Extravascular perivenous fibrin support leads to aneurysmal degeneration and intimal hyperplasia in arterialized vein grafts in the rat

Stojanović, Tomislav; Ahmad, Ali; Didilis, Vassilios; Ali, Osama; Popov, Aron Frederik; Danner, B; Seipelt, Ralf; Dörge, Hilmar; Schöndube, Friedrich A.

doi:10.1007/s00423-008-0341-3

Cited by 5 publications

(9 citation statements)

References 18 publications

(23 reference statements)

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“…Experimental data have shown that the application of fibrin glue on the external surface of vein grafts lead to aneurysmal degeneration and excessive intimal hyperplasia which may have jeopardized vein graft patency [17][18]. Recent clinical data showed that suturing and fixating an external support device to the anastomoses leads to early failure of vein grafts, most probably due to an acute constriction of the anastomosis site [15].…”

Section: Resultsmentioning

confidence: 99%

Inhibition of vein graft remodeling and neo-intimal formation using a cobalt chrome external support

Nitecki¹,

Yosef²,

Tozzi³

et al. 2018

Arch Clin Exp Surg

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IntroductionThe autologous vein bypass remains the most effective and durable revascularization strategy for patients with critical limb ischemia [1]. However, despite significant advances in the understanding of venous pathophysiology post-implantation, little progress was made in the clinical setting in which vein graft failure rate is still 30 -50% within 3 to 5 years [1,2].Early graft occlusion, within one month from implantation, is generally ascribed to technical or procedural related complications (e.g., kinking and twisting) or poor conduit quality. Late vein graft failure is attributed to the structural changes that occur in the conduit immediately post-implantation due to the exposure to Following completion of the first anastomosis, randomization was performed to allocate the experimental and control grafts in each animal. Post-procedure, Doppler US was used to assess grafts lumen diameter at T0 and then 3-5 and 12-14 weeks after surgery. At 12-14 weeks, all sheep underwent angiography to assess grafts patency and lumen uniformity (coefficient of variance -CV) after which they were sacrificed, and all grafts were harvested for microscopic histological analysis. Results: Baseline (T0) internal diameter was not significantly different between the supported and unsupported grafts. At twelve to fourteen weeks, the internal diameter of supported grafts remained unchanged and was significantly lower compared to the non-supported grafts (6.6mm±0.4mm vs. 12.8mm±4.0mm respectively, p= 0.0001). Percentage coefficient of variance (%CV) was 4.6% ± 4.3 in the supported grafts as opposed to average CV% of 14.7% ±6.5 in the non-stented group (p=0.011). Neointimal area was significantly lower in the stented compared to the non-stented group (1.4 mm2± 3.3mm2 versus 9.6mm2 ± 9.7mm2 respectively, p=0.009). Inhibition of vein graft remodeling and neo-intimal formation using a cobalt chrome external support Conclusions:External support of vein grafts using a braided cobalt chrome external stent reduces early vein graft remodeling and mitigates the development of neointimal hyperplasia.

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Section: Resultsmentioning

confidence: 99%

Inhibition of vein graft remodeling and neo-intimal formation using a cobalt chrome external support

Nitecki¹,

Yosef²,

Tozzi³

et al. 2018

Arch Clin Exp Surg

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“…This effect is associated with maintenance of blood vessel endothelium integrity, inhibition of PCNA expression, facilitation of smooth muscle cell migration, and formation of a new vascular network (Wan et al, 2006a,b). However, the long-term consequences are disputed (Stojanovic et al, 2009); therefore, attention must be given to the mechanism underlying restenosis.…”

