Application of decellularized vascular matrix in small-diameter vascular grafts

Abstract

Coronary artery bypass grafting (CABG) remains the most common procedure used in cardiovascular surgery for the treatment of severe coronary atherosclerotic heart disease. In coronary artery bypass grafting, small-diameter vascular grafts can potentially replace the vessels of the patient. The complete retention of the extracellular matrix, superior biocompatibility, and non-immunogenicity of the decellularized vascular matrix are unique advantages of small-diameter tissue-engineered vascular grafts. However, after vascular implantation, the decellularized vascular matrix is also subject to thrombosis and neoplastic endothelial hyperplasia, the two major problems that hinder its clinical application. The keys to improving the long-term patency of the decellularized matrix as vascular grafts include facilitating early endothelialization and avoiding intravascular thrombosis. This review article sequentially introduces six aspects of the decellularized vascular matrix as follows: design criteria of vascular grafts, components of the decellularized vascular matrix, the changing sources of the decellularized vascular matrix, the advantages and shortcomings of decellularization technologies, modification methods and the commercialization progress as well as the application prospects in small-diameter vascular grafts.

Nonlinear Elasticity of Blood Vessels and Vascular Grafts

“…Therefore, they still face risks of infection, restenosis, and thrombosis. 108 Insufficient endothelialization leading to postimplantation restenosis is a major challenge in the clinical use of small-diameter decellularized vascular grafts. 52 3.1.1.4.…”

“…However, they are ineffective in countering the mechanical properties loss caused by the decellularization process. Therefore, they still face risks of infection, restenosis, and thrombosis . Insufficient endothelialization leading to postimplantation restenosis is a major challenge in the clinical use of small-diameter decellularized vascular grafts …”

Biological Materials for Tissue-Engineered Vascular Grafts: Overview of Recent Advancements

“…For instance, Badylak et al produced TEVGs from decellularized small intestine submucosa which were applied as large-diameter vascular infrarenal aorta grafts in dog models, with survival up to 52 weeks post-implantation, as far back as 1989 [ 59 ]. In recent years, numerous studies have been performed to optimize the techniques, including functionalizing the decellularized grafts for better recellularization and maintenance of biomechanical properties [ 60 , 61 , 62 , 63 ].…”

Small diameter vascular grafts: progress on electrospinning matrix/stem cell blending approach

“…The basic principle of the decellularization method is using physical methods or ionic solvents to efficiently rid out of the cells from the extracellular matrix (ECM), while retaining the main components of the ECM with biological activities as much as possible. However, the process is rather complex, which would inevitably destroy the integrity of the ECM and leave certain immunogenic substances, thus affecting the overall performance of the scaffold material ( Li et al, 2023 ; Shu et al, 2024 ). The dipping/leaching method and the coagulation method are similar in principle, which is to dip and dry the mold repeatedly in the raw material solution or carry out coagulation bath to form the basic molding.…”