Prosthetic tubular article

Abstract: The invention involves the use of at least two different absorbable and at least two different nonabsorbable components to fabricate tubular articles of all sizes and specifically for repair of the peripheral vascular system and for coronary bypass use.

Description: This invention relates to a tubular article and specifically to a vascular graft containing an absorbable/nonabsorbable biomaterial. The use of the vascular graft is for repair of the peripheral vascular system and for coronary bypass. The absorbable material fosters increased tissue ingrowth into the graft as compared to nonabsorbable grafts. Increased tissue ingrowth leads to greater patency through formation of a vascularized neointima and less tendency to be aneurysmal through formation of a suitable adventitia. The absorbable material can vary and includes polyglycolic acid (hereafter PGA), and a copolymer comprising glycolic acid ester and trimethylene carbonate linkages, e.g. the copolymer in the MAXON™ (American Cyanamid Company, Wayne, New Jersey 07470 U.S.A.) suture. The nonabsorbable material (which is used as the backbone) can be proprietary materials, e.g. a Hytrel™ (E.I. DuPont and Co., Wilmington, Delaware, U.S.A.) polymer, such as the polymer in the NOVAFIL™ (American Cyanamid Company, Wayne, New Jersey) suture. Alternatively, the nonabsorbable material can be more conventional polymers including a polyester, polyamide, polypropylene or polyurethane. An example of a polyurethane is a spandex polymer. There has been a long felt need in the vascular graft art to develop a small diameter graft which will be generally acceptable to essentially all of the surgical community. The reasons for this long felt need are many and relate both to the biological requirements for a small diameter graft and to the limitations of the biomaterials generally used for these applications. Consequently, prior art small diameter vascular grafts, e.g. at or less than 8 mm diameter to even smaller diameter grafts, e.g. at or less than 4 mm diameter, have not been universally accepted by the surgical community. To solve this long felt need, critical questions about vascular graft construction and use have to be considered, including, but not limited to, the following: a. What is the porosity of the vascular graft? b. What is the compliance of the vascular graft? c. What are the optimum textile and biological factors for manufacturing a graft, having a double tube configuration specifically, a nonabsorbable outer tube and an absorbable inner tube structure? d. What are the optimum textile and biological factors for manufacturing a vascular graft having an external support structure? A tubular article useful in prosthetic surgery has been invented. A generic embodiment is a tubular article comprising a vascular graft. The vascular graft can have a plurality of fibers which are manufactured from an absorbable copolymer. The copolymer can comprise up to about 50% by weight of trimethylene carbonate linkages. The copolymer in the MAXON™ (American Cyanamid Company, Wayne, New Jersey, U.S.A.) suture contains a copolymer having trimethylene carbonate linkages. MAXON™, which is a poly (glycolide- co-trimethylene carbonate), has superior and unexpected properties when contrasted to other absorbable fibers. It is long-lasting. A portion of its original strength is retained out to 56 days; 50% of the strength remains through 28 days. The absorption rate of MAXON™ is approximately equal to polyglycolic acid ("PGA"). A MAXON™ fiber is more compliant than polyglycolic acid (herein PGA). A graft containing 75% MAXON™ in combination with Dacron™ has a measured compliance of 3.03. A similarly constructed PGA/Dacron™ graft has a compliance of 2.45. Compliance is measured as a percentage of diametral change per lOO mm Hg internal pressure change. Finally, the bending modulus of MAXON™ is approximately 325,000 p.s.i., indicating that MAXON™ is a much more flexible fiber than other absorbable fibers. A quadricomponent tubular article useful in prosthetic surgery as defined in claim 1 has been invented. The article comprises a plurality of fibers manufactured from at least two different absorbable and two different nonabsorbable polymers. In one embodiment, at least one of the absorbable polymers is a copolymer. In another embodiment, the absorbable polymer fibers in a warp knit article comprise more than about 50% by weight of the article. In still another embodiment, the absorbable polymer fibers in a weft knit article comprise more than about 50% by weight of the article. In yet another embodiment, the absorbable polymer fibers in a woven