Chapter 58 - Engineering of Large Diameter Vessels

Abstract

Cardiovascular diseases are the leading causes of mortality in developed nations despite advance in comprehensive treatments. Vascular grafts are commonly used to treat cardiovascular disease during vascular surgical procedures. Nondegradable synthetic grafts are used to treat aortic and peripheral artery diseases whereas autologous grafts are used for coronary artery disease. However, vascular grafts have limitations such as a lack of growth capacity and risks for thrombosis, stenosis, and infection. To address these limitations, various tissue engineered vascular grafts (TEVGs) have been developed. The ideal TEVG should be easily handled, cost-effective, thrombus-free, biocompatible, and durable, and remodel into a neovessel. In this chapter, we will review the status of large-diameter TEVGs, focusing on biological-based and biodegradable synthetic-based scaffolds materials in large-animal models and clinical studies. Although several clinical studies investigating state-of-the-art TEVGs have shown favorable long-term results, TEVGs are still not widely employed clinically. To increase TEVG use clinically, more multidisciplinary approaches, collaboration, and technologies will be required.