There remains a significant clinical need for an alternative to autologous vein grafts in small-diameter applications such as coronary bypass, but no clinically viable, synthetic small-diameter vascular grafts have been developed. While ePTFE and Dacron have long been used for large diameter grafts, it is likely that in small-diameter, low flow conditions, alternative materials and techniques are required, which have shown promising experimental results through enhancing compliance, biocompatibility, and endothelialization of vascular grafts. It is likely that the integration of synthetic materials that possess optimized mechanical properties combined with techniques for improved biocompatibility, such as the use of pure extracellular matrix proteins, will be the impetus for the creation of a new generation of clinically viable, smalldiameter vascular substitutes.

Background: Transbronchial lung cryobiopsy (TBCB) plays an increasing role in the evaluation of diffuse parenchymal lung disease with acceptable diagnostic yield and safety profile compared with that of video-assisted thoracoscopic surgical lung biopsy on most reports. However, published outcomes with regard to safety and complication rates vary. We aim to determine the safety profile of TBCB when performed using a standardized protocol consistent with recently published expert guidelines. Materials and Methods: We reviewed prospectively maintained databases from 5 Australian tertiary referral centers. The procedures were performed in accordance with a recent expert statement recommending standardization of TBCB procedures, in particular with fluoroscopy, a secured airway, and prophylactic bronchial blockers. Periprocedural complications were assessed along with clinical outcomes. Results: A total of 121 patients underwent TBCB between August 2013 and August 2017 following a standardized protocol using general anesthesia. Of them, 84 patients (66.7%) were discharged on the day of the procedure. Pneumothorax occurred in 18 patients (14.9%), 13 (10.7%) of whom required chest tube drainage. Moderate bleeding occurred in 15 patients (13.2%) and severe bleeding in 1 (0.83%). Histopathologic diagnosis was made in 80 patients (66.1%). Conclusion: Pooled outcomes from Australian tertiary centers indicate that TBCB is safe when performed in a protocolized fashion. Active measures to anticipate and manage bleeding and to direct biopsy position result in low rates of major complications.