The FLOW Framework: a panvascular-on-a-chip platform to model systemic disease and guide panvascular interventional device suitcordance

Panvascular diseases, encompassing systemic vascular disorders driven by atherosclerosis, represent the leading cause of global mortality, posing significant challenges in modeling due to their prolonged, multi-organ nature and complex device-vessel interactions. Current in vitro and in vivo models fall short in recapitulating high-fidelity hemodynamics, long-term monitoring, multi-vascular bed heterogeneity, and three-dimensional (3D) dynamic interactions essential for advancing interventional device development. To address these gaps, we introduce the FLOW framework-a novel panvascular-on-a-chip platform leveraging organ-on-a-chip (OoC) technology. This framework integrates four core modules: Fidelity hemodynamic reconstruction (F) for simulation of physiological/pathological blood flow; Longitudinal physiological surveillance (L) for real-time tracking of chronic processes like endothelialization and inflammation; Omni-vascular bed modeling (O) for simulating coexisting lesions across diverse vascular beds and inter-organ crosstalk; and Whole-space 3D interactive work-flow (W) for evaluating device deployment and biomechanical interactions in 3D vascular microenvironments. Guided by the concept of "suitcordance" (defined here as short-term suitability and long-term concordance between devices and vascular tissues), the FLOW platform enables high-fidelity modeling of panvascular pathologies, such as atherosclerosis-induced downstream diseases (e.g., myocardial infarction, stroke, diabetic foot) and thrombosis, while facilitating optimization of interventional devices like stents, valves, and thrombectomy catheters to achieve post-intervention rebalancing of biomechanical, cellular, and physicochemical-immune ecologies. We review macro-construction foundations, including microfluidic technologies, real-time sensing, cell engineering, and hydrogel-based structural designs, and discuss applications in mechanistic studies and device translation. Future prospects include multi-organ integration, AI-driven analytics, long-term culture, and gene editing for personalized medicine, positioning panvascular-on-a-chip as a paradigm-shifting tool to bridge clinical outcomes, enhancing device-vessel harmony and combating humanity's "number one killer".