article comprise more than about 50% by weight of the article. The quadricomponent tubular article can be a vascular graft. A vascular graft has also been invented. The graft comprises a plurality of fibers manufactured from at least two different absorbable and two different nonabsorbable polymers. At least one of the absorbable polymers is a copolymer. The copolymer comprises up to about 50% by weight of trimethylene carbonate linkages. In one embodiment, the copolymer comprises about 50% by weight of glycolic acid ester linkages. In another embodiment, the copolymer consists of at least one glycolic or lactic acid ester linkage. In a specific embodiment, the absorbable polymer fibers in a warp knit graft comprise more than about 50% by weight of the graft. In a more specific embodiment, the graft is a Raschel knit graft. In a most specific embodiment, the plurality of nonabsorbable polymer fibers comprise about 20 to 35% by weight of the graft. In yet another embodiment, the plurality of absorbable and nonabsorbable fibers are separately texturized by either a false twist or a knit/deknit process. In still another embodiment, at least one of the nonabsorbable polymers is selected from the group consisting of a poly(C₂-C₁₀ alkylene terephthalate), poly(C₂-C₆ alkylene), polyamide, polyurethane, and polybutester. In a specific embodiment, one of the nonabsorbable polymers is polyethylene terephthalate. In another specific embodiment, one of the nonabsorbable polymers is polybutylene terephthalate. In still another specific embodiment, one of the nonabsorbable polymers is a spandex polymer. In yet another specific embodiment, one of the nonabsorbable polymers is a polybutester. In a more specific embodiment, the nonabsorbable polymers are polyethylene terephthalate and a spandex polymer. An improved tubular article useful in prosthetic surgery has been invented. The article comprises a plurality of at least three different fibers. The first and second fibers are manufactured from two different absorbable polymers. The third fiber is manufactured from a nonabsorbable polymer. The improvement comprises a fourth fiber. The improvement also comprises the third and fourth fibers manufactured from two different nonabsorbable polymers. An improved knitted vascular graft has also been invented. The graft comprises a plurality of at least three different fibers. The first and second fibers are manufactured from two different absorbable polymers. One of the absorbable polymers comprises up to about fifty percent by weight of trimethylene carbonate linkages. The third fiber is manufactured from a nonabsorbable polymer. The improvement comprises a fourth fiber. The improvement also comprises the third and fourth fibers manufactured from two different nonabsorbable polymers. An improved vascular graft having at least three different components has also been invented. The first, second and third components are manufactured respectively from three different fibers. The first and second fibers are manufactured from two different absorbable polymers. One of the absorbable polymers comprises up to about fifty percent by weight of trimethylene carbonate linkages. The third fiber is manufactured from a nonabsorbable polymer. The components knitted or woven together in a concentric relationship. The improvement comprises a fourth fiber. The improvement also comprises the third and fourth fibers manufactured from two different nonabsorbable polymers. In another embodiment, the tubular article and/or vascular graft described above also comprises an external support. The support has at least one fiber. The fiber is helically wrapped and attached to the article on graft. Still another embodiment is an article wherein at least one of the absorbable polymers is selected from the group consisting of poly(glycolic acid), poly (lactic acid), polydioxanone, and blends of the same. In a specific embodiment, the poly(glycolic acid) is a homopolymer. In another specific embodiment, the poly(glycolic acid) is a copolymer. In a more specific embodiment, the copolymer is manufactured from the monomer glycolic acid and from one monomer selected from the group consisting of lactic acid, trimethylene carbonate and ε-caprolactone. In a most specific embodiment, the first fiber is manufactured from a copolymer of glycolic acid and trimethylene carbonate; the second fiber is manufactured from a homopolymer of glycolic acid; the third fiber is manufactured from a polymer selected from the group consisting of polyethylene terephthalate, polybutylene terephthalate, a polybutester, and blends of the same; and the fourth fiber is manufactured from a spandex