Vascular surgery is facing a critical demand for novel vascular grafts that are biocompatible and thromboresistant. This urgency is particularly applicable to bypass operations involving small caliber vessels. In the realm of tissue engineering, the development of fully vascularized organs is promising as a solution to organ shortage for transplantation. To achieve this, it is essential to (re)construct a biocompatible and nonthrombogenic vascular network within these organs. In this systematic review, we identify, classify, and discuss basic principles and methods used to perform in vitro/ex vivo dynamic thrombogenicity testing of perfusable tissue-engineered organs and tissues. We conducted a preregistered systematic review of studies published in the last 23 years according to PRISMA-P Guidelines. This comprised a systematic data extraction, in-depth analysis, and risk of bias assessment of 116 included studies. We identified shaking (n = 28), flow loop (n = 17), ex vivo (arteriovenous shunt, n = 33), and dynamic in vitro models (n = 38) as the main approaches for thrombogenicity assessment. This comprehensive review reveals a prevalent lack of standardization and provides a valuable guide in the design of standardized experimental setups.
Impact Statement
The thrombogenicity of synthetic or biological engineered organs and tissues is the primary obstacle to their integration into clinical applications and should be properly examined. This review outlines the technical aspects associated with each method commonly implemented for dynamic thrombogenicity testing. Readers can learn about the experimental setup implemented in the main four methods, including shaking, flow loop, ex vivo dynamic perfusion, and arteriovenous shunts. Each table depicts detailed information on relevant parameters for each method. We are confident that this review will contribute to increasing standardization in the field and aid researchers in the process of conception and experiment design.
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