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Orthopedic suture, as an implantable surgical device for skeletal and soft tissue connection, is vital in tendon or ligament injury repair. Resorbable therapy approaches exhibit excellent biocompatibility in the field of suture materials but lack a long-term fixation effect in orthopedic treatment. Herein, this study focused on a series of partially absorbable orthopedic sutures, which were composed of absorbable polycaprolactone (PCL) multifilament and non-absorbable ultra-high molecular weight polyethylene (UHMWPE) multifilament. Comprehensive in vitro mechanical evaluations were conducted to probe the relationship between material composition and mechanical properties of the sutures. The results showed that the partially absorbable sutures, especially P/U = 50/50 and P/U = 25/75, exhibited significant improvements in mechanical properties compared to single-material sutures. The tensile strength of P/U = 50/50 and P/U = 25/75 was 180.99 and 210.91 N, respectively, which was about two times higher than that of absorbable PCL suture P/U = 100/0 (62.42 N). Furthermore, their suture-to-suture friction force was 1.89 times and 2.51 times that of non-absorbable UHMWPE suture P/U = 0/100, respectively, which guaranteed good knot security. Compared with the clinically used orthopedic suture Ethibond (110 N), P/U = 50/50 and P/U = 25/75 also presented superior tensile properties. Notably, P/U = 50/50 and P/U = 25/75 had similar tensile curves to that of the native tendon/ligament, which might be beneficial to tissue healing. Moreover, the R2 of Eyring's model to simulate the creep curves of each suture was higher than 0.99, which indicated that Eyring's model could be used in predicting the long-term creep behavior of the sutures.

A PVA/PAAm (polyvinyl alcohol/polyacrylamide) hydrogel vascular graft reinforced by a braided fiber stent was prepared in the present work, and a series of characterizations were carried out for evaluating the comprehensive performance of the reinforced hydrogel vascular graft (RHVG), including the morphology, the mechanical properties and the biocompatibility. The results show that hydrogel with a mass ratio of 5:8 (PVA:PAAm) is the best candidate for developing an implantation-oriented vascular graft, whose overall performance is the closest to the requirements of clinical applications. The surface of the PVA/PAAm hydrogel is smooth, and the porous structure is uniform and stable. When the longitudinal strain of the RHVG was 50%, the tensile strength reached 905.6 ± 63.1 kPa, much higher than that of a swine common carotid artery (185 kPa). Moreover, the circumferential tensile strength was significantly enhanced by the integration of the stent, and the circumferential compression recovery reached 93.4 ± 6.7%, showing satisfactory structural stability. Furthermore, the suture retention force approached (9.89 ± 0.64 N), higher than that of a canine femoral artery (7.90 ± 0.36 N). More importantly, the radial dynamic compliance reached 3.11 ± 0.09% under testing pressure of 80–120 mmHg, which is 6.9 times that of a commercial expanded polytetrafluoroethylene vascular graft. Lastly, the RHVG has satisfying cytocompatibility and a low hemolysis rate. In summary, the present work may pave the way for developing a novel small-diameter vascular graft for clinical implantation.

Water permeability of textile vascular grafts has been considered as a key indicator for predicting blood permeability after implantation. However, a correlation between water and blood permeability has not been established yet. Therefore, even though the water permeability of a vascular graft can be tested according to the standard ISO 7198, the results fail to guide a manufacturer or a surgeon to judge whether this vascular graft needs pre-clotting or not prior to implantation. As a result, all commercial graft products show almost zero water permeability, which leads to the loss of advantages that textile vascular grafts have the pore size-controlled porous wall. To solve this problem, four types of woven vascular grafts were designed and manufactured in the present work. Then their permeability to water, simulated plasma, and anticoagulated whole blood were measured at graded pressures from 8 to 16 kPa. Moreover, the correlations among the water permeability, the simulated plasma permeability, and the anticoagulated whole blood permeability were established. The results suggest that relatively steady correlations exist between the water permeability and the anticoagulated whole blood permeability, and that the evaluation of the blood permeability using the water permeability is feasible and objective. The present work provides a quantitative method for evaluating the blood permeability using the water permeability, and the latter is thus endowed with practical significance for guiding designs and clinical pre-clotting operations of textiles vascular grafts.

