Carbons vascular applications

A wide variety of natural and synthetic materials have been used for biomedical applications. These include polymers, ceramics, metals, carbons, natural tissues, and composite materials (1). Of these materials, polymers remain the most widely used biomaterials. Polymeric materials have several advantages which make them very attractive as biomaterials (2). They include their versatility, physical properties, ability to be fabricated into various shapes and structures, and ease in surface modification. The long-term use of polymeric biomaterials in blood is limited by surface-induced thrombosis and biomaterial-associated infections (3,4). Thrombus formation on biomaterial surface is initiated by plasma protein adsorption followed by adhesion and activation of platelets (5,6). Biomaterial-associated infections occur as a result of the adhesion of bacteria onto the surface (7). The biomaterial surface provides a site for bacterial attachment and proliferation. Adherent bacteria are covered by a biofilm which supports bacterial growth while protecting them from antibodies, phagocytes, and antibiotics (8). Infections of vascular grafts, for instance, are usually associated with Pseudomonas aeruginosa Escherichia coli. Staphylococcus aureus, and Staphyloccocus epidermidis (9). 

Cardiac valves with components fabricated from low temperature isotropic carbons (pyrolytic carbon) are successfully used clinically [23]. These materials are appropriate for such applications as mechanical valves which require long-term chemical inertness, smoothness, and wear-resistance. The reasons for the marked improvement in the performance (reduced thrombosis and thromboembolic stroke rates) of these newer vs. older style heart valves are not entirely understood, but are undoubtedly multifactorial and related to improved patient management and valve design, as well as to the nature of the carbon surface. The specific benefits conferred by pyrolytic carbons with respect to blood cell and protein interactions, resulting in a very low frequency of clinical complications, remain to be defined. The use of carbon coatings has been proposed for other devices, i.e., vascular grafts, although such devices have not yet been used clinically. 

However, even the external application of medical carbonic add is of growing importance, as for example in sanatoria, where carbonic add baths have become firmly established for the successful treatment of certain dysfunctions of the cardiac and circulatory system as well as of the vascular system. 

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