Off-the-Shelf Synthetic Biodegradable Grafts Transform In Situ into a Living Arteriovenous Fistula in a Large Animal Model

Paul J Besseling, Wojciech Szymczyk, Martin Teraa, Raechel J Toorop, Dan Jing Wu, Rob C H Driessen, Arturo M Lichauco, Henk M Janssen, Melanie van de Kaa, Krista den Ouden, Petra M de Bree, Joost O Fledderus, Carlijn V C Bouten, Gert J de Borst, Patricia Y W Dankers, Marianne C Verhaar*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Current vascular access options require frequent interventions. In situ tissue engineering (TE) may overcome these limitations by combining the initial success of synthetic grafts with long-term advantages of autologous vessels by using biodegradable grafts that transform into autologous vascular tissue at the site of implantation. Scaffolds (6 mm-Ø) made of supramolecular polycarbonate-bisurea (PC-BU), with a polycaprolactone (PCL) anti-kinking-coil, are implanted between the carotid artery and jugular vein in goats. A subset is bio-functionalized using bisurea-modified-Stromal cell-derived factor-1α (SDF1α) derived peptides and ePTFE grafts as controls. Grafts are explanted after 1 and 3 months, and evaluated for material degradation, tissue formation, compliance, and patency. At 3 months, the scaffold is resorbed and replaced by vascular neo-tissue, including elastin, contractile markers, and endothelial lining. No dilations, ruptures, or aneurysms are observed and grafts are successfully cannulated at termination. SDF-1α-peptide-biofunctionalization does not influence outcomes. Patency is lower in TE grafts (50%) compared to controls (100% patency), predominantly caused by intimal hyperplasia. Rapid remodeling of a synthetic, biodegradable vascular scaffold into a living, compliant arteriovenous fistula is demonstrated in a large animal model. Despite lower patency compared to ePTFE, transformation into autologous and compliant living tissue with self-healing capacity may have long-term advantages.

Original languageEnglish
Article numbere2303888
Number of pages12
JournalAdvanced Healthcare Materials
Issue number17
Early online date7 Mar 2024
Publication statusPublished - Jul 2024


  • AV shunt
  • biodegradable supramolecular material
  • biofunctionalization
  • goat model
  • in situ tissue engineering
  • vascular dialysis access


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