RESUMO
Abstract Background: Vein graft restenosis has an adverse impact on bridge vessel circulation and patient prognosis after coronary artery bypass grafting. Objectives: We used the extravascular supporter α-cyanoacrylate (α-CA), the local application rapamycin/sirolimus (RPM), and a combination of the two (α-CA-RPM) in rat models of autogenous vein graft to stimulate vein graft change. The aim of our study was to observe the effect of α-CA, RPM, and α-CA-RPM on vein hyperplasia. Methods: Fifty healthy Sprague Dawley (SD) rats were randomized into the following 5 groups: sham, control, α-CA, RPM, and α-CA-RPM. Operating procedure as subsequently described was used to build models of grafted rat jugular vein on carotid artery on one side. The level of endothelin-1 (ET-1) was determined by enzyme-linked immunosorbent assay (ELISA). Grafted veins were observed via naked eye 4 weeks later; fresh veins were observed via microscope and image-processing software in hematoxylin-eosin (HE) staining and immunohistochemistry after having been fixed and stored" (i.e. First they were fixed and stored, and second they were observed); α-Smooth Muscle Actin (αSMA) and von Willebrand factor (vWF) were measured with reverse transcription-polymerase chain reaction (RT-PCR). Comparisons were made with single-factor analysis of variance and Fisher's least significant difference test, with p < 0.05 considered significant. Results: We found that intimal thickness of the α-CA, RPM, and α-CA-RPM groups was lower than that of the control group (p < 0.01), and the thickness of the α-CA-RPM group was notably lower than that of the α-CA and RPM groups (p < 0.05). Conclusion: RPM combined with α-CA contributes to inhibiting intimal hyperplasia in rat models and is more effective for vascular patency than individual use of either α-CA or RPM.
Resumo Fundamento: Reestenose de enxertos venosos tem um impacto adverso na circulação de pontagens e no prognóstico de pacientes após a cirurgia de revascularização miocárdica. Objetivos: Nós utilizamos α-cianoacrilato (α-CA) como suporte extravascular, rapamicina/sirolimus (RPM) como aplicação local e a combinação dos dois (α-CA-RPM) em modelos de enxerto venoso autógeno em ratos para estimular mudança no enxerto venoso. O objetivo do nosso estudo foi observar o efeito de α-CA, RPM e α-CA-RPM na hiperplasia venosa. Métodos: Cinquenta ratos Sprague Dawley (SD) saudáveis foram randomizados nos 5 grupos seguintes: sham, controle, α-CA, RPM e α-CA-RPM. O procedimento operacional descrito subsequentemente foi utilizado para construir modelos de enxertos da veia jugular na artéria carótida em ratos, em um lado. O nível de endotelina-1 (ET-1) foi determinado por ensaio de imunoabsorção enzimática (ELISA). As veias enxertadas foram observadas a olho nu 4 semanas após; as veias frescas foram observadas via microscópio e software de processamento de imagem com coloração hematoxilina-eosina (HE) e imuno-histoquímica depois de serem fixadas e armazenadas; α-actina do músculo liso (αSMA) e o fator de von Willebrand (vWF) foram medidos com reação em cadeia da polimerase-transcriptase reversa (RT-PCR). Realizaram-se as comparações com análise de variância de fator único (ANOVA) e o teste de diferença mínima significativa (LSD) de Fisher, com p < 0,05 sendo considerado estatisticamente significante. Resultados: Nós achamos que a espessura intimal nos grupos α-CA, RPM e α-CA-RPM era menor que no grupo controle (p < 0,01) e a espessura no grupo α-CA-RPM era notavelmente menor que nos grupos α-CA e RPM (p < 0,05). Conclusão: A combinação de RPM e α-CA contribui à inibição de hiperplasia em modelos em ratos e é mais efetivo para patência vascular que uso individual de α-CA ou RPM.
