Small Intestinal Submucosa as a Small-Diameter Arterial Graft in the Dog

Abstract

Autogenous saphenous vein, human umbilical vein, modified bovine collagen, Dacron, and PTFE have been used as small-diameter arterial grafts with moderate success. We tested autogenous small intestine submucosa as a small-diameter arterial graft in both a carotid and femoral artery (mean ID 4.3 mm) of 18 dogs (total of 36 grafts). All dogs received aspirin and warfarin sodium for the first 8 weeks after surgery. Graft patency was evaluated by Doppler ultrasound techniques and angiography. Two grafts ruptured and 5 grafts occluded by 21 days after surgery. One graft became occluded at 14 weeks. Fifteen dogs were sacrificed at periodic intervals until 48 weeks after surgery. Patent grafts had no evidence of infection, propagating thrombus, or intimal hyperplasia. Graft aneurysmal dilation occurred in 4 grafts (11%). The grafts were composed of a dense organized collagenous connective tissue with no evidence of endothelial cell growth on the smooth luminal surface. Three dogs are alive at 76 to 82 weeks after surgery. Overall, graft patency was 75%. Graft patency after cessation of anticoagulation therapy was 92.3% (12 of 13 grafts). We conclude that autogenous small intestinal submucosa can be used as a small-diameter arterial graft in the dog and is worthy of further investigation.

Intestinal regeneration by a novel surgical procedure

“…Vacanti's group, using polyglycolic acid scaffolds seeded with intestinal epithelial organoid units harvested from neonatal rats, successfully obtained an enteric cyst, which has similar mucosal architecture and basic physiology to that of native bowel but lacks the normal tubular appearance and properly oriented muscle 13 . Porcine small intestine submucosa has been widely studied for use in arterial and venous grafts 14,15 , and to repair the urinary bladder 16 , ligaments and tendons 17 , and defects in the body wall 18 . Chen and Badylak 19 produced three regenerated layers of intestine using a patch of small intestine submucosa in a canine model, but they failed to produce regeneration with a tube of small intestine submucosa.…”

Tissue engineering in the cardiovascular system: Progress toward a tissue engineered heart

“…Researchers have also looked at other approaches using natural materials. For example, small-intestine submucosa has been used as a vascular graft in dogs (Badylak et al, 1989;Lantz et al, 1990;Sandusky et al, 1992) and has been combined with type I bovine collagen to create a scaffold material (Huynh et al, 1999). Both have been shown to remodel in vivo to histologically resemble native vessel.…”

Tissue engineering in urology

“…14,15 This result was recognized by Lantz and colleagues, who first used SIS in animal studies as a vascular patch, where it demonstrated tissue-specific regeneration in both arteries and veins. 16,17 Kropp and colleagues subsequently demonstrated, in both small and large animal models, that SIS alone can promote bladder regeneration when used as an unseeded graft. Histological evaluation demonstrated that the serosal, muscle and mucosal layers of the bladder wall had undergone regeneration.…”