A novel hybrid silk-fibroin/polyurethane three-layered vascular graft: Towards in situ tissue-engineered vascular accesses for haemodialysis

Sebastião van Uden, Noemi Vanerio, Valentina Catto, Barbara Bonandrini, Matteo Tironi, Marina Figliuzzi, Andrea Remuzzi, Linda Kock, Alberto C.L. Redaelli, Francesco G. Greco, Stefania A. Riboldi (Corresponding author)

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Clinically available alternatives of vascular access for long-term haemodialysis - currently limited to native arteriovenous fistulae and synthetic grafts - suffer from several drawbacks and are associated to high failure rates. Bioprosthetic grafts and tissue-engineered blood vessels are costly alternatives without clearly demonstrated increased performance. In situ tissue engineering could be the ideal approach to provide a vascular access that profits from the advantages of vascular grafts in the short-term (e.g. early cannulation) and of fistulae in the long-term (e.g. high success rates driven by biointegration). Hence, in this study a three-layered silk fibroin/polyurethane vascular graft was developed by electrospinning to be applied as long-term haemodialysis vascular access pursuing a 'hybrid' in situ engineering approach (i.e. based on a semi-degradable scaffold). This Silkothane ® graft was characterized concerning morphology, mechanics, physical properties, blood contact and vascular cell adhesion/viability. The full three-layered graft structure, influenced by the polyurethane presence, ensured mechanical properties that are a determinant factor for the success of a vascular access (e.g. vein-graft compliance matching). The Silkothane ® graft demonstrated early cannulation potential in line with self-sealing commercial synthetic arteriovenous grafts, and a degradability driven by enzymatic activity. Moreover, the fibroin-only layers and extracellular matrix-like morphology, presented by the graft, revealed to be crucial in providing a non-haemolytic character, long clotting time, and favourable adhesion of human umbilical vein endothelial cells with increasing viability after 3 and 7 d. Accordingly, the proposed approach may represent a step forward towards an in situ engineered hybrid vascular access with potentialities for vein-graft anastomosis stability, early cannulation, and biointegration.

Original languageEnglish
Article number025007
Pages (from-to)025007
Number of pages18
JournalBiomedical Materials
Issue number2
Publication statusPublished - 1 Mar 2019


  • early cannulation
  • electrospinning
  • fibroin
  • haemodialysis vascular access
  • hybrid vascular graft
  • in situ tissue engineering
  • polyurethane


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