R. L. Varcoe, A. B. P. Teo, M. H. Pelletier, Y. Yu, J. -L. Yang, P. J

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Presentation transcript:

An Arteriovenous Fistula Model of Intimal Hyperplasia for Evaluation of a Nitinol U-Clip Anastomosis R.L. Varcoe, A.B.P. Teo, M.H. Pelletier, Y. Yu, J.-L. Yang, P.J. Crowe, W.R. Walsh European Journal of Vascular and Endovascular Surgery Volume 43, Issue 2, Pages 224-231 (February 2012) DOI: 10.1016/j.ejvs.2011.11.002 Copyright © 2011 European Society for Vascular Surgery Terms and Conditions

Figure 1 The nitinol U-Clip with its delivery apparatus intact (A), demonstrating the release trigger point (B, Arrow) and resuming its circular shape (C). (B and C Images taken with environmental scanning electron microscopy (TM-1000, Hitachi, Japan)). European Journal of Vascular and Endovascular Surgery 2012 43, 224-231DOI: (10.1016/j.ejvs.2011.11.002) Copyright © 2011 European Society for Vascular Surgery Terms and Conditions

Figure 2 A diagram showing the formation of side-to-side arteriovenous fistulae in the superficial femoral artery and vein (A). Photography of the ovine surgery showing fistulae creation with continuous polypropylene suture (B and C) and nitinol U-Clip (D and E). European Journal of Vascular and Endovascular Surgery 2012 43, 224-231DOI: (10.1016/j.ejvs.2011.11.002) Copyright © 2011 European Society for Vascular Surgery Terms and Conditions

Figure 3 Polypropylene AVF with demarcation of the luminal surface and border of the media to calculate intima media area. The artery is seen on the right, the vein on the left and the IH mass at the junction between the two. European Journal of Vascular and Endovascular Surgery 2012 43, 224-231DOI: (10.1016/j.ejvs.2011.11.002) Copyright © 2011 European Society for Vascular Surgery Terms and Conditions

Figure 4 Intimal media area per unit length over the three time points. Error bars represent standard deviation. European Journal of Vascular and Endovascular Surgery 2012 43, 224-231DOI: (10.1016/j.ejvs.2011.11.002) Copyright © 2011 European Society for Vascular Surgery Terms and Conditions

Figure 5 Intimal media area per unit length (IMA/L) for each sheep demonstrating its response for the paired anastomoses. One side was created with the nitinol U-Clip, the other with a standard polypropylene suture. European Journal of Vascular and Endovascular Surgery 2012 43, 224-231DOI: (10.1016/j.ejvs.2011.11.002) Copyright © 2011 European Society for Vascular Surgery Terms and Conditions

Figure 6 Micrographs of paraffin embedded sections. Neo-intima formed over both anastomotic materials, however was more pronounced and raised in the polypropylene group (A (B and C are higher magnification of the boxed areas)). This group also had more necrosis and inflammatory cellular infiltrate observed when compared to the U-Clip group (D (E and F are higher magnification of the boxed areas)). European Journal of Vascular and Endovascular Surgery 2012 43, 224-231DOI: (10.1016/j.ejvs.2011.11.002) Copyright © 2011 European Society for Vascular Surgery Terms and Conditions