Experience in using a cell-free vascular matrix in smalldiameter arterial surgery

Introduction. Modern vascular surgery faces a need for reliable biocompatible models for small-diameter vessel prosthetics, as traditional methods are limited due to donor material shortages and risks of complications such as thrombosis and infection. In this context, the use of prostheses made from decellularized aorta (DCA) – a natural biological scaffold preserving the extracellular matrix that stimulates vascular wall regeneration – is studied.

Aim: To evaluate the manufacturability and biocompatibility of DCA prostheses made from rat aorta, when transplanted into the abdominal aorta of animals, with investigation of patency and vascular wall response over 4 weeks.

Material and Methods. Chemical and physical decellularization of the aorta using SDS, Triton X-100, and enzymes was performed; prostheses were implanted into 20 Wistar rats. Patency was assessed immediately and 30 minutes post-operation, with morphological control including ultrasound with Doppler performed at 4 weeks. Histological analysis used cross-sections stained with hematoxylin and eosin.

Results. Prosthesis transplantation occurred without technical complications. The DCA showed sufficient strength and elasticity. After 4 weeks, normal capillary perfusion in hind limb tissues was noted. Doppler imaging revealed a decrease in mean linear blood flow velocity (about 25%, p < 0.001) in the prosthesis region. Thrombosis or stenosis developed in 60% of animals, aneurysms in 30%. Histology revealed lymphocytic infiltration and intimal hyperplasia in most animals, explaining impaired vessel patency.

Conclusion. Decellularized aortic prostheses demonstrate unique biocompatibility and structural similarity to native vessels but carry a high risk of complications such as thrombosis, stenosis, and aneurysms. Modifications, possibly including synthetic coatings or endothelial cell cultivation, are needed to improve stability and thromboresistance.

1. Emmert M.Y., Fioretta E.S., Hoerstrup S.P. Translational challenges in cardiovascular tissue engineering. J. Cardiovasc. Transl. Res. 2017;10(2):139–149. https://doi.org/10.1007/s12265-017-9728-2

2. Naso F., Gandaglia A. Can heart valve decellularization be standardized? A Review of the parameters used for the quality control of decellularization processes. Front. Bioeng. Biotechnol. 2022;17(10):830–899. https://doi.org/10.3389/fbioe.2022.830899

3. Li Y., Zhou Y., Qiao W., Shi J., Qiu X., Dong N. Application of decellularized vascular matrix in small-diameter vascular grafts. Front. Bioeng. Biotechnol. 2023;10:1081233. https://doi.org/10.3389/fbioe.2022.1081233

4. Mallis P., Kostakis A., Stavropoulos-Giokas C., Michalopoulos E. Future perspectives in small-diameter vascular graftengineering. Bioengineering. 2020;7(4):160. https://doi.org/10.3390/bioengineering7040160

5. Zhao P., Li X., Fang Q., Wang F., Ao Q., Wang X. et al. Surface modification of small intestine submucosa in tissue engineering. Regen. Biomater. 2020;7:339–348 . https://doi.org/10.1093/rb/rbaa014

6. Aleksandrov V.N., Kriventsov A.V., Mikhailova E.V., Figurkina M.A., Sokolova M.O., Yudin V.E. et al. Prostheses from decellularized aorta and bioresorbable material in in vivo experiment. Bulletin of the Russian Military Medical Academy. 2017;58(2):120–125. https://doi.org/10.17816/brmma623251

7. Bäck M., Michel J.B. From organic and inorganic phosphates to valvular and vascular calcifications. Cardiovasc. Res. 2021;117(9):2016–2029. https://doi.org/10.1093/cvr/cvab038