Document Detail


Bioengineered vascular access maintains structural integrity in response to arteriovenous flow and repeated needle puncture.
MedLine Citation:
PMID:  22917043     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Tissue-engineered blood vessels (TEBV) have been proposed as an alternative to prosthetic grafts for dialysis access. However, arteriovenous (AV) grafts must withstand extreme flow rates and frequent needle trauma. In a proof-of-concept study, we sought to determine whether scaffold-based TEBV could withstand the hemodynamic and mechanical challenges of chronic dialysis access.
METHODS: TEBV were constructed using decellularized arterial scaffolds seeded with autologous ovine endothelial cells (EC) derived from circulating endothelial progenitor cells (EPC) using a novel high-affinity capture approach. Seeded scaffolds were preconditioned to arterial pressure and flow in a bioreactor for 2 weeks prior to implantation to create carotid artery to jugular vein AV grafts in each animal. TEBV were healed for 1 month before initiating percutaneous needle puncture 3 days/week. TEBV wall geometry and patency were monitored using duplex imaging and were either explanted for histologic analysis at 2 months (n = 5) or followed for up to 6 months until venous outflow stenosis threatened AV graft patency (n = 6).
RESULTS: Despite high flow, TEBV maintained stable geometry with only modest wall dilation (under 6%) by 4 months after implantation. Needle access was well tolerated with a single puncture site complication, a small pseudoaneurysm, occurring in the late group. Time-to-hemostasis at puncture sites averaged 4 ± 2 minutes. Histologic analysis at 2 months demonstrated repopulation of the outer TEBV wall by host cells and healing of needle punctures by cellular ingrowth and new matrix deposition along the tract. TEBV followed beyond 2 months showed stable wall geometry but, consistent with the primary mode of clinical AV graft failure, all TEBV eventually developed venous anastomotic stenosis (mean, 4.4 ± 0.9 months; range, 3.3-5.6 months postimplantation; n = 6).
CONCLUSIONS: This pilot study supports the concept of creating dialysis access from scaffold-based autologous TEBV. Engineered AV grafts were created within a clinically relevant time frame and demonstrated stable wall geometry despite high flow and repeated puncture. Cellular ingrowth and puncture site healing may improve wall durability, but venous outflow stenosis remains the primary mode of TEBV graft failure in the ovine model.
Authors:
Bryan W Tillman; Saami K Yazdani; Lucas P Neff; Matthew A Corriere; George J Christ; Shay Soker; Anthony Atala; Randolph L Geary; James J Yoo
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  56     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-24     Completed Date:  2012-11-02     Revised Date:  2013-04-18    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  783-93     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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MeSH Terms
Descriptor/Qualifier:
Angiography, Digital Subtraction
Animals
Arteriovenous Shunt, Surgical / adverse effects,  instrumentation*
Bioreactors
Blood Pressure
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation / adverse effects,  instrumentation*
Carotid Arteries / pathology,  physiopathology,  radiography,  surgery*,  ultrasonography
Cell Culture Techniques
Cells, Cultured
Constriction, Pathologic
Endothelial Cells / transplantation*
Equipment Failure Analysis
Feasibility Studies
Graft Occlusion, Vascular / diagnosis,  etiology,  physiopathology
Hemodynamics*
Jugular Veins / pathology,  physiopathology,  radiography,  surgery*,  ultrasonography
Materials Testing
Models, Animal
Needles
Pilot Projects
Prosthesis Design
Prosthesis Failure
Pulsatile Flow
Punctures
Regional Blood Flow
Renal Dialysis*
Sheep
Stem Cell Transplantation
Stress, Mechanical
Time Factors
Tissue Engineering* / methods
Tissue Scaffolds
Tomography, X-Ray Computed
Ultrasonography, Doppler, Color
Ultrasonography, Doppler, Pulsed
Vascular Patency
Comments/Corrections
Comment In:
Expert Rev Med Devices. 2013 Mar;10(2):171-5   [PMID:  23480086 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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