polymer. In the most specific embodiment, the first fiber comprises about 35 to 55%; the second fiber comprises about 15 to 35%; the third fiber comprises about 10 to 20% of Polyethylene terephthalate; and the fourth fiber comprises about 5 to 15%, all percentages based on the total weight of the article. In the most specific embodiments, at least the first, second and third fibers can be separately texturized by either a false twist or a knit/deknit process. It is to be understood that the claims can be amended without adding or subtracting from the scope of this invention. A drawing which describes the shape and/or geometrical configuration of the improved tubular article is not necessary for an understanding of this invention. That is, any person skilled in vascular graft art will know how to manufacture and how to use the invention by reading this specification, generally and the examples 1 to 14, specifically. Throughout this disclosure, it is to be understood that the terms Lycra and Dacron are trademarks of the E. I. DuPont and Company, DE, U.S.A., whether the terms Lycra or Dacron are or are not so identified as a trademark. The term polyurethane is generic and includes both the polyether and polyester types. A polyether type spandex is preferred. The Lycra™ described in the examples 1 to 14 is a polyether type polyurethane. It is to be understood that the term polybutester as used in this disclosure is synonymous with the terms polyetherester, polyether-ester or polyether ester. A commercially available polybutester is the Hytrel™ (E. I. DuPont and Co.) copolymer. The external support described and claimed in this application can be attached to the tubular article, e.g. a vascular graft, by either melt or adhesive attachment. DESCRIPTION The following steps are followed when preparing knit vascular grafts starting from the appropriate yarns. The proper denier yarns for the specific construction have to be knit. If the denier to be used can only be obtained by using three or more ends, the yarn must be ply-twisted together. For example, if the construction is a 330-denier PGA and lOO-denier textured Dacron™, and the only available PGA is llO-denier, it is necessary to twist three ends of llO-denier PGA and the one end of lOO-denier Dacron™. Other variations can be used, depending on the type of construction called for. After ply-twisting onto a king spool, the twisted yarn is transferred to a model 50 cone, using a coning machine. It is preferred that any material that is not twisted and is to be used for knitting be transferred to a cone, or to a similar type package from which the yarn may easily be removed. The yarn is then set up on the knitting machine. The knitting machine can be commercially available. It can be a floor-type self-contained unit, completely assembled, with exception of the yarn tension or stop-motion assembly. A direct V-belt drive from a fractional horsepower motor to the knitting head allows for a quiet knitting speed up to about 1100 r.p.m. A variable speed take-down assures minimum breakdowns and absolute quality stitch control. Operating speeds can vary depending on cylinder size and also the type of yarn or fibers used. The proper density of the graft construction is obtained by changing the stitch cam and take-down settings. The stitch cam controls the length of the stitch, and the take-down controls the tension of the tubular fabric being knit. After knitting, the graft material is scoured in xylene under ultrasonic agitation for two ten-minute baths. The material is allowed to dry in a fume hood until no xylene odors can be detected. The graft material is then cut to appropriate lengths (e.g. 4 mm x 60 mm; and/or 8 mm x 80 mm) and then reversed. Reversing involves turning the graft inside out to have a smooth inner surface, and a rougher outer surface to promote ingrowth. Any graft containing PGA is then post-treated on stainless steel mandrels at temperatures of about 115°C to 150°C, under a vacuum approximately equal to 1 torr or lower. The post-treatment process seems to increase the tensile strength retention for the absorbable component, up to about 60 days after implant. A graft that does not contain PGA may not undergo the post-treatment process. The ends of the graft may then be heat-sealed on a hot surface to prevent unravelling. During heat-sealing, the ends of the graft are melted only slightly. Following scouring in xylene or another medically approved nonaqueous solvent and drying, the graft is then packaged in a polycarbonate folding container, which is then placed in a foil inner pouch. The graft is then sent through an absorbable device EtO-sterilization cycle. After sterilization, the graft is repacked in a 2-web TYVEK® (a spun bonded polyolefin manufactured by E. I. DuPont & Co., Wilmington, Del., U.S.A.)