Tissue Engineering of a Completely Biological & Autologous Human Blood Vessel for Adult Arterial Revascularization

In the mid‐'90s, the concept of engineering a living and completely biological blood vessel that would have physiological strength was widely considered as unachievable without the inclusion of a permanent synthetic scaffold. In the last decade, new approaches have partly challenged this dogma by relying on resorbable polymers or xeno/allogeneic biological components. Sheet‐based Tissue Engineering (SBTE) proposes a novel strategy to produce completely biological tissues and organs that display surprisingly high mechanical strength without the need for any exogenous materials. Using fibroblasts from a small skin biopsy (1cm 2 ), tissue engineered blood vessels were produced for 6 patients undergoing hemodialysis. Theses vessels had burst pressures (3658±1074 mmHg) and suture retention strengths (192±29 gf), similar to that of native vessels. This group had an average age of 67±11 (range 56–89) and typical comorbidity factors such as diabetes, hypertension or hypercholesterolemia. This demonstrates for the first time that completely biological blood vessel with clinically relevant mechanical properties can be produced from age‐ and risk‐matched human cells. Vessels were implanted in the arm of 3 patients to serve as arteriovenous shunts for hemodialysis access. Surgical implantation did not require special techniques or instruments and confirmed positive suturing characteristics. Repeated punctures associated with the hemodialysis treatment confirmed the ability of these vessels to rapidly seal at the insertion sites while maintaining patency. After a total of 18 patient‐months, two interventions have been required to maintain secondary patency. This rate compares favorably with that of ePTFE controls in similar patient populations. Studies are currently being expanded to include more patients as well as expanded indications.