Endothelial cell seeding of polymeric vascular grafts

Pioneers in the field of small diameter graft development sought to promote graft endothelialization and, thereby, increase patency by transplanting a varying degree of autologous endothelial cells onto vascular grafts prior to implantation. This process has become known as endothelial cell seeding. The underlying hypothesis is quite simple; that is, by promoting the establishment of the patient's own endothelial cells on the blood contacting surface of a vascular prosthesis, a "normal" endothelial cell lining and associated basement membrane, together known as the neointima, will form on the graft and counteract the rheologic, physiologic, and biomaterial forces working synergistically to promote graft failure. After 30 years of research in this area, this simple hypothesis has proven to be deceptively naive. The purpose of this review is to summarize the historic context and current base of knowledge regarding many of the technical issues relevant to the endothelial cell seeding process. Special attention is given to electrostatic endothelial cell seeding, the latest research methodology designed specifically to accelerate endothelial cell adhesion and morphological maturation onto expanded poly(tetrafluoroethylene) (e-PTFE) small diameter vascular grafts.