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The Ideal Graft of the Future: A Prospect of Messianic Proportions?

The demand for vascular grafts in modern medicine and surgery is vast. Vascular grafts are required in a plethora of vascular surgical procedures for obstructed native vessels or dialysis purposes. As many as 1,500,000 angioplasties are performed annually in the USA, along with 500,000 coronary artery bypass procedures and 150,000 carotid endarterectomies, and 300,000 patients are receiving dialysis. It is estimated that the sum of such procedures worldwide reaches billions of dollars every year. This does not include the millions of procedures for implantation of interposition grafts to replace obstructed arteries in peripheral vascular disease. Almost invariably (except for the latter), surgeons use autologous grafts to carry out these procedures. Saphenous veins, internal thoracic arteries, epigastric arteries, homografts, and radial arteries are being sacrificed to treat the consequences of vascular disease, altogether a major health-related socioeconomic plague. Yet the body’s own generosity is not inexhaustible. The availability of grafts, particularly in procedures that involve multiple utilizations, such as coronary artery bypass, is limited and also associated with significant surgical trauma and infection rates. Moreover, venous grafts tend to degenerate and fail after some period of time, estimated to reach a rate of more than 50% at 10 years after a coronary artery bypass procedure. Science is therefore seeking alternative ways to fill the gap and provide patients with a limitless source of grafts. Robert Eckel, president of the American Heart Association and Professor of Medicine at the University of Colorado at Denver and the Health Sciences Center stated: ‘‘There is great need. This is an important area of bioengineering. The applications are broad and could benefit the quality of life of a great number of people’’. An emerging new science, vascular tissue engineering, offers the prospect of living, inert, and biological vessels to cover the needs of millions of patients if the fabricated grafts can fulfill some crucial biological and functional requirements.