Bioengineered Human Arteries for the Repair of Vascular Injuries
Authors: Moore Ernest E. , Curi Michael , Namias Nicholas , Kundi Rishi , Lum Ying Wei , Fox Charles J. , Rajani Ravi R. , Rasmussen Todd E. , Sokolov Oleksandr , Niklason Laura E. , Khondker Zakaria , Parikh Shamik J. ,   CLN-PRO-V005 Investigators and the CLN-PRO-V017 Investigators, Kundi Rishi , Morrison Jonathan , Brenner Megan , Lum Ying Wei , Shores Jaimie , Rajani Ravi , Namias Nicholas , Moore Ernest , Fox Charles , Curi Michael , Fujitani Roy , Magee Gregory , Batista Philip , Trani Jose , Oresanya Lawrence , Sjoholm Lars , Calero Aurelia , Seamon Mark , Malas Mahmoud , Clouse Darrin , Naslund Thomas , Schreiber Martin , Callcut Rachael , Grandas Oscar , Skarupa David , Southerland Kevin , Freeman Carl , Rasmussen Todd , Hurie Justin , Goldin Ilya , Karram Tony , Greenberg George , Halak Moshe , Sokolov Oleksandr , Shaprynskyi Vasyl , Skupyy Oleh , Yurets Serhii , Stanko Oleksandr 
Published: November 2024

ImportanceVascular injuries require urgent repair to minimize loss of limb and life. Standard revascularization relies on autologous vein or synthetic grafts, but alternative options are needed when adequate vein is not feasible and when clinical conditions preclude safe use of synthetic materials.ObjectiveTo evaluate the performance of the acellular tissue engineered vessel (ATEV) in the repair of arterial injuries.Design, Setting, and ParticipantsTwo open-label, single-arm, nonrandomized clinical trials, including 1 prospective civilian study (CLN-PRO-V005 [V005]) and 1 retrospective observational study in a war zone (CLN-PRO-V017 [V017]), were conducted from September 2018 to January 2024 (follow-up ongoing) at 19 level 1 trauma centers in the US and Israel and 5 frontline hospitals in Ukraine. Patients had vascular injury, no autologous vein available for emergent revascularization, and risk factors for wound infection. Data were analyzed from September 2023 to January 2024.InterventionThe ATEV is a bioengineered vascular conduit grown from human vascular cells, available off the shelf, and implantable without immunosuppression.Main Outcomes and MeasuresPrimary patency at day 30 was the primary outcome. Secondary outcomes included limb salvage, graft infection, and patient survival. A systematic literature review identified synthetic graft benchmarks in the treatment of arterial trauma for the same end points.ResultsThe V005 and V017 studies evaluated 69 and 17 patients, respectively, and included 51 in V005 and 16 in V017 with noniatrogenic arterial injuries of the extremities. The majority were male (V005, 38 [74.5%]; V017, 16 [100%]), the mean (SD) ages were similar (V005, 33.5 [13.6] years; V017, 34.2 [9.0] years), and the mean (SD) Injury Severity Scores were similar (V005, 20.8 [10.5]; V017, 20.1 [18.9]). Penetrating injuries dominated (V005, 29 patients [56.9%]; V017, 14 patients [87.5%]). At day 30 for the V005 and V017 trials, respectively, ATEV primary patency was 84.3% (95% CI, 72.0%-91.8%) and 93.8% (95% CI, 71.7%-98.9%); secondary patency was 90.2% (95% CI, 79.0%-95.7%) and 93.8% (95% CI, 71.7%-98.9%); amputation rate was 9.8% (95% CI, 4.3%-21.0%) and 0% (95% CI, 0.0%-19.4%); ATEV infection rate was 2.0% (95% CI, 0.4%-10.3%) and 0% (95% CI, 0.0%-19.4%); and death rate was 5.9% (95% CI, 2.0%-15.9%) and 0% (95% CI, 0.0%-19.4%) (no deaths attributed to the ATEV). Day 30 synthetic graft benchmarks were as follows: secondary patency, 78.9%; amputation, 24.3%; infection, 8.4%; and death, 3.4%.Conclusions and RelevanceResults of 2 single-arm trials in civilian and real-world military settings suggest that the ATEV provides benefits in terms of patency, limb salvage, and infection resistance. Comparing ATEV outcomes with synthetic graft benchmarks demonstrates improved outcomes in the treatment of acute vascular injuries of the extremities.Trial RegistrationClinicalTrials.gov Identifiers: NCT03005418, NCT05873959