Novel Bioengineered Small Caliber Vascular Graft With Excellent One-Month Patency

State of the Art of Small-Diameter Vessel-Polyurethane Substitutes

Cardiovascular diseases are a severe threat to human health. Implantation of small-diameter vascular substitutes is a promising therapy in clinical operations. Polyurethane (PU) is considered one of the most suitable materials for this substitution due to its good mechanical properties, controlled biostability, and proper biocompatibility. According to biodegradability and biostability, in this review, PU small-diameter vascular substitutes are divided into two groups: biodegradable scaffolds and biostable prostheses, which are applied to the body for short- and long-term, respectively. Following this category, the degradation principles and mechanisms of different kinds of PUs are first discussed; then the chemical and physical methods for adjusting the properties and the research advances are summarized. On the basis of these discussions, the problems remaining at present are addressed, and the contour of future research and development of PU-based small-diameter vascular substitutes toward clinical applications is outlined.

Diagnosis and treatment of congenital abdominal aortic aneurysm: a systematic review of reported cases

Background

Congenital abdominal aortic aneurysm (AAA) is distinctly rare in infants and children and carries a high mortality rate. Our objective was to summarize the experience of the diagnosis and treatment in patients with congenital AAA.

Methods

Reported cases of congenital AAA published prior to November 8, 2014, were identified through PubMed, EMBASE, Web of Science, and reference lists. All selected cases were evaluated for main clinical characteristics.

Results

Twenty-six cases of congenital AAA were identified in the English language literature. Congenital AAA occurred primarily in children under three years old, but it was also found in young adults and fetuses. With regards to the localization, the great majority of congenital AAA was infrarenal AAA. The majority of the AAA patients lacked specific symptoms, and a painless pulsatile abdominal mass was the most common clinical presentation. The diagnosis of AAA was based on ultrasound scanning in twenty-five cases, multi-slice spiral computed tomography angiography (MSCTA) in sixteen cases, and magnetic resonance angiography (MRA) in nine cases. Histopathological analyses were available in seven cases. Seven patients received conservative management. Surgical treatment was performed in seventeen cases, and open repair with an artificial graft was the main surgical intervention. The mortality associated with congenital AAA was high (30.76%). Ruptured aneurysm and renal failure were the main causes of death.

Conclusions

Good outcomes can be achieved in children with early identification of congenital AAA and individualized surgical repair with grafts.

Biomechanics and biocompatibility of the perfect conduit-can we build one?

No currently available conduit meets the criteria for an ideal coronary artery bypass graft. The perfect conduit would combine the availability and complication-free harvest of a synthetic vessel with the long-term patency performance of the internal mammary artery. However, current polymer conduits suffer from inelastic mechanical properties and especially poor surface biocompatibility, resulting in early loss of patency as a coronary graft. Approaches to manufacture an improved conduit using new polymers or polymer surfaces, acellular matrices, or cellular constructs have to date failed to achieve a commercially successful alternative. Elastin, by mimicking the native extracellular environment as well as providing elasticity, provides the 'missing link' in vascular conduit design and brings new hope for realization of the perfect conduit.

Local hemodynamic disturbance accelerates early thrombosis of small-caliber expanded polytetrafluoroethylene grafts

OBJECTIVE

Small-caliber expanded polytetrafluoroethylene (ePTFE) grafts cannot be used widely in the clinical situation because of early thrombosis and occlusion. This unsolved and under-recognized problem warrants further investigation.

METHODS

Grafts of uncoated ePTFE (n = 6) and anti-CD34-coated ePTFE (n = 6) were implanted unilaterally into the carotid artery in 12 domestic pigs. Ultrasonography was used to test the proximal and distal anastomotic stoma morphology, diameters and blood velocities. A thrombosis instrument was used to examine the blood coagulation state. After seven days, the pigs were sacrificed and the implanted grafts were excised for general and histological analysis. Computational fluid dynamics was used to investigate the blood flow fields of the implanted grafts and to calculate parameters that might be indicative of thrombosis.

RESULTS

Thrombosis was detected in 10 of 12 (83.3%) implanted ePTFE grafts, 5 in uncoated grafts and 5 in anti-CD34-coated grafts. Endothelial cell coverage was observed in both uncoated and anti-CD34-coated grafts. No obvious abnormalities in anastomotic stoma or blood coagulation state were observed. Computer-based local hemodynamic simulation showed the low flexibility of synthetic ePTFE grafts caused obvious coarctation. Local wall pressure, velocity and wall shear stress were much higher than in the contralateral normal vessel.

CONCLUSIONS

The patency of small-caliber ePTFE grafts for clinical use is impaired by early thrombosis due to mixed causes. Local hemodynamic disturbance was the most powerful predictor of early thrombosis. Decreasing local hemodynamic disturbance, improving the quality of anastomotic stoma, selecting reasonable anticoagulation strategies and promoting rapid endothelialization may increase the long-term patency of small-caliber vascular grafts.

