Vascular tissue engineering - Biomaterials and Devices for the Circulatory System - page 302

12
Vascular tissue engineering

A. T. HALKA, Northern General Hospital, UK,
C. KIELTY, University of Manchester, UK and
M. G. WALKER, Alexandra Hospital, UK

Abstract : Bypass grafts are an effective technique of salvaging the
circulation to ischaemic brain, heart and muscle tissue. Suitable
autologous arterial and vein grafts are limited while synthetic grafts are
too unreliable. In the quest for an alternative 'off-the-shelf' graft-source,
scientists and surgeons are increasingly investigating the vast potential of
vascular tissue engineering. This chapter reviews the history of vascular
tissue engineering, the scaffold types employed and the traditional and
alternative manufacturing approaches used. Construct enhancement
through seeding mature vascular cells is examined as is the potential
employment of adult, embryonic and induced pluripotent stem cells. The
role of mechanotransduction is also considered.

Key words : vascular tissue engineering, scaffold, vascular cells, stem
cells, mechanotransduction.

12.1 Introduction

The mortality rate from cardiovascular disease remains unacceptably high
in the United Kingdom despite advances in medical management and
numerous government initiatives to combat this pandemic. The British
Heart Foundation reports that 36% of all annual deaths in the UK are
caused by diseases of the circulatory system (BHF, 2005). This fi gure
eclipses the combined annual death rate prompted by all types of cancer,
which is reported as 26% by Cancer Research UK (CRUK, 2005). The
human cost of cardiovascular disease far exceeds the economic penalty,
which in 2004 was estimated at £29.1 billion to the UK (Luengo-Fernandez
et al. , 2006).
Medical and surgical modalities have been employed in treating the
causes and consequences of diseases of the circulatory system with varying
degrees of success (Cassar et al. , 2009). More defi nitive and invasive thera-
peutic approaches are required when salvaging perfusion to important ana-
tomical entities such as the brain, heart and limbs. These more invasive
therapeutic options include percutaneous transluminal angioplasty with or
without stent deployment and surgery (Doostzadeh et al. , 2010). Surgical
management, involving reconstructive and bypass procedures, is usually
reserved for cases where angioplasty and stent deployment have failed or

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