Vascular grafts devices

This example of vascular grafts devices points out the evolution of fibrous implantable medical devices and highlights the great potential offered by each scale level of fibrous structures for biocompatibility improvements. Fibers as well as whole fibrous stmctures should be considered as implantable devices that have inherent abilities to interact with the biological environment at each of the three predetermined scale levels. Study of characteristics and specificities of fibers, fibrous siuface, and fibrous volume should then provide a more forward-looking approach in the textile substitute s area for design and achievement of smart medical implantable textile devices. 

Vascular grafts are tubular devices implanted throughout the body to replace blood vessels which have become obstmcted by plaque, atherosclerosis, or otherwise weakened by an aneurysm. Grafts are used most often in peripheral bypass surgery to restore arterial blood flow in the legs. 

Polyurethanes as Biomaterials. Much of the progress in cardiovascular devices can be attributed to advances in preparing biostable polyurethanes. Biostable polycarbonate-based polyurethane materials such as Corethane (9) and ChronoFlex (10) offer far-reaching capabiUties to cardiovascular products. These and other polyurethane materials offer significant advantages for important long-term products, such as implantable ports, hemodialysis, and peripheral catheters pacemaker interfaces and leads and vascular grafts. 

The worldwide market for vascular grafts was approximately 150 million and growing at about 5% annuaUy as of 1995. The vascular graft area has tremendous market potential in development of smaU-diameter grafts of 3—4 mm for coronary bypass surgery. The total market for the intra-aortic baUoon pump, a cardiac-assist device, is ca 80 million worldwide. About 75,000 patients were supported by these baUoon pumps in 1994. This market is thought to have peaked. 

As an integral member of THI s animal research team, Brano designed and preformed studies involving myocardial protection during cardiac operations, as well as temporary and permanent mechanical circulatory assist devices, heart valve prostheses, and synthetic vascular grafts. In addition he authored, and co- authored approximately 300 publications, and oversaw the writing of numerous heart failure and transplant protocols. 

More compliant highly fluorinated polymers for reconstructive surgery (e.g., vascular grafts) and other surgical devices will undoubtedly be developed. Various ophthalmologic aids are also being commonly used. 

Artificial biologies, whelher soff or hard, can be categorized as eifher temporary (short term) or permanent (long term) in their intended application. Most, but certainly not all, polymers for biomedical applications are of the short-term type and include sutures, drug delivery devices, temporary vascular grafts and stents, tissue scaffolds. 

Early reports of the biomedical use of poly(lactic acid) date back to the 1960s [3, 175]. Since then, PLA has gained widespread application in the medical field, for use in sutures [8], drug delivery devices [15, 17, 24, 59-90], prosthetics, scaffolds, vascular grafts, and bone screws, pins and plates for temporary internal fracture fixation [10-13]. Good mechanical properties and the fact that it de-... 

Many other applications for plasma polymers in the Life Sciences have been dted, often in relation to implantable medical devices or materials, with the goal of concealing the device from the bodies defence mechanisms, or improving cell colonisation of the material, e.g. endothelial cell growth into vascular grafts. A number of excellent studies from the group of Hans Griesser (CSIRO, Australia) describe the use of plasma polymers as substrates to which biomolecules can be immobilised. These immobilisations have been demonstrated to enhance the medium-term acceptability of contact lens materials and may prove relevant to implantable devices. 

Devices principally contacting blood (pacemaker electrodes, heart valves, vascular grafts and stents, internal drug delivery catheters, and ventricular assist devices)... 

Permanent implants, prostheses, vascular grafts, catheters, and drug delivery devices... 

Medical PUs are another subset of PU elastomers. Segmented PUs were first suggested for use in a biomedical application in 1967. ° Early work with PU elastomers showed that these materials could be used for implants without causing a large, unwanted inflammatory response. The first medical devices made of PUs, however, were found to be susceptible to hydrolysis and degraded faster than desired. ° From that time, new biostable materials have been developed for use as pacemaker leads, catheters, vascular grafts. 

A wide number and great variety of clinically important cardiovascular implants and devises exist. Some (e.g., catheters) may only contact the blood once, and for a relatively short time others (e.g., kidney dialyzers and blood oxygenators) may be exposed to blood for hours, while tissue implants (e.g., heart valves and vascular grafts) will hopefully last for years, or the lifetime of the patient. All of these implants nd devices contain materials that are recognized by blood as foreign the result is a process of thrombosis often followed by formation of thromboemboli. This process generally involves a sequence of protein adsorption steps followed by blood cell interactions (especially involving platelets). 

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