex increased almost linearly with the Reynolds number. The pressure drop through the stenosis was affected by blood flow rate, severity, and stenosis length. When the stenosis ratio was low, the pressure drop through the stenosis increased gradually and almost linearly with blood flow rate. In a severe stenosis, the pressure drop was no longer a linear function of flow rate, but increased significantly with increasing flow rate. In conclusion, satisfactory healing of the internal capsule requires fast resorption of any impregnated protein. If the resorption is slow, incomplete, or nonuniform, there is a tendency for the lumen to narrow, causing stenosis, an increased pressure drop through the narrowed graft and disturbed flow distal to the stenosis. This phenomenon therefore constitutes a major limitation for using this type of graft in small diameter arterial reconstruction.