Optimal Prosthetic Graft Design for Small Diameter Vascular Grafts

Abstract

Autogenous vein and arterial grafts, such as great saphenous veins and internal mammary and radial arteries, remain the gold standard conduits for vascular reconstruction. Expanded polytetrafluoroethylene (PTFE) grafts, which exhibit little inflammatory and thrombogenic reactivity, are the most commonly used material of choice for small diameter vascular grafts when autogenous grafts are not available. Several modifications of the basic graft have been attempted to enhance graft healing of expanded PTFE grafts, and little but definite experimental and clinical improvement has been achieved so far. The technique of vascular tissue engineering, in combination with stem cell research, may hold the key for the creation of a practical and successful small diameter prosthetic graft.

Comparing the endothelialisation of extracellular matrix bioscaffolds with coated synthetic vascular graft materials

“…The lack of a confluent endothelial lining is repeatedly cited as the most common cause of conduit failure [2,3]. In vitro graft endothelialisation is an emerging method, which has been shown in several long-term human clinical trials to significantly enhance the patency rates of small caliber synthetic grafts [4][5][6][7].…”

Enhancement of Endothelial Cell Retention on ePTFE Vascular Constructs by siRNA-Mediated SHP-1 or SHP-2 Gene Silencing

“…Poor performance in small-diameter applications has precluded their clinical use for bypassing arteries less than approximately 6 mm in diameter, which includes the coronary arteries. 21 It is widely established that a viable endothelium is required for small-diameter bypass applications. 13 This is because endothelial cells prevent pathogenic processes including thrombosis, inflammation, and neointimal hyperplasia.…”

“…25,33 While exhibiting distinct features beneficial to vascular reconstruction, these materials often cause thrombosis and neointimal hyperplasia, both of which are pathological changes that lead to graft failure. 17,21 An effective approach for mitigating these pathological changes is endothelial cell seeding onto the luminal surface of vascular constructs. 13 However, endothelial cells are not stable and often detach when subjected to blood flow.…”

Silk‐Based Biomaterials in Biomedical Textiles and Fiber‐Based Implants

“…Silk grafts with small diameters, < 3 mm, and 0.15 mm thick, were employed to reconstruct an intra-cranial aneurysm artery [178] . The burst strength of these silk prostheses was 811 mm Hg, lower than gold standard saphenous veins (1,800 mm Hg) [179, 180] . In order to simulate the multilayer structure of human blood vessels, multilayer grafts were fabricated.…”