Abstract
Globally, millions of patients are affected by myocardial infarction or lower limb gangrene/amputation due to atherosclerosis. Available surgical treatment based on vein and synthetic grafts provides sub-optimal benefits. We engineered a highly flexible and mechanically robust nanotextile-based vascular graft (NanoGraft) by interweaving nanofibrous threads of poly-L-lactic acid to address the unmet need. The NanoGrafts were rendered impervious with selective fibrin deposition in the micropores by pre-clotting. The pre-clotted NanoGrafts (4 mm diameter) and ePTFE were implanted in a porcine carotid artery replacement model. The fibrin-laden porous milieu facilitated rapid endothelization by the transmural angiogenesis in the NanoGraft. In-vivo patency of NanoGrafts was 100% at 2- and 4-weeks, with no changes over time in lumen size, flow velocities, and minimal foreign-body inflammatory reaction. However, the patency of ePTFE at 2-week was 66% and showed marked infiltration, neointimal thickening, and poor host tissue integration. The study demonstrates the in-vivo feasibility and safety of a thin-layered vascular prosthesis, viz., NanoGraft, and its potential superiority over the commercial ePTFE.Graphical
Highlights
Worldwide > 220 million patients are at risk of stroke, myocardial infarction, lower limb gangrene, and amputation due to severe atherosclerosis, a disease mainly affecting arteries with < 6 mm diameter [1]
In‐vitro testing of leakage, physical properties, and biocompatibility of the single layered NanoGraft Flexible and kink-resistant nanotextile conduits of 4 mm diameter were developed from polymeric nanofibrous yarns of electrospun poly(L-lactic acid) (PLLA) using a modified weaving system as described earlier [18], see Fig. 1a–c
This interwoven structure resulted in a significantly high burst pressure compared to the control expanded polytetrafluoroethylene grafts (ePTFE) graft (p < 0.0001) (Fig. 1d)
Summary
Worldwide > 220 million patients are at risk of stroke, myocardial infarction, lower limb gangrene, and amputation due to severe atherosclerosis, a disease mainly affecting arteries with < 6 mm diameter [1]. Available synthetic ePTFE and polyethylene terephthalate (PET) grafts made from non-degradable materials feature lower patency rates of < 50% at 1-year due to poor endothelialisation, marked intimal thickening, and acute thrombosis [12] This is triggered by the low flow through the small cross-sectional area and high turbulence at the anastomotic sites. Different strategies of engineering small vascular grafts have utilized biodegradable polymers, surface modification techniques, tissue engineering, and decellularization of xenografts [15, 16] None of these approaches have proven success.
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