Assuntos
Animais , Masculino , Feminino , Túnica Íntima/efeitos dos fármacos , Túnica Íntima/patologia , Sirolimo/farmacologia , Cianoacrilatos/farmacologia , Hiperplasia/prevenção & controle , Fatores de Tempo , Ensaio de Imunoadsorção Enzimática , Artérias Carótidas/patologia , Artérias Carótidas/transplante , Distribuição Aleatória , Ponte de Artéria Coronária/efeitos adversos , Reprodutibilidade dos Testes , Actinas/análise , Resultado do Tratamento , Ratos Sprague-Dawley , Endotelina-1/sangue , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Proliferação de Células/efeitos dos fármacos , Modelos Animais de Doenças , Combinação de Medicamentos , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/patologia , Oclusão de Enxerto Vascular/prevenção & controle , Veias Jugulares/patologia , Veias Jugulares/transplanteRESUMO
BACKGROUND: Vein graft restenosis has an adverse impact on bridge vessel circulation and patient prognosis after coronary artery bypass grafting. OBJECTIVES: We used the extravascular supporter α-cyanoacrylate (α-CA), the local application rapamycin/sirolimus (RPM), and a combination of the two (α-CA-RPM) in rat models of autogenous vein graft to stimulate vein graft change. The aim of our study was to observe the effect of α-CA, RPM, and α-CA-RPM on vein hyperplasia. METHODS: Fifty healthy Sprague Dawley (SD) rats were randomized into the following 5 groups: sham, control, α-CA, RPM, and α-CA-RPM. Operating procedure as subsequently described was used to build models of grafted rat jugular vein on carotid artery on one side. The level of endothelin-1 (ET-1) was determined by enzyme-linked immunosorbent assay (ELISA). Grafted veins were observed via naked eye 4 weeks later; fresh veins were observed via microscope and image-processing software in hematoxylin-eosin (HE) staining and immunohistochemistry after having been fixed and stored" (i.e. First they were fixed and stored, and second they were observed); α-Smooth Muscle Actin (αSMA) and von Willebrand factor (vWF) were measured with reverse transcription-polymerase chain reaction (RT-PCR). Comparisons were made with single-factor analysis of variance and Fisher's least significant difference test, with p < 0.05 considered significant. RESULTS: We found that intimal thickness of the α-CA, RPM, and α-CA-RPM groups was lower than that of the control group (p < 0.01), and the thickness of the α-CA-RPM group was notably lower than that of the α-CA and RPM groups (p < 0.05). CONCLUSION: RPM combined with α-CA contributes to inhibiting intimal hyperplasia in rat models and is more effective for vascular patency than individual use of either α-CA or RPM.
Assuntos
Cianoacrilatos/farmacologia , Hiperplasia/prevenção & controle , Sirolimo/farmacologia , Túnica Íntima/efeitos dos fármacos , Túnica Íntima/patologia , Actinas/análise , Animais , Artérias Carótidas/patologia , Artérias Carótidas/transplante , Proliferação de Células/efeitos dos fármacos , Ponte de Artéria Coronária/efeitos adversos , Modelos Animais de Doenças , Combinação de Medicamentos , Endotelina-1/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/patologia , Oclusão de Enxerto Vascular/prevenção & controle , Veias Jugulares/patologia , Veias Jugulares/transplante , Masculino , Distribuição Aleatória , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: Bovine carotid artery (BCA) grafts have been described as a possibly superior alternative to expanded polytetrafluoroethylene hemoaccess grafts. However, published experience remains limited, and patency rates for nonautogenous arteriovenous grafts remain unsatisfactory. We report herein the largest published experience with the current generation of BCA grafts for dialysis access and analyze subgroups to determine whether obesity, gender, or prior access surgery influences patency. METHODS: We retrospectively reviewed 134 BCA grafts (Artegraft, North Brunswick, NJ) implanted for hemodialysis access in the upper extremities of 126 patients between January 2012 and May 2015. Patients had a mean of 1.8 prior access operations. Primary, primary assisted, and secondary patency rates were calculated using the Kaplan-Meier method, and longitudinal infection risk was tabulated. Patency differences were calculated using the log-rank method. RESULTS: For the entire group, 1-year primary patency was 32%, primary assisted patency was 49%, and secondary patency was 78%. Ten of 133 grafts (7%) developed infection requiring graft excision between 1 and 9 months after implantation. There was no statistical difference between men and women in primary or secondary patency (P = .88, P = .69). There was no difference in primary patency or secondary patency for patients with body mass index >30 or <30 (P = .85, P = .54). Patients who had a BCA graft as their first access attempt had a higher primary and primary assisted patency than that of patients who had the graft placed after prior access failure (P = .039, P = .024). CONCLUSIONS: This represents the largest published series of BCA grafts for arteriovenous grafts in the modern era. The primary patency of BCA grafts in this series was lower than that reported in a smaller randomized study. However, primary assisted and secondary patency were similar. Infection rates in this series appear to be somewhat lower than polytetrafluoroethylene infection rates reported in the literature. BCA grafts are a satisfactory alternative to expanded polytetrafluoroethylene for hemodialysis access, but larger controlled studies are needed to determine whether superior primary patency previously reported is a reproducible finding.