Enhanced endothelialization for developing artificial vascular networks with a natural vessel mimicking the luminal surface in scaffolds

Large tissue regeneration remains problematic because of a lack of oxygen and nutrient supply. An attempt to meet the metabolic needs of cells has been made by preforming branched vascular networks within a scaffold to act as channels for mass transport. When constructing functional vascular networks with channel patency, emphasis should be placed on anti-thrombogenic surface issues. The aim of this study was to develop a rapid endothelialization method for creating an anti-thrombogenic surface mimicking the natural vessel wall in the artificial vascular networks. Shear stress preconditioning and scaffold surface modification were investigated as effective approaches for promoting biomaterial endothelialization. We found that a transient increase in shear stress at the appropriate time is key to enhancing endothelialization. Moreover, surface modification with bioactive materials such as collagen and recombinant mussel adhesive protein fused with arginine-glycine-aspartic acid peptide (MAP-RGD) showed a synergetic effect with shear stress preconditioning. Platelet adhesion tests demonstrated the anti-thrombogenic potential of MAP-RGD itself without endothelialization. The rapid endothelialization method established in this study can be easily applied to preformed artificial vascular networks in porous scaffolds. Development of artificial vascular networks with an anti-thrombogenic luminal surface will open up a new chapter in tissue engineering and regenerative medicine.

Prediction of sphingosine 1-phosphate-stimulated endothelial cell migration rates using biochemical measurements

The ability to predict endothelial cell migration rates may aid in the design of biomaterials that endothelialize following implantation. However, the complexity of the signaling response to migration-promoting stimuli such as sphingosine 1-phosphate (S1P) makes such predictions quite challenging. A number of signaling pathways impact S1P-mediated cell migration, including the Akt and Src pathways, which both affect activation of the small GTPase Rac. Rac activation promotes the formation of lamellipodia, and thus should be intimately linked to cell migration rates. In immortalized endothelial cells, expression of proteins that inhibit Akt, Src, and Rac (PTEN, CSK, and beta2-chimaerin, respectively) was decreased using RNA interference, resulting in increases in the basal level of activation of Akt, Src, and Rac. Cells were scrape-wounded and stimulated with 1 microM S1P. The timecourse of Akt, Src, and Rac activation was followed over 2 h in the perturbed cells, while migration into the scrape wound was measured over 6 h. Rac activation at 120 min post-stimulation was highly correlated with the mean migration rate of cells, but only in cells stimulated with S1P. Using partial least squares regression, the migration rate of cells into the scrape wound was found to be highly correlated with the magnitude of the early Akt peak (e.g., 5-15 min post-stimulation). These results demonstrated that biochemical measurements might be useful in predicting rates of endothelial cell migration.

Animal models for the assessment of novel vascular conduits

The development of an ideal small-diameter conduit for use in vascular bypass surgery has yet to be achieved. The ongoing innovation in biomaterial design generates novel conduits that require preclinical assessment in vivo, and a number of animal models have been used for this purpose. This article examines the rationale behind animal models used in the assessment of small-diameter vascular conduits encompassing the commonly used species: baboons, sheep, pigs, dogs, rabbits, and rodents. Studies on the comparative hematology for these species relative to humans are summarized, and the hydrodynamic values for common implant locations are also compared. The large- and small-animal models are then explored, highlighting the characteristics of each that determine their relative utility in the assessment of vascular conduits. Where possible, the performance of expanded polytetrafluoroethylene is given in each animal and in each location to allow direct comparisons between species. New challenges in animal modeling are outlined for the assessment of tissue-engineered graft designs. Finally, recommendations are given for the selection of animal models for the assessment of future vascular conduits.

Fabrication of burst pressure competent vascular grafts via electrospinning: effects of microstructure

In this work, electrospun tubes of interest for vascular tissue engineering were fabricated and evaluated for burst pressure and suture retention strength (SRS) in the same context as tensile strength providing a direct, novel comparison. Tubes could be fabricated displaying average burst pressures up to 4000 mmHg--well above the standard of 2000 mmHg--and SRS values matching those of relevant natural tissues. Surprisingly, highly oriented fiber and maximal tensile properties are not absolutely necessary to attain clinically adequate burst pressures. The ability to resist bursting is clearly related to both initial solution solids loading and electrospinning deposition time. We make novel in situ observations of the relative microstructural characteristics of failure during bursting, and connect this to the conditions used to fabricate the graft. Processes typically thought to promote fiber alignment are, in fact, highly condition-dependent and do not always provide superior properties. In fact, electrospun structures displaying no discernable alignment could achieve burst pressures regarded clinically sufficient. The properties of individual electrospun fiber clearly do not fully dictate macroscale properties. Normal background levels of point bonding are enhanced by increased rotational speeds, and can have effects on properties more dominant than those of alignment.

Large neonatal thoracoabdominal aneurysm: case report and review of the literature

We present a neonate with a large saccular aneurysm of the thoracoabdominal aorta, extending from the intrathoracic aorta to the left common iliac artery. No underlying cause could be identified. Despite an early diagnosis, the aneurysm was deemed inoperable because of the lengthy involvement and the frail aspect of all visceral arteries. A review of the literature on congenital abdominal aortic aneurysm in infants was conducted. Eleven cases of live-born infants with a congenital abdominal aortic aneurysm have previously been published. None of them involved as large a part of the thoracic and abdominal aorta as the case presented here.

Fat-covered vein graft

Vein graft is widely used in peripheral vascular surgery. Many free flaps and replantation failures are the result of technical problems in performing the anastomoses. A remarkable number of these technical errors are caused by tension or improper placement of the surgical union. Use of a vein graft may prevent tensioning and give us a more accessible repair site. However, the use of a graft not only doubles the repair side, but may also increase the risk of circulatory disturbance. Many technical, mechanical, and histological factors were cited as factors in the formation of thrombus. The use of a vein graft with a fatty tissue cover may prevent many of the potential risk factors.