title: New biological solutions for hemodialysis access.
abstract: Since Scribner described the first prosthetic chronic dialysis shunt in 1961, the surgical techniques and strategies to maintain vascular access have improved dramatically. Today, hundreds of thousands of patients worldwide are treated with some combination of native vein fistula, synthetic vascular graft, or synthetic semipermanent catheter. Despite significantly lower efficacy compared with autologous fistulae, the basic materials used for synthetic shunts and catheters have evolved surprisingly slowly. The disparity between efficacy rates and concomitant maintenance costs has driven a strong campaign to decrease the use of synthetic grafts and catheters in favor of native fistulae. Whether arguing the benefits of Fistula First or "Catheter Last," the fact that clinicians are in need of an alternative to expanded polytetrafluoroethylene (ePTFE) is irrefutable. The poor performance of synthetic materials has a significant economic impact as well. End-stage renal disease (ESRD) accounts for approximately 6% of Medicare's overall budget, despite a prevalence of about 0.17%. Of that, 15%-25% is spent on access maintenance, making hemodialysis access a critical priority for Medicare. This clinical and economic situation has spawned an aggressive effort to improve clinical care strategies to reduce overall cost and complications. While the bulk of this effort has historically focused on developing new synthetic biomaterials, more recently, investigators have developed a variety of cell-based strategies to create tissue-engineered vascular grafts. In this article, we review the evolution of the field of cardiovascular tissue engineering. We also present an update on the Lifeline™ vascular graft, an autologous, biological, and tissue-engineered vascular graft, which was the first tissue-engineered graft to be used clinically in dialysis patients.
authors.affiliation: Cytograft Tissue Engineering, Novato, California, USA.
authors.forename: Marissa K
authors.initials: MK
authors.lastname: Peck
authors.forename: Nathalie
authors.initials: N
authors.lastname: Dusserre
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Zagalski
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Garrido
authors.forename: Wojciech
authors.initials: W
authors.lastname: Wystrychowski
authors.forename: Marc H
authors.initials: MH
authors.lastname: Glickman
authors.forename: Nicolas A F
authors.initials: NA
authors.lastname: Chronos
authors.forename: Lech
authors.initials: L
authors.lastname: Cierpka
authors.forename: Nicolas
authors.initials: N
authors.lastname: L'Heureux
authors.forename: Todd N
authors.initials: TN
authors.lastname: McAllister
mesh_terms: D000818:Animals; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000266:history / Q000295:instrumentation*; D001672:Biocompatible Materials / Q000266:history; D001705:Bioprosthesis / Q000266:history; D001807:Blood Vessel Prosthesis / Q000266:history; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000266:history / Q000295:instrumentation*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007676:Kidney Failure, Chronic / Q000266:history / Q000628:therapy*; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D006435:Renal Dialysis / Q000266:history; D023822:Tissue Engineering / Q000266:history
chemical_list: D001672:Biocompatible Materials; D011138:Polytetrafluoroethylene