Section: Discussionmentioning

confidence: 99%

Apoptosis, proliferation, and morphology during vein graft remodeling in rabbits

et al. 2016

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ABSTRACT. Neo-intima development and atherosclerosis limit the long-term use of vein grafts for revascularization of ischemic tissues. Recently, studies have confirmed that proliferating cell nuclear antigen (PCNA) plays an important role in cell proliferation. Our research confirmed that 28 days after vein transplantation, PCNA expression increases significantly. Using rabbits, rather than rodents, for a more representative model of human vein grafts, we aimed to establish a time course of changes in cell proliferation and apoptosis using morphometric and immunohistochemical analyses, western blot, terminal deoxynucleotidyl transferase dUTP nick end labeling, and transmission electron microscopy (TEM). The external jugular veins of 42 healthy purebred male New Zealand white rabbits were grafted onto their common carotid arteries. The rabbits were divided into seven groups, with vein grafts being harvested before surgery, and at 1, 3, 7, 14, 28, and 90 days afterwards. The extent of stenosis and apoptosis, PCNA protein levels, and TEM morphology were subsequently examined. Intimal thickness was slightly decreased 1 day following surgery, but then increased continuously until the 90th day. Western blot and immunohistochemistry both indicated lowered PCNA expression on day 1, although levels subsequently increased, peaking at 7 days post-surgery. After surgery, apoptosis was lowest on day 7, and remained low thereafter. TEM revealed signs of apoptosis as vein graft restenosis progressed. Proliferation and apoptosis cooccurred following grafting, indicating that both processes were involved in vein graft remodeling. Apoptosis levels were highest between days 1 and 3 after surgery, whereas proliferation culminated on the 7th day.

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“…Grafik 1: (Stojanovic et al 2009) Kontrollgruppe: Venentransposition ohne Anwendung von Fibrinkleber (schwarze Säulen) vs. Fibrinkleber-Gruppe: Venentransposition mit Anwendung von Fibrinkleber (weiße Säulen).…”

Section: Intimale Flächeunclassified

“…Intimafläche (µm 2 ) 2517166±356 p < 0,05 18424000±493 p < 0,05 Grafik 2: (Stojanovic et al 2009) Totale Wanddicke (μm) gemessen in der Kontrollgruppe (weiße Säulen) und in der Fibrinkleber-Gruppe (schwarze Säulen). Kontrollgruppe: Venentransposition ohne Anwendung von Fibrinkleber (weiße Säulen) Fibrinkleber-Gruppe: Venentransposition mit Anwendung von Fibrinkleber (schwarze Säulen).…”

Section: Ergebnisse Der Messungenunclassified

“…Bild 2: (Stojanovic et al 2009) Der histologische Schnitt eines Venengrafts mit externer Stabilisierung mittels Fibrinkleber nach Hämatoxylin-und Eosin-Färbung zeigt die Zerstörung der Adventitia einer aneurysmatischen degenerierten Wand des Venengrafts (25fache Vergrößerung). Bild 3: (Stojanovic et al 2009) Der detaillierte histologische Schnitt eines Venengrafts mit externer Stabilisierung mittels Fibrinkleber nach Hämatoxylin-und Eosin-Färbung zeigt eine starke Infiltration von mononukleären Zellen und Schaumzellen (Pfeile) (100-fache Vergrößerung).…”

Section: Der Histologische Schnitt Eines Venengrafts Mit Externer Sta...unclassified

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Externe Stabilisierung von Venenbypässen durch Fibrinkleber führt zur Intimahyperplasie und aneurysmatischen Venengraftdegeneration.

Ali¹

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Extravascular perivenous fibrin support leads to aneurysmal degeneration and intimal hyperplasia in arterialized vein grafts in the rat

Cited by 5 publications

References 18 publications

Inhibition of vein graft remodeling and neo-intimal formation using a cobalt chrome external support

Inhibition of vein graft remodeling and neo-intimal formation using a cobalt chrome external support

Apoptosis, proliferation, and morphology during vein graft remodeling in rabbits

Externe Stabilisierung von Venenbypässen durch Fibrinkleber führt zur Intimahyperplasie und aneurysmatischen Venengraftdegeneration.

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