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Small-diameter vascular tissue engineering

Abstract

Vascular occlusion remains the leading cause of death in Western countries, despite advances made in balloon angioplasty and conventional surgical intervention. Vascular surgery, such as CABG surgery, arteriovenous shunts, and the treatment of congenital anomalies of the coronary artery and pulmonary tracts, requires biologically responsive vascular substitutes. Autografts, particularly saphenous vein and internal mammary artery, are the gold-standard grafts used to treat vascular occlusions. Prosthetic grafts have been developed as alternatives to autografts, but their low patency owing to short-term and intermediate-term thrombosis still limits their clinical application. Advances in vascular tissue engineering technology—such as self-assembling cell sheets, as well as scaffold-guided and decellularized-matrix approaches—promise to produce responsive, living conduits with properties similar to those of native tissue. Over the past decade, vascular tissue engineering has become one of the fastest-growing areas of research, and is now showing some success in the clinic.

Key Points

  • Coronary artery occlusion accounts for 50% of deaths from cardiovascular diseases; given the limited number of autologous vessel substitutes, an urgent need for engineered vascular grafts exists

  • Synthetic polymers were investigated as vascular substitutes because of their availability, structural diversity, and mechanical properties; however, mechanical mismatch and adverse host response remain major impediments to their clinical applicability

  • Natural polymers (collagen, elastin, and fibrin) were originally used as vascular scaffolds; synthetic degradable and nondegradable polymers have subsequently been explored and have improved mechanical properties

  • Self-assembled cell sheets have emerged as alternatives to scaffold-based vascular tissue engineering—vascular cells are cultured on a flat surface, and then the cell sheet is rolled around a mandrel

  • Decellularized, natural matrices from allogenic, heterogenic, or xenogenic sources are an alternative form of scaffold—complete cellular removal is followed by recellularization with cells from a patient

  • None of these approaches has produced ideal small-diameter vascular grafts for reconstructive surgery, but they have greatly advanced our understanding of vascular tissue engineering

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Figure 1: Progressive stages of vascular disease and the corresponding treatment modalities.
Figure 2: Advances in cell biology and engineering contribute to vascular tissue engineering.
Figure 3: Self-assembled vascular tissue engineering.
Figure 4: Scaffold-guided vascular tissue engineering.
Figure 5: Decellularized-matrix vascular tissue engineering.
Figure 6: Timelines of various vascular tissue engineering techniques.

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Seifu, D., Purnama, A., Mequanint, K. et al. Small-diameter vascular tissue engineering. Nat Rev Cardiol 10, 410–421 (2013). https://doi.org/10.1038/nrcardio.2013.77

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