Effects of Fabrication on Early Patency and Regeneration of Small Intestinal Submucosa Vascular Grafts

• Published in: ASAIO journal (1992) Vol. 61; no. 5; p. 596
• Main Authors: Sánchez-Palencia, Diana M, Navarro, Javier, Araque, Juan C, Umaña, Juan B, Guerrero, Alvaro F, Quijano, Lina M, López, Rocío D P, Sandoval, Néstor F, Briceno, Juan C
• Format: Journal Article
• Language: English
• Published: United States 01.09.2015
• Subjects: Animals; Bioprosthesis; Blood Vessel Prosthesis; Blood Vessels - physiology; Carotid Arteries - physiology; Carotid Arteries - surgery; Graft Occlusion, Vascular; Intestinal Mucosa - physiology; Intestinal Mucosa - transplantation; Jejunum - physiology; Jejunum - transplantation; Models, Animal; Regeneration; Swine; Vascular Patency
• ISSN: 1538-943X
• DOI: 10.1097/MAT.0000000000000254

Small intestinal submucosa grafts for vascular regeneration have produced variable patency (0-100%) that has been concurrent with variability in fabrication techniques. We hypothesized that 1) preservation (P) or removal (R) of the stratum compactum layer of the intestine and 2) a dehydrated (D) or hydrated (H) state of the graft, affect early patency and tissue regeneration. We combined both parameters through a 2(2) factorial experimental design into four groups (PD, RD, PH, RH), and compared them in an in vivo early response predictive model (swine, ID 4.5 mm, 7d, n = 4). Patency, thrombogenicity, vascularization, fibroblast infiltration, macrophage polarization profile, endothelialization, and biaxial mechanics were assessed. PD grafts remained patent (4/4) but had scarce vascularization and fibroblast infiltration. RD and RH had extensive vascularization and fibroblast infiltration, however, RD had sustained patency (4/4) and the highest number of regeneration-associated phenotype macrophages (M2), whereas RH had lower patency (3/4) and less M2 macrophages. PH had a modest cellular infiltration, but the lowest patency (2/4) and a dominant adverse macrophage phenotype. Elasticity of R grafts evolved toward that of native carotids (particularly RD), while P grafts kept their initial stiffness. We concluded that fabrication parameters drastically affected early patency and regeneration, with RD providing the best results.