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Introduction : AFX is a bifurcated unibody aortic endograft for the treatment of Abdominal Aortic aneurysms. It consists of an inner metallic endoskeleton with multiple metallic struts covered by a polytetrafluoroethylene graft fabric. The endoskeleton is sutured to the outer fabric only at the proximal and distal ends. The unique design of AFX aims at fixation onto the aortic bifurcation while a proximal cuff ensures sealing at the infrarenal level. Areas covered : Since this endograft design by Endologix has undergone significant changes over the last years, the aim of this article is to present its unique structure and deployment method and discuss the relevant clinical results as well as reported complications and associated concerns. Expert commentary : the AFX stent-graft exhibits very satisfactory clinical mid-term results in abdominal aortic aneurysms treated within the instructions-for-use. Its 'active-seal' concept of infrarenal fixation stemming from the loose conjugation of the fabric material to the endoskeleton can accommodate efficiently to challenging necks with thrombus or morphological irregularities, thereby extending the anatomical sealing zone without exerting significant radial outward force. Long-term results are needed to validate the promising performance of AFX.

This article reviews the present state of small-diameter vascular substitution, the mechanisms of graft failure and the ongoing matters of graft design, with particular attention to small-caliber grafts. Tissue engineering of blood vessels with the mechanical properties of native vessels and with the antithrombotic properties required is really a great challenge. Recent advances, however, indicate that the goal of providing a tissue-engineered vascular graft that will remain patent in vivo for substantial periods of time, is achievable. This review describes the specific requirements of the successful replacement artery from a biomaterial- and tissue-engineering perspective, as well as various approaches in vascular tissue engineering including cells and cell sources, scaffolds and their improvements as well as bioreactors and signaling.

This article reviews the clinical use of stents in the treatment of coronary artery disease and the rationale for the use of degradable, drug-eluting polymer stents. The authors note the challenges of using off-the-shelf polymers for the development of degradable stents, as well as the interplay between polymer properties and a functional stent design. Drug-eluting metal stents are the most significant advancement in the treatment of coronary artery disease, and have significantly reduced the occurrence of in-stent restenosis after placement. Some regard drug-eluting metal stents as the final technologic advancement in the treatment of coronary artery disease, others consider the future development of degradable, drug-eluting stents as the next logical step.

Currently, autologous veins are the first choice for patients in need of bypass grafting materials. However, due to either pre-existing conditions or previous bypass surgery, some patients lack the necessary amount of host tissue for such procedures. Unfortunately, current synthetic vascular grafts of less than 6 mm in diameter have been plagued by a variety of problems. For this reason, there has been significant research aimed at finding more suitable small-diameter vascular graft materials. In order to improve vascular cell functions on such synthetic materials, several techniques are currently under development that attempt to mimic the natural nanometer architecture of the vascular basement membrane. This review presents several processes including colloidal lithography, chemical etching, electrospinning and solid free-form fabrication that could play a role in the future of vascular nanostructured biomaterial development.