Development of a small diameter vascular prosthesis with capacity of collateral formation to ischemic region due to angiogenesis

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Basic fibroblast growth factor (bFGF) is one of the strongest angiogenic agent, and affects all cell types involved in would healing. The distribution of bFGF is widespread, because it plays an important role in regulating cell proliferation and mitosis. Angiogenesis by bFGF is important for endothelialization in vascular prostheses and is significant from shortly after implantation. Lack of angiogenic factors in the vascular graft wall may cause for unhealing neointima. Antithrombogenicity is important when the diameter of vascular prostheses become small for satisfactory patency. Natural and permanent antithrombogenicity due to host endothelial cells should be excellent. Collateral formation in ischemic heart disease is induced by angiogenic factors including bFGF.We hypothesized that tissue-fragmented (TF-) grafts are rich of angiogenic activity from shortly after implantation and it ability may work for collateral formation to the ischemic area when it is used for a small diameter vascular prosthesis in the coronary artery position. We developed a TF-graft and observed the healing process including angiogenesis and endothelialization. Proliferation and mitosis of endothelial cells ware active in the graft wall 5 days after implantation. The full thickness of the intima was organized at 7 days. These results demonstrated that endogenous bFGF is important for endothelialization due to angiogenesis in fabric vascular prostheses, whereas thrombus and infection might have a negative effect. It might be possible to have patent grafts in the coronary position, if we could have fine basic small-diameter fabric prosthesis with good handling characteristics, excellent antithrombogenicity.