Human transluminally placed endovascular stented grafts: Preliminary histopathologic analysis of healing grafts in aortoiliac and femoral artery occlusive.

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Presentation transcript:

Human transluminally placed endovascular stented grafts: Preliminary histopathologic analysis of healing grafts in aortoiliac and femoral artery occlusive disease Michael L. Marin, MD, Frank J. Veith, MD, Jacob Cynamon, MD, Luis A. Sanchez, MD, Curtis W. Bakal, MD, William D. Suggs, MD, Ross T. Lyon, MD, Michael L. Schwartz, MD, Richard E. Parsons, MD, Kurt R. Wengerter, MD, Juan C. Parodi, MD Journal of Vascular Surgery Volume 21, Issue 4, Pages 595-604 (April 1995) DOI: 10.1016/S0741-5214(95)70191-5 Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Schematic drawing of technique of endovascular stent graft repair for femoropopliteal occlusive disease. A, Guiding catheter (arrow) is inserted directly SFA (o represents occluded SFA). B, Angled directional catheters are used to guide hydrophilic wire through occluded artery into patent popliteal vessel (arrow). Ideally, wire will travel within residual lumen of stenotic artery, or within intraintimal plane of occluded vessel (x). C, Diffuse balloon dilation with over-the-wire technique provides wide tract for insertion of endovascular graft. D, Stent grafts are inserted and deployed at precise location, which is determined by fluoroscopic imaging. Retraction of guiding sheath exposes stent (arrow). E, Cranial end of graft may then be directly sewn to common femoral artery (A) or endoluminally anastomosed to inflow artery ((B). Arteriotomy is then closed in continuous fashion over endoluminal anastomosis. Journal of Vascular Surgery 1995 21, 595-604DOI: (10.1016/S0741-5214(95)70191-5) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Schematic drawing of technique of endovascular stent graft repair for femoropopliteal occlusive disease. A, Guiding catheter (arrow) is inserted directly SFA (o represents occluded SFA). B, Angled directional catheters are used to guide hydrophilic wire through occluded artery into patent popliteal vessel (arrow). Ideally, wire will travel within residual lumen of stenotic artery, or within intraintimal plane of occluded vessel (x). C, Diffuse balloon dilation with over-the-wire technique provides wide tract for insertion of endovascular graft. D, Stent grafts are inserted and deployed at precise location, which is determined by fluoroscopic imaging. Retraction of guiding sheath exposes stent (arrow). E, Cranial end of graft may then be directly sewn to common femoral artery (A) or endoluminally anastomosed to inflow artery ((B). Arteriotomy is then closed in continuous fashion over endoluminal anastomosis. Journal of Vascular Surgery 1995 21, 595-604DOI: (10.1016/S0741-5214(95)70191-5) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Schematic drawing of technique of endovascular stent graft repair for femoropopliteal occlusive disease. A, Guiding catheter (arrow) is inserted directly SFA (o represents occluded SFA). B, Angled directional catheters are used to guide hydrophilic wire through occluded artery into patent popliteal vessel (arrow). Ideally, wire will travel within residual lumen of stenotic artery, or within intraintimal plane of occluded vessel (x). C, Diffuse balloon dilation with over-the-wire technique provides wide tract for insertion of endovascular graft. D, Stent grafts are inserted and deployed at precise location, which is determined by fluoroscopic imaging. Retraction of guiding sheath exposes stent (arrow). E, Cranial end of graft may then be directly sewn to common femoral artery (A) or endoluminally anastomosed to inflow artery ((B). Arteriotomy is then closed in continuous fashion over endoluminal anastomosis. Journal of Vascular Surgery 1995 21, 595-604DOI: (10.1016/S0741-5214(95)70191-5) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Schematic drawing of technique of endovascular stent graft repair for femoropopliteal occlusive disease. A, Guiding catheter (arrow) is inserted directly SFA (o represents occluded SFA). B, Angled directional catheters are used to guide hydrophilic wire through occluded artery into patent popliteal vessel (arrow). Ideally, wire will travel within residual lumen of stenotic artery, or within intraintimal plane of occluded