Vascular Research
The Division of Vascular Surgery has active research programs in both clinical and basic science. The Division has developed a clinical focus on
surgical outcomes and the functional health of patients with vascular disease. The central objective of the basic science program is to develop an improved
understanding of the important cell-cell and cell-biomaterial interactions within the vasculature.
Clinical Research
The faculty of the Division of Vascular Surgery has a diversity of clinical interests that is reflected in the clinical research performed.
A common theme to the many projects both completed and in progress is a focus on improving the outcome and functional health of patients after vascular surgery.
There are ongoing projects in many areas including: the use of prophylactic inferior vena cava filters to prevent fatal pulmonary embolism in high risk trauma
patients; evaluation of the ability to reduce the risk of stroke following carotid endarterectomy combined with coronary artery bypass grafting in patients with
significant narrowing of the carotid arteries; identification of optimal treatment strategies for the management of dialysis access grafts and fistulae; and the
prospective evaluations of endovascular interventions for lower extremity ischemia and aortic aneurysmal disease.
A new direction in research has been the addition of a focus on surgical outcomes as a means to evaluate treatment modalities. The first project
brought to completion was a study utilizing the SF-36 health assessment questionnaire to identify determinants of patient health following either supra or
infra-inguinal reconstructions for lower extremity ischemia. This study identified clinical predictors of the functional health of patients undergoing surgical
reconstruction. The second project is an evaluation comparing the functional outcome of patients with aortic occlusive and aortic aneurysmal disease after traditional
surgical reconstructions.
Basic Research
The basic science efforts of the Division are lead by Gary Nackman, M.D. the focus of this program has been translational research.
The areas of interest include: identifying mechanisms responsible for vascular wall remodeling, measuring hemodynamic forces in blood vessels, studying the
interactions of the constituent cells of a blood vessel with biomaterials, and identifying the relationship of biomaterial infection with graft thrombosis.
We have developed and validated a unique endothelial cell-smooth muscle cell flow model co-culture system. This novel model provides a better
understanding of the role of ECs in the modulation of SMC behavior, and the ability to study methods to improve endothelial cell adaptation to the mechanical force of
shear stress. A focus of this project is to examine the biochemical and molecular interactions between endothelial cells and smooth muscle cells in the context of
physiologic hemodynamic forces, and to test the hypothesis that exposure of endothelial cells to different levels of continuous shear stress is a sufficient cause to
change smooth muscle cell behavior associated with the process of intimal hyperplasia. This project has been supported by a grant from the Foundation of UMDNJ. We have
identified that human vascular smooth muscle cells improve endothelial cell adaptation to shear stress and have used this observation to initiate a program to study
methods of improving endothelial adaptation. This projected is funded by both the NIH and the NJ Center for Biomaterials.
We are continuing a project to study the role of biomaterial porosity on endothelial cell-smooth muscle cell interactions in the co-culture flow
model. This project is a multi-investigator program linking mechanical and biochemical engineers from Rutgers to our Division. This study has been funded by the NJ
Center for Biomaterials and UMDNJ-RWJMS Dept. of Surgery in the past and is currently funded by the NIH.
Dr. Graham has been a leader in the study of graft infection. We have performed studies identifying links between infection of prosthetic graft
material and both thrombosis and intimal hyperplasia. We have identified that latent graft infection may be a stimulus for anastomotic intimal hyperplasia and have
started planning of a clinical project to confirm this observation.
In addition, collaborations with The NJ Center for Biomaterials have been strengthened through the successful submission of a NIH training grant
for post-doctoral education in bioengineering. This collaborative effort among the NJCBM and the Dept. of Surgery has yielded the only T32 grant of its kind in the
U.S.A. Our Vascular Fellows have had tremendous opportunities to purse both clinical and basic research projects as demonstrated by numerous presentations and
publications at meetings such as the Surgical Forum, Association for Academic Surgery, Society for Vascular Surgery, Society of University Surgeons, Society of Vascular
Medicine and Biology, Eastern Vascular Society, and the Vascular Society of NJ.
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