Study Shows Ability Available to 'Grow' New Veins
There are many times when "new" veins are needed for grafting. Veins are taken from the legs to use in coronary artery bypass surgery routinely. Artificial grafts are sometimes used to create arteriovenous (AV) fistulas or shunts in renal patients for use in dialysis.
Now there is a way to create a small diameter vascular grafts using the patient’s own skin cells. The technique is one developed at Cytograft who funded the study published in the April 25 issue of The Lancet.
Dr Todd McAllister and colleagues report results after a minimum of 6 months of follow-up for the first ten patients implanted with a completely biological and autologous tissue-engineered vascular graft.
Ten patients with end-stage kidney disease were recruited for the study. All were dialysis patients who used AV fistula access and had had at least one access failure. The patients were enrolled from centers in Buenos Aires, Argentina and Katowice, Poland, between September, 2004, and April, 2007.
Two types of skin cells were taken from each patient. The fibroblasts were used to make the scaffolding. The endothelial cells were used to make the lining of the blood vessel tissue. First “sheets” of tissue were grown. These were then formed into tubes which were used to create the AV shunts in each patient. These AV shunts were used for access for dialysis.
The grafts worked for 76% of these high risk patients for 3 months without requiring correction or repair. Three grafts failed early which is consistent with any type of graft in this high-risk population. One patient withdrew from the study. One patient died of unrelated causes. Five patients had functioning grafts for 6-20 months.
While the study is promising in the ability to engineer new vessels, the expense may prevent this from becoming mainstream. At this time, it cost 5-7 times as much to “grow” a vein as to simple use an artificial graft. Results are similar in both at this time.
Effectiveness of haemodialysis access with an autologous tissue-engineered vascular graft: a multicentre cohort study; The Lancet, Volume 373, Issue 9673, Pages 1440 - 1446, 25 April 2009 (doi:10.1016/S0140-6736(09)60248-8); Todd N McAllister, Marcin Maruszewski, Sergio A Garrido, Wojciech Wystrychowski, Nathalie Dusserre, Alicia Marini, Krzysztof Zagalski, Alejandro Fiorillo, Hernan Avila, Ximena Manglano, Jorge Antonelli, Alfred Kocher, Marian Zembala, Lech Cierpka, Luis M de la Fuente, Nicolas L'Heureux.