vessel (x). C, Diffuse balloon dilation with over-the-wire technique provides wide tract for insertion of endovascular graft. D, Stent grafts are inserted and deployed at precise location, which is determined by fluoroscopic imaging. Retraction of guiding sheath exposes stent (arrow). E, Cranial end of graft may then be directly sewn to common femoral artery (A) or endoluminally anastomosed to inflow artery ((B). Arteriotomy is then closed in continuous fashion over endoluminal anastomosis. Journal of Vascular Surgery 1995 21, 595-604DOI: (10.1016/S0741-5214(95)70191-5) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Schematic drawing of technique of endovascular stent graft repair for femoropopliteal occlusive disease. A, Guiding catheter (arrow) is inserted directly SFA (o represents occluded SFA). B, Angled directional catheters are used to guide hydrophilic wire through occluded artery into patent popliteal vessel (arrow). Ideally, wire will travel within residual lumen of stenotic artery, or within intraintimal plane of occluded vessel (x). C, Diffuse balloon dilation with over-the-wire technique provides wide tract for insertion of endovascular graft. D, Stent grafts are inserted and deployed at precise location, which is determined by fluoroscopic imaging. Retraction of guiding sheath exposes stent (arrow). E, Cranial end of graft may then be directly sewn to common femoral artery (A) or endoluminally anastomosed to inflow artery ((B). Arteriotomy is then closed in continuous fashion over endoluminal anastomosis. Journal of Vascular Surgery 1995 21, 595-604DOI: (10.1016/S0741-5214(95)70191-5) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 (A) Light micrograph of endovascular aortofemoral PTFE graft (g) studied 6 weeks after insertion. Neointima composed of monolayer of cells overlying thin fibrous stroma covers graft at site 2 cm from distal anastomosis (arrow) (L represents lumen). (Trichrome stain.) (B) Immunohistochemical staining for factor VIII-related antigen labels cell monolayer positive (arrow) (L represents lumen). Journal of Vascular Surgery 1995 21, 595-604DOI: (10.1016/S0741-5214(95)70191-5) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 (A) Light micrograph of endovascular aortofemoral PTFE graft (g) studied 6 weeks after insertion. Neointima composed of monolayer of cells overlying thin fibrous stroma covers graft at site 2 cm from distal anastomosis (arrow) (L represents lumen). (Trichrome stain.) (B) Immunohistochemical staining for factor VIII-related antigen labels cell monolayer positive (arrow) (L represents lumen). Journal of Vascular Surgery 1995 21, 595-604DOI: (10.1016/S0741-5214(95)70191-5) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 (A) Macroscopic longitudinal image of perianastomotic region of aortofemoral endovascular stented graft studied 3 months after grafting. Note stenosis at artery-to-graft interface (open arrow). (Solid arrows represent endoluminal anastomotic sutures.) (B) Neointimal hyperplastic smooth muscle cell response (N) is seen 1 cm from anastomosis (G represents graft; arrow points toward lumen). (Hematoxylin and eosin staining.). Journal of Vascular Surgery 1995 21, 595-604DOI: (10.1016/S0741-5214(95)70191-5) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 (A) Macroscopic longitudinal image of perianastomotic region of aortofemoral endovascular stented graft studied 3 months after grafting. Note stenosis at artery-to-graft interface (open arrow). (Solid arrows represent endoluminal anastomotic sutures.) (B) Neointimal hyperplastic smooth muscle cell response (N) is seen 1 cm from anastomosis (G represents graft; arrow points toward lumen). (Hematoxylin and eosin staining.). Journal of Vascular Surgery 1995 21, 595-604DOI: (10.1016/S0741-5214(95)70191-5) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Light micrograph of endovascular stented graft within external iliac artery explanted at 6 months. Most of the displaced native vessel plaque (P) is composed of fibrous tissue. Cellularity is seen in region of obliterated native lumen (arrow). Inset, PC-10 immunoreactivity is documented predominantly in region denoted by arrow in main figure (arrows represent PC-10–positive nuclei). Journal of Vascular Surgery 1995 21, 595-604DOI: (10.1016/S0741-5214(95)70191-5) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions