Bioresorbable Tissue-Engineered Vascular Prostheses of Small Diameter Made of Poly(L-lactide)

   Introduction. Reconstructive surgery of small-diameter vessels remains an urgent task due to the limitations of autovenous grafts and problems with nonresorbable synthetic prostheses, especially in pediatric surgery, where the need for repeated operations is high. Polylactide prostheses represent a promising bioresorbable alternative with thromboresistance and stimulation of tissue regeneration.

   Objective. To evaluate the efficacy and safety of poly(L-lactide) tissue-engineered vascular prostheses of small diameter in an experiment on rats, including mechanical properties, biocompatibility and risks of complications.

   Materials and Methods. This study used 50 male Wistar rats with polylactide prostheses implanted in the infrarenal aorta. The surgical technique included median laparotomy and end-to-end anastomoses. The condition of the prostheses was monitored by ultrasound angioscanning, multispiral computed tomography angiography, histological and immunohistochemical analysis at 4, 12, 24 and 48 weeks.

   Results. During the 48-week follow-up, the animals showed no signs of impaired blood flow and trophic changes. The diameter of the prostheses remained stable, and the histological examination data showed the formation of a neointima. Vascular patency with polylactide prostheses was 83 %, while thrombosis occurred in 17 % of cases. However, 53 % of the animals had prosthetic aneurysms in the anastomosis areas.

   Conclusion. Poly(L)-lactide prostheses have bioresorbability, thromboresistance and optimal mechanical properties, which makes them promising for vascular reconstructive surgery. At the same time, the high risk of aneurysms in the area of anastomoses requires further research and improvement of implantation materials and techniques.

1. Hibino N, McGillicuddy E, Matsumura G, et al. Late-term results of tissue-engineered vascular grafts in humans. J. Thorac. Cardiovasc. Surg. 2010;139(2):431–436. Doi: 10.1016/j.jtcvs.2009.09.057.

2. Klinkert P, Post PN, Breslau PJ, van Bockel JH. Saphenous vein versus PTFE for above-knee femoropop-liteal bypass. A review of the literature. Eur. J. Vasc. Endovasc. Surg. 2004;27(4):357–362. Doi: 10.1016/j.ejvs.2003.12.027.

3. Niklason LE, Gao J, Abbott WM, et al. Functional arteries grown in vitro. Science. 1999;284(5413):489–493. Doi: 10.1126/science.284.5413.489.

4. Berglund JD, Mohseni MM, Nerem RM, Sambanis A. A biological hybrid model for collagen-based tissue engineered vascular constructs. Biomaterials. 2003;24(7):1241–1254. Doi: 10.1016/s0142-9612(02)00506-9.

5. Ravi S, Qu Z, Chaikof EL. Polymeric materials for tissue engineering of arterial substitutes. Vascular. 2009;17(Suppl 1):45–54. Doi: 10.2310/6670.2008.00084.

6. Kim BS, Park IK, Hoshiba T, et al. Design of artificial extracellular matrices for tissue engineering. Prog. Polym. Sci. 2011;36(2):238–268. Doi: 10.1016/j.progpolymsci. 2010.10.001.

7. Shum-Tim D, Stock U, Hrkach J, et al. Tissue engineering of autologous aorta using a new biodegradable polymer. Ann. Thorac. Surg. 1999;68(6):2298–2304. Doi: 10.1016/s0003-4975(99)01055-3.

8. Shin’oka T, Matsumura G, Hibino N, et al. Midterm clinical result of tissue – engineered vascular autografts seeded with autologous bone marrow cells. J. Thorac. Cardiovasc. Surg. 2005;129(6):1330–1338. Doi: 10.1016/j.jtcvs.2004.12.047.

9. Maduka CV, Alhaj M, Ural E, et al. Stereochemistry Determines Immune Cellular Responses to Polylactide Implants. ACS Biomaterials Science & Engineering. 2023;9(2):932–943. Doi: 10.1021/acsbiomaterials.2c01279.

10. Zhao L, Li X, Yang L, et al. Evaluation of remodeling and regeneration of electrospun PCL/fibrin vascular grafts in vivo. Materials science and engineering. C, Materials for biological applications. 2021;118(1):1–12. Doi: 10.1016/j.msec.2020.111441.

11. Zhang F, Bambharoliya T, Xie Y, et al. A hybrid vascular graft harnessing the superior mechanical properties of synthetic fibers and the biological performance of collagen filaments. Mater Sci Eng C Mater Biol Appl. 2021;118:111418. Doi: 10.1016/j.msec.2020.111418.

12. Fayon A, Menu P, El Omar R. Cellularized small-caliber tissue-engineered vascular grafts: looking for the ultimate gold standard. NPJ Regen Med. 2021;6(1):46. Doi: 10.1038/s41536-021-00155-x.

13. Kuang H, Wang Y, Shi Y, et al. Construction and performance evaluation of Hep/silk-PLCL composite nanofiber small-caliber artificial blood vessel graft. Biomaterials. 2020;259:120288. Doi: 10.1016/j.biomaterials.2020.120288.

14. Teng Y, Zhang X, Song L, et al. Construction of anti-calcification small-diameter vascular grafts using decellularized extracellular matrix/poly (L-lactide-co-ε- caprolactone) and baicalin-cathepsin S inhibitor. Acta Biomater. 2025;197:184–201. Doi: 10.1016/j.actbio.2025.03.033.

15. Ozdemir S, Oztemur J, Sezgin H, Yalcin-Enis I. Optimization of Electrospun Bilayer Vascular Grafts through Assessment of the Mechanical Properties of Monolayers. ACS Biomater Sci Eng. 2024;10(2):960–974. Doi: 10.1021/acsbiomaterials.3c01161.