Developing a small-diameter vascular graft with a satisfactory performance in terms of mechanical and biological properties remains a challenging issue because of comprehensive requirements from clinical applications. Polyvinyl alcohol (PVA)/polyacrylamide (PAAm) hydrogels exhibit many desirable characteristics for small-diameter vascular grafts because of their tunable mechanical properties, especially high compliance. However, poor cells adhesion hinders their application for endothelialization in situ. Therefore, in the present work, polydopamine (PDA) and tetrapeptide Arg-Glu-Asp-Val (REDV) were used to functionalize the hydrogels surface and improve cells adhesion. A series of characterizations were systematically conducted to examine the applicability of coated hydrogels to small-diameter vascular grafts. Results showed that bare and coated hydrogels have appropriate structural stability, and no significant differences in tensile properties could be found after being coated with PDA or PDA-REDV. The hydrophilicity of the hydrogels decreased with the coatings of PDA and especially PDA-REDV to improve protein adsorption, porcine iliac artery endothelial cells (PIECs) adhesion, viability, proliferation, and spreading on the hydrogels. Lower hemolysis percentages and higher blood clotting index values were attained for the hydrogels, suggesting their satisfactory hemocompatibility. Overall, the present work provided insights into the development of a novel hydrogel-based small-diameter vascular graft. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:117-127, 2020.

An endothelial cell (EC) monolayer aligned along the direction of blood flow in vivo shows excellent capacity for anti-inflammation and anti-thrombosis. Therefore, aligned electrospun fibers have been much studied in the field of vascular implants since they are considered to facilitate the formation of an aligned EC monolayer, yet few research studies have been comprehensively reported concerning the effects of diameter scales of aligned fibers. In the present work, a series of aligned polycaprolactone (PCL) electrospun fibers with varying diameters ranging from dozens of nanometers to several micrometers were developed, and the effects of the fiber scales on EC behaviors, hemocompatibility as well as inflammatory cell behaviors were investigated, to evaluate their potential performance in the field of vascular implants. Our results showed that platelets exhibited small attachment forces on all fibers, and the anticoagulation property improved with the decrease of the fiber diameters. The impact of fiber diameters on human umbilical vein endothelial cell (HUVEC) adhesion and NO release was limited, while significant on HUVEC proliferation. With the increase of the fiber diameters, the elongation of HUVECs on our samples increased first then decreased, and exhibited maximum elongation degrees on 2738 nm and 2036 nm due to the strong contact guidance effect on these graphical cues; too thick or too fine fibers would weaken the contact guidance effect. Furthermore, we hypothesized that HUVECs cultured on 2036 nm had the smallest spreading area because of their elongation, but 2738 nm restricted HUVECs spreading limitedly. Similarly, NO production of HUVECs showed a similar change trend as their elongation degrees on different fibers. Except for 2036 nm, it exhibited the second highest NO production. For RAW 264.7 cells, poorer cell adhesion and lower TNF-α concentration of 1456 nm indicated its superior anti-inflammation property, while 73 nm showed a contrasting performance. Overall, these findings partly revealed the relationship between different topographies and cell behaviors, providing basic insight into vascular implant design.

Polyethylene glycol terephthalate (PET) fabrics with woven structures have proved to be quite effective for use on large diameter artificial blood vessels. However, their use within small-diameter artificial blood vessels has been associated with poor long-term patency, a problem resulting from slow endothelialization on PET and an over hyperplasia of smooth muscle cells. Previous research from our laboratory has revealed that ICAM-1 can be used as a marker to investigate cell adhesion, an effect which was closely associated with cell behavior on the surface of polycaprolactone (PCL) films. Moreover, we found that the coarseness or pore size of the surface exerts considerable influence on cell adhesion and proliferation on PCL films. In this study, we successfully fabricated six types of PET woven fabrics with varying gradients of tightness and porosities. Levels of ICAM-1 expression (membrane ICAM-1 & soluble ICAM-1) were then determined in these woven fabrics. Our results show that increased levels of mICAM-1 and decreased levels of sICAM-1 expression were obtained in HUVECs seeded on these six samples. These findings indicate that cell adhesion and proliferation on fabric surfaces were strongly influenced by their structural parameters, in particular the initial adhesion between the cell and fabric surface. In addition, we also found that extracellular matrix adhesion tends to prefer flat and tight surfaces, which promotes cell-cell and cell-matrix interactions, as well as the endothelialization on the surface of PET fabrics. These findings provide some novel insights with regard to the design and application of small-diameter artificial blood vessels. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 954-964, 2018.

Acute thrombosis remains the main limitation of small-diameter vascular grafts (inner diameter &lt, 6 mm) for bridging and bypassing of small arteries defects and occlusion. The use of hydrogel tubes represents a promising strategy. However, their low mechanical strength and high swelling tendency may limit their further application. In the present study, a hydrogel vascular graft of Ca alginate/polyacrylamide reinforced with a braided fiber strut was designed and fabricated with the assistance of a customized casting mold. Morphology, structure, swellability, mechanical properties, cyto- and hemocompatibility of the reinforced graft were characterized. The results showed that the reinforced graft was transparent and robust, with a smooth surface. Scanning electron microscopic examination confirmed a uniform porous structure throughout the hydrogel. The swelling of the reinforced grafts could be controlled to 100%, obtaining clinically satisfactory mechanical properties. In particular, the dynamic circumferential compliance reached (1.7 &plusmn, 0.1)%/100 mmHg for 50&ndash, 90 mmHg, a value significantly higher than that of expanded polytetrafluoroethylene (ePTFE) vascular grafts. Biological tests revealed that the reinforced graft was non-cytotoxic and had a low hemolysis percentage (HP) corresponding to (0.9 &plusmn, 0.2)%. In summary, the braided fiber-reinforced hydrogel vascular grafts demonstrated both physical and biological superiority, suggesting their suitability for vascular grafts.