/Mylar™ (a polyethylene terephthalate also manufactured by E. I. DuPont & Co.) pouch, sealed and EtO-sterilized a second time. The overall patency rate for PGA containing grafts was substantially higher than controls: 58% vs. 41%. Multicomponent vascular grafts made of biodegradable and non-degradable fibers have been studied in-vivo. Observations carried out from ∼30 days to ∼7 months showed that as the absorbable component left the graft structure, organized and oriented tissue invaded the graft approximating the location of the degraded material. The tissue ingrowth appeared to mobilize as a neointima with the lumenal surface covered by cells strongly resembling endothelium. The non-degradable component exhibited dispersed fibers within a matrix of mature, highly vascularized granulation tissue. This rich blood supply persisted for the period of maximum observation. The graft structures were provided in two diameters: 4 and 8 mm ID. The former were studied as interpositional grafts in both carotids of the host; the latter as interpositional grafts in the thoracic aorta. The 4 mm grafts (40-60 mm in length) were examined at 1 and 2 months and showed high degrees of patency. The tissue reaction showed progressively increasing tissue incorporation although endothelization was absent at 1 month and only partially manifest at 2 months. The 8 mm grafts examined at ∼3- ∼7 months were uniformly patent and showed uninterrupted complete endothelization of the graft lumen and complete replacement of the degradable material by the tissue elements noted above. The present invention is illustrated by the following examples which can be useful in peripheral vascular surgery, as coronary artery bypasses or in general arterial or venous grafting. Example 1 Two 3-plied yarns each comprised of 50 denier MAXON®, 46 denier PGA, and 20 denier textured DACRON® twisted at 2.3 turns per inch 'Z' twist were fed separately to a Lamb ST-3A circular knitter along with one end of 70 denier LYCRA® T-126C. The yarns were knit on a 25 needle per inch cylinder in a single jersey stitch to form (1) a 4 mm I.D. and (2) an 8 mm I.D. tube, the wall thickness of which was between .60 and .70 mm. Following knitting, the graft material was scoured in xylene, cut to length, reversed and post treated in a vacuum oven at 130°C ± 5°C for 2 1/2 ± 1/2 hours. These grafts were evaluated in dogs in both the carotid artery and thoracic aorta. The results revealed 11 of 12 grafts to be patent with little or no dilation and good tissue ingrowth after sacrifice time periods of 1 and 2 months. Example 2 A graft was made and processed as in Example 1 but using 25 denier textured NOVAFIL® in place of DACRON®. Example 3 A graft was made and processed as in Example 1 but using a 33 needle/inch cylinder and the following supply yarns: (1) 3-ply yarn containing 25 denier MAXON®, 26 denier PGA, and 30 denier textured DACRON® twisted at 1.8 turns per inch "S" twist (2) 3-ply yarn containing 2 ends of 25 denier MAXON® and 1 end of 20 denier PGA twisted at 1.8 T.P.I. "S" and (3) 1 end of 40 denier LYCRA® T-146C. The wall thickness of the graft was .40 - .50 mm. Example 4 A graft as in Example 3 but using 25 denier textured NOVAFIL® to replace the 30 denier textured DACRON®. Example 5 A graft construction was made on a 60 gauge (30 needle/inch) double needle bar Raschel warp knitting machine by supplying the following yarns to the inside guide bars (bars 2 + 7): a 3-ply yarn consisting of 80 denier textured MAXON® 62 denier textured PGA and 30 denier textured DACRON®, plied together at 4 turns/inch 'Z' twist and the following yarns to the outside guide bars (bars 1 + 8): 40 denier T-146C LYCRA®. The grafts were knit using the following construction: Outside Guide Bars (1 + 8) 2-4/2-0 Inside Guide Bars (2 + 7) 2-0/2-4 Following knitting, the grafts were processed as in Example 1. Example 6 A graft was made as in Example 5 except that 46 denier textured PGA was used to replace the 62 denier textured PGA. Example 7 A graft was made as in Example 5 except that 25 denier textured NOVAFIL® was used to replace 30 denier textured DACRON®. Example 8 A graft was made as in Example 6 except that 25 denier textured NOVAFIL® was used to replace 30 denier textured DACRON®. Example 9 A graft was made as in Example 5 except that the knit construction was as follows: Outside Guide Bars (1 + 8) 4-6/2-0 Inside Guide Bars (2 + 7) 2-0/2/4 Example 10 A graft was made as in Example 9 except that 46 denier textured PGA was used to replace 62 