Endothelialization of prosthetic vascular grafts: current status and future directions

Synthetic vascular grafts perform satisfactorily as large caliber (e.g., aortoiliac) arterial substitutes but commonly fail when employed in small diameter and low flow applications. It is likely that prosthetic grafts in humans do not become endothelialized except for a few centimeters from each anastomosis. The lack of an endothelial lining has been postulated as an important factor contributing to the poor patency rates of prosthetic bypass grafts placed in the distal arterial circulation. Increased appreciation of the diverse functions of endothelium in maintaining vascular homeostasis, coupled with improved techniques for in vitro cultivation of human endothelial cells (ECs), spawned efforts to employ endothelium to produce a less thrombogenic inner lining for vascular prostheses.