Assuntos
Derivação Arteriovenosa Cirúrgica/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Artérias Carótidas/transplante , Diálise Renal , Animais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Bioprótese , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Índice de Massa Corporal , Artérias Carótidas/fisiopatologia , Bovinos , Feminino , Oclusão de Enxerto Vascular/diagnóstico , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/terapia , Xenoenxertos , Humanos , Estimativa de Kaplan-Meier , Masculino , Obesidade/complicações , Obesidade/diagnóstico , Philadelphia , Retratamento , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
Fifteen adult rabbits were used to evaluate the repair of experimental common calcaneal tendon defects treated with glycerin-preserved canine carotid artery xenografts alone or associated with autologous mononuclear bone marrow cells (AMCs). Rabbits were submitted to daily clinical examination; implanted sites were analyzed under light microscopy within 15, 30 and 60 days of surgery. Pelvic limbs receiving xenografts associated with AMCs had better physical performance as well as higher collagen fiber, fibroblast, lymphocyte and new vessel counts at all postoperative time points considered. Glycerin-preserved canine carotid artery xenografts associated with AMCs constituted an effective method for common calcaneal tendon repair in rabbits.(AU)
Utilizou-se 15 coelhos adultos para avaliar o reparo de lesão do tendão calcanear comum com implante de artéria carótida de cães, preservada em glicerina, associado ou não a células mononucleares autólogas da medula óssea (CMAs). Os animais foram observados diariamente por meio de avaliações clínicas e o local do implante foi analisado sob microscopia de luz decorridos 15, 30 e 60 dias de pós-operatório. Notou-se em todos os períodos de observação, com o implante associado às CMAs, melhor desempenho físico dos membros pélvico e maior intensidade de fibras colágenas, fibroblastos e linfócitos e neovascularização. A utilização de xenoimplante de artéria carótida de cães preservada em glicerina associado à administração de células mononucleares da medula óssea foi eficiente no reparo do tendão calcanear comum de coelhos.(AU)
Assuntos
Animais , Coelhos , Tendão do Calcâneo/lesões , Células-Tronco Adultas/transplante , Transplante de Medula Óssea/veterinária , Artérias Carótidas/transplante , Glicerol/uso terapêutico , Transplante Autólogo/veterináriaRESUMO
Fifteen adult rabbits were used to evaluate the repair of experimental common calcaneal tendon defects treated with glycerin-preserved canine carotid artery xenografts alone or associated with autologous mononuclear bone marrow cells (AMCs). Rabbits were submitted to daily clinical examination; implanted sites were analyzed under light microscopy within 15, 30 and 60 days of surgery. Pelvic limbs receiving xenografts associated with AMCs had better physical performance as well as higher collagen fiber, fibroblast, lymphocyte and new vessel counts at all postoperative time points considered. Glycerin-preserved canine carotid artery xenografts associated with AMCs constituted an effective method for common calcaneal tendon repair in rabbits.