denier textured PGA. Example 11 A graft was made as in Example 9 except that 25 denier textured NOVAFIL® was used to replace 30 denier textured DACRON®. Example 12 A graft was made as in Example 10 except that 25 denier textured NOVAFIL® was used to replace 30 denier textured DACRON®. Example 13 A 4-ply yarn consisting of three ends of 105-denier MAXON™ and one end of lOO-denier texturized Dacron™ was plied together at a twist level of approximately 2 turns/inch. The yarn was knit into 4 and 8 mm I.D. tubes on separate Lamb ST3A circular weft knitting machines, using 25-needle per inch knitting cylinders. These grafts had wall thicknesses of between 650 and 850 microns. Following knitting, the graft material was scoured, cut to 45 and 80 mm lengths. heat-set at llO°C for 1 to 3 minutes on stainless steel sizing rods, helically wrapped with 2-0 monofilament MAXON™ suture material as a means of external support, packaged and sterilized. An external support material was attached to the outside surface of the vascular graft, using polymeric glycolide/trimethylene carbonate (TMC) dissolved in methylene chloride as an adhesive. Alternatively, poly-TMC dissolved in methylene chloride can be used as an adhesive. Table 1 is a summary of the in vivo animal data for the knit grafts constructed according to Example 13. Example 14 A 4-ply yarn consisting of two ends of 46-denier PGA, one end of 62-denier PGA and one end of lOO-denier texturized NOVAFIL® was assembled at approximately 2 turns per inch of twist. The texturized NOVAFIL® yarn was false-twist texturized, using the Helanca® (trademark of Heberlein Corp.. Wattwil, Switzerland) process in order to provide a surface texture that would encourage maximum tissue ingrowth. The combined yarn was knit into 4 and 8 mm I.D. tubes similar to Example 13, except that the cylinder had a needle spacing of 33 needles per inch. Following knitting, the graft materials were scoured, cut to 45 and 80 mm length tubes, post-treated on stainless steel rods under vacuum of 1 torr at 130°C for 3 hours, cooled, helically wrapped with 3-0 MAXON™ monofilament suture material, attached to the surface of the graft using Poly-TMC as an adhesive and, finally, packaged and sterilized.

Claims: A quadricomponent tubular article useful in prosthetic surgery having a first and a second fiber manufactured from two chemically distinct absorbable polymers and a third fiber manufactured from a nonabsorbable polymer, characterized by at least one of the first or second absorbable polymers being selected from the group consisting of a copolymer of glycolic acid, poly(lactic acid), polydioxanone, and blends of the same, and comprising a fourth fiber, the third and fourth fibers being chemically distinct and manufactured from two different nonabsorbable polymers. The article of claim 1 comprising a vascular graft having at least one of the absorbable polymers being a copolymer, the copolymer comprising up to about 50% by weight of glycolic acid ester linkages. The article of claim 1 or 2 wherein at least one of the nonabsorbable polymers is selected from the group consisting of a poly(C₂-C₁₀ alkylene terephthalate), poly (C₂-C₆ alkylene), polyamide, polyurethane, and polybutester. The article of claim 2 wherein the copolymer is manufactured from the monomer glycolic acid and from one monomer selected from the group consisting of lactic acid, trimethylene carbonate and ε-caprolactone. The article of claim 1 wherein the first, second and third fibers are separately texturized by either a false twist or a knit/deknit process. The article of claim 1 comprising a vascular graft wherein the first fiber is manufactured from a copolymer of glycolic acid and trimethylene carbonate; the second fiber is manufactured from a homopolymer of glycolic acid; the third fiber is manufactured from a polymer selected from the group consisting of polyethylene terephthalate, polybutylene terephthalate, a polybutester, and blends of the same; and the fourth fiber is manufactured from a spandex polymer. The knitted or woven article of claim 6 wherein the first fiber comprises 35 to 55%; the second fiber comprises 15 to 35%; the third fiber comprises 10 to 20% of polyethylene terephthalate; and the fourth fiber comprises 5 to 15%, all percentages based on the total weight of the article. The article of claim 1 or 2 or 4 or 5 comprising an external support, said support having at least one fiber, said fiber helically wrapped and attached to said article.

Inventors: DUMICAN BARRY LEE, DUMICAN, BARRY LEE
Applicants: AMERICAN CYANAMID CO, AMERICAN CYANAMID COMPANY
Application year: 1989
Main classification: A61L27
IPC codes: A61L27, A61F2