Here, we investigate the relationship between the expression of intercellular adhesion molecule-1 (ICAM-1) and the adhesion of human umbilical vein endothelial cells (HUVECs) on a poly-e-caprolactone (PCL) film with micropores of different pore sizes. The results showed that surface hydrophilicity increased with larger pore sizes, while surfaces became less hydrophilic as the pore size decreased. The ability for adhesion and proliferation of HUVECs on surfaces with larger pore sizes was enhanced as compared with that of surfaces with smaller pore sizes or a flat film. Furthermore, levels of mICAM-1 were increased and sICAM-1 decreased as a function of increasing pore size. These findings demonstrate that film surfaces with larger pore sizes may promote cell adhesion and proliferation and lead to increases in expression of mICAM-1. Thus, we conclude that the pore size of the material's surface exerts a significant impact on the expression of adhesion molecules, the expression of which can represent an important new marker for investigating cell-surface adhesion and proliferation. Moreover, as elevated levels of sICAM-1 are associated with conditions such as inflammation, thrombosis, cerebral infarct and other diseases in vivo, it may serve as an early-warning risk marker when using medical biomaterials. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2775-2784, 2016.

Stents have been widely used in percutaneous surgery to treat stenosis diseases. The braided NiTi stent, as a promising prototype, still has limitations of low radial force and loose structure. In the present study, a newly integrated composite stent was designed and braided with NiTi wires and polyester multifilament yarns by textile technology. The mechanical properties of four composite stents and the control bare NiTi stent were evaluated by in vitro compression, bending and anti-torsion tests. The results showed that integrated polyester/NiTi composite stents were superior in radial support. The stents could keep patency even when highly curved and had lower stent straightening force. Composite stents with certain structure stayed stable under twisting. The configuration of NiTi wires in composite stents could significantly impact stent deformation under twisting. Keywords: Vascular stent, Mechanical performance, Compression, Bending, Torsion

Stent-grafts in peripheral arteries suffer from complex cyclic loadings in vivo, including pulsatile, axial bending and torsion. Normal fatigue durability evaluation technologies, however, are majorly based on pulsation and thus are short of accuracy under the complicated stress conditions experienced physiologically. While there is a little research focused on the cyclic fatigue of stent-grafts in bending, it remains an almost total lack of deformation or fatigue mechanisms. In this work, composite braided stent-grafts incorporating Nitinol (NiTi) yarns and polyethylene terephthalate (PET) multifilament yarns were cycled in bending by the self-developed testing system to investigate their deformation behaviors. Deformation mechanisms at the yarn level were discussed, and NiTi yarn crossover structure was considered the primary factor affecting the deformation modes. Four yarn-crossover-based deformation modes (accordion buckling, diamond-shaped buckling, neck propagation and microbuckling) revealed the mechanisms of energy absorption of braided stent-grafts on the mesoscopic scale. Further, mechanical modes were applied to help regulate stent designs.

Vascular basement membrane (VBM) is a thin layer of fibrous extracellular matrix linking endothelium, and collagen type IV (COL IV) is its main composition. VBM plays a crucial role in anchoring down the endothelium to its loose connective tissue underneath. For vascular grafts, constructing biomimetic VBMs on the luminal surface is thus an effective approach to improve endothelialization in situ. In the present work, three types of polycaprolactone (PCL) membranes were produced and characterized through cell counting kit-8 (CCK-8) assay, adhesion force and elastic modulus test to examine the influence of fiber diameter and membrane composition on vascular endothelial cell (EC) behaviors. The PCL membranes with finer fibers of 54.77 nm (PCL-54) could biomimic the nanotopography of VBMs more efficiently than 544.64 nm (PCL-544), and they were more suitable for Pig iliac endothelium cells (PIECs) adhesion and proliferation, meanwhile, inducing higher elastic modulus and adhesion force of PIECs. On this foundation, we further immobilized COL IV onto PCL-54 (PCL-COL IV) to biomimic VBMs compositionally. Results showed that PIECs on PCL-COL IV exhibited the highest viability and proliferation. Besides, quantitative data indicated that the elastic modulus of the PIECs on PCL-COL IV (4441.00 Pa) was as two times higher than that on PCL-54 (2312.26 Pa), and the adhesion force grew to 1120.99 pN from 673.58 pN of PIECs on PCL-54. In summary, the PCL-COL IV membranes show high similarity with the native VBMs in terms of structure and composition, suggesting a promising potential for surface modification to vascular grafts for improved endothelialization.