Utilizou-se 15 coelhos adultos para avaliar o reparo de lesão do tendão calcanear comum com implante de artéria carótida de cães, preservada em glicerina, associado ou não a células mononucleares autólogas da medula óssea (CMAs). Os animais foram observados diariamente por meio de avaliações clínicas e o local do implante foi analisado sob microscopia de luz decorridos 15, 30 e 60 dias de pós-operatório. Notou-se em todos os períodos de observação, com o implante associado às CMAs, melhor desempenho físico dos membros pélvico e maior intensidade de fibras colágenas, fibroblastos e linfócitos e neovascularização. A utilização de xenoimplante de artéria carótida de cães preservada em glicerina associado à administração de células mononucleares da medula óssea foi eficiente no reparo do tendão calcanear comum de coelhos.
Assuntos
Animais , Coelhos , Artérias Carótidas/transplante , Células-Tronco Adultas/transplante , Glicerol/uso terapêutico , Tendão do Calcâneo/lesões , Transplante de Medula Óssea/veterinária , Transplante Autólogo/veterináriaRESUMO
Fifteen adult rabbits were used to evaluate the repair of experimental common calcaneal tendon defects treated with glycerin-preserved canine carotid artery xenografts alone or associated with autologous mononuclear bone marrow cells (AMCs). Rabbits were submitted to daily clinical examination; implanted sites were analyzed under light microscopy within 15, 30 and 60 days of surgery. Pelvic limbs receiving xenografts associated with AMCs had better physical performance as well as higher collagen fiber, fibroblast, lymphocyte and new vessel counts at all postoperative time points considered. Glycerin-preserved canine carotid artery xenografts associated with AMCs constituted an effective method for common calcaneal tendon repair in rabbits.(AU)
Utilizou-se 15 coelhos adultos para avaliar o reparo de lesão do tendão calcanear comum com implante de artéria carótida de cães, preservada em glicerina, associado ou não a células mononucleares autólogas da medula óssea (CMAs). Os animais foram observados diariamente por meio de avaliações clínicas e o local do implante foi analisado sob microscopia de luz decorridos 15, 30 e 60 dias de pós-operatório. Notou-se em todos os períodos de observação, com o implante associado às CMAs, melhor desempenho físico dos membros pélvico e maior intensidade de fibras colágenas, fibroblastos e linfócitos e neovascularização. A utilização de xenoimplante de artéria carótida de cães preservada em glicerina associado à administração de células mononucleares da medula óssea foi eficiente no reparo do tendão calcanear comum de coelhos.(AU)
Assuntos
Animais , Coelhos , Tendão do Calcâneo/lesões , Artérias Carótidas/transplante , Transplante de Medula Óssea/veterinária , Células-Tronco Adultas/transplante , Glicerol/uso terapêutico , Transplante Autólogo/veterináriaRESUMO
The aim of this study was to characterize and compare human great saphenous veins (HGSVs), HGSV cryoallografts, expanded polytetrafluoroethylene (ePTFE) segments, and elastic and muscular arteries' biomechanics, so as to identify if the biomechanical coupling and the HGSV advantages with respect to ePTFE depend on the arterial type and/or on the biomechanical property considered. Pressure and diameter were measured in vitro, under arterial hemodynamic conditions, in elastic and muscular arteries, and in vascular substitutes: fresh and cryopreserved HGSV and ePTFE segments. The wall's dynamics (compliance, viscosity, and inertia), energy dissipation, and buffering were calculated. The coupling was quantified for each biomechanical parameter. Cryopreservation preserved HGSV biomechanics. The HGSV cryoallografts' dynamics, energetics, and buffering were lesser with respect to both arteries, but were higher than the ePTFE. The coupling differed, depending on the arterial type and property considered. The biomechanical coupling depended on the artery and property considered. HGSV cryoallograft advantages over ePTFE were arterial type and property independent.
