Vascular grafts

Abstract

Native autogenous vessels have served as the gold standard conduit material in the treatment of many vascular diseases. However, a significant percentage of patients lack suitable autogenous vessels for use in vascular interventions. For these patients, alternative grafts comprised most commonly of synthetic polymers demonstrate poor long-term patency rates when bypassing arteries of small caliber. This chapter begins with a discussion of the clinical efficacy of autogenous vessels in comparison to the most commonly utilized synthetic materials used in vascular procedures, expanded polytetrafluoroethylene and polyethylene terepthalate. It then discusses the interactions between the host and the material at circulatory, perivascular, and anastomotic interfaces, which generally account for the inferior performance of currently available synthetic grafts. Finally, it concludes with a discussion of some of the strategies employed to improve the long-term efficacy of synthetic grafts by modulating host-biomaterial interactions, including a description of the methodologies utilized for the construction of tissue-engineered blood vessels.