Assuntos
Fenômenos Biomecânicos , Prótese Vascular , Vasos Sanguíneos/transplante , Criopreservação/métodos , Veia Safena/transplante , Adulto , Análise de Variância , Anastomose Cirúrgica , Velocidade do Fluxo Sanguíneo , Artérias Carótidas/fisiologia , Artérias Carótidas/transplante , Feminino , Artéria Femoral/fisiologia , Artéria Femoral/transplante , Humanos , Masculino , Modelos Teóricos , Politetrafluoretileno , Probabilidade , Sensibilidade e Especificidade , Resistência à Tração , Doadores de Tecidos , Coleta de Tecidos e Órgãos/métodosRESUMO
The viscoelastic and inertial properties of the arterial wall are responsible for the arterial functional role in the cardiovascular system. Cryopreservation is widely used to preserve blood vessels for vascular reconstruction but it is controversially suspected to affect the dynamic behaviour of these allografts. The aim of this work was to assess the cryopreservation's effects on human arteries mechanical properties. Common carotid artery (CCA) segments harvested from donors were divided into two groups: Fresh (n = 18), tested for 24-48 h after harvesting, and Cryopreserved (n = 18) for an average time of 30 days in gas-nitrogen phase, and finally defrosted. Each segment was tested in a circulation mock, and its pressure and diameter were registered at similar pump frequency, pulse and mean pressure levels, including those of normotensive and hypertensive conditions. A compliance transfer function (diameter/pressure) derived from a mathematical adaptive modelling was designed for the on line assessment of the arterial wall dynamics and its frequency response. Assessment of arterial wall dynamics was made by measuring its viscous (eta), inertial (M) and elastic (E) properties, and creep and stress relaxation time constant (tauC and tauSR, respectively). The frequency response characterization allowed to evaluate the arterial wall filter or buffer function. Results showed that non-significant differences exist between wall dynamics and buffer function of fresh and cryopreserved segments of human CCA. In conclusion, our cryopreservation method maintains arterial wall functional properties, close to their fresh values.
Assuntos
Artérias Carótidas , Criopreservação , Artérias Carótidas/transplante , Elasticidade , Humanos , Transplante HomólogoRESUMO
During the last 7 years, approximately 170 neoplasms, and 35 vascular lesions involving the cavernous sinus were treated by the first two authors. During the treatment of such lesions, the direct vein graft reconstruction of the internal carotid artery from the petrous to the supraclinoid or infraclinoid ICA was performed in 23 patients. Graft occlusion occurred in 3 patients and in one of these, it was successfully salvaged by placing a long venous graft from the extracranial ICA to the M3 segment of the middle cerebral artery. The latter 3 patients were neurologically normal. One patient with significant atherosclerotic disease suffered the dissection of the distal internal carotid artery with the graft being patent. The suturing technique. This patient eventually died. Two patients with severely compromised collateral circulation suffered minor strokes due to the temporary occlusion of the ICA. This has been avoided in the more recent patients by the adoption of brain protection techniques such as moderate hypothermia, induced hypertension, and barbiturate coma. Low dose heparin therapy during grafting and high dose intravenous steroids prior to the grafting also appear to be beneficial. Direct vein graft reconstruction of the intracavernous carotid artery is a valuable tool during the management of cavernous sinus lesions. The advantages and disadvantages of this technique as well as the pros and cons of other revascularization techniques will be discussed. During microsurgical removal of cavernous sinus lesions, the cranial nerves III-VI were reconstructed by direct resuture or by nerve grafting in 16 patients. In the majority of these patients, recovery of cranial nerve function was observed, which was very encouraging.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Artérias Carótidas/transplante , Seio Cavernoso/cirurgia , Nervos Cranianos/transplante , Humanos , Estudos Retrospectivos , Doenças Vasculares/cirurgiaRESUMO
The present study is undertaken to determine whether the elastic tube model originally developed by Kuchar and Ostrach (Biomedical Fluid Mechanics Symposium, pp. 45-69, 1966) accurately provides a first approximation of the biomechanics of the anastomotic junction. The experimental protocol involves the use of canine carotid arteries as the host vessel and several graft materials including autogenous and prosthetic substitutes. The host artery-graft combinations are perfused in vitro in a pulsatile perfusion apparatus which simulates the natural hemodynamic environment. This apparatus provides accurate dynamic measurements of radial wall motion (measured at various longitudinal increments), associated pressures and rates of fluid flow. These data are then applied to the theoretical model for calculation of anastomotic induced bending stresses. The results indicate that the predictions derived from the elastic model consistently overestimate the measured radial change adjacent to the anastomotic junction. As a result shear stresses based on elastic theory deviate from values derived from a numerical curve fit to the experimental data.