Histologic analysis of stent graft oversizing in the thoracic aorta

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Histologic analysis of stent graft oversizing in the thoracic aorta Igor Rafael Sincos, MD, PhD, Erasmo Simão da Silva, MD, PhD, Sergio Quilici Belczak, MD, PhD, Anna Paula Weinhardt Baptista Sincos, MD, Maria de Lourdes Higuchi, MD, PhD, Vitor Gornati, MD, José Piñatas Otoch, MD, PhD, Ricardo Aun, MD, PhD Journal of Vascular Surgery Volume 58, Issue 6, Pages 1644-1651.e4 (December 2013) DOI: 10.1016/j.jvs.2013.02.005 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 A, Locations of the circumferential fragments. B, Paired tissue fragments were used for the biomechanical and histologic studies. Journal of Vascular Surgery 2013 58, 1644-1651.e4DOI: (10.1016/j.jvs.2013.02.005) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 Cross-section of the aorta (Masson stained). The photomicrograph shows indentations in the wall of the aorta with neointima and thrombi caused by compression of the metal supports of the stent. A, View of the entire cross-section (magnification, ×1.2). Black arrow-I, intima; red arrow-A, adventitia; M, medial layer; T, mural thrombi. B, Higher magnification view (×4). Blue arrow, site of compression; black arrow, gap between the metal struts of the stent. Journal of Vascular Surgery 2013 58, 1644-1651.e4DOI: (10.1016/j.jvs.2013.02.005) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 Comparison of relative muscle fiber content in the aortic wall among the five groups (the percentage of field of view stained red in uncompressed areas)‒Masson stained. Values are presented as the mean ± 95% confidence interval. *P < .01 and **P < .001 vs control. Journal of Vascular Surgery 2013 58, 1644-1651.e4DOI: (10.1016/j.jvs.2013.02.005) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 4 Masson-stained tissue sections of an aorta in the control group vs group A. Blue, collagen; red, muscle fiber. A, Cross-section of the aortic wall in control group (magnification, ×4). B, Higher magnification view of the middle third of the aortic wall in control group (magnification, ×20). C, Cross-section of the aortic wall showed increased collagen and decreased muscle fiber in the middle layer in group A (magnification, ×4). D, Higher magnification view of the inner third of the aortic wall in group A (magnification, ×8.6). Journal of Vascular Surgery 2013 58, 1644-1651.e4DOI: (10.1016/j.jvs.2013.02.005) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 5, online only Van Gieson-stained tissue sections of an aorta in the control group vs group D. Black, elastic fiber. A, Cross-section of the aortic wall in control group (magnification, ×4). B, Higher magnification view of the middle third of the aortic wall in control group (magnification, ×8). C, Cross-section of the aortic wall in group D (magnification, ×2). D, Higher magnification view of the middle third of the aortic wall in group D (magnification, ×20). Journal of Vascular Surgery 2013 58, 1644-1651.e4DOI: (10.1016/j.jvs.2013.02.005) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 6, online only Comparison of relative elastic fiber content in the aortic wall among the five groups (the percentage of field of view stained black in uncompressed areas)‒Van Gieson-stained. Values are presented as the mean ± 95% confidence interval, *P < .001 vs control. Journal of Vascular Surgery 2013 58, 1644-1651.e4DOI: (10.1016/j.jvs.2013.02.005) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 7, online only Tissue sections of an aorta from group D showing evidence of an aneurysm. Black, elastic fiber. A, Cross-section of the aortic wall (magnification, ×5; Masson). B, Higher magnification of the inner third of the aortic wall (magnification, ×11; Masson). C, Van Gieson staining of the section shown in (B). Journal of Vascular Surgery 2013 58, 1644-1651.e4DOI: (10.1016/j.jvs.2013.02.005) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 8, online only α-actin-stained tissue sections of an aorta in the control group vs. group C. Yellow, smooth muscle fibers in the endothelium. A, Cross-section of the aortic wall in control group (magnification, ×4). B, Higher magnification view of the middle third of the aortic wall in control group (magnification, ×8.6). C, Cross-section of the aortic wall showing the loss of α-actin in the inner layer in group C (magnification, ×5). D, Higher magnification view of the middle third of the aortic wall in group C (magnification, ×11). Journal of Vascular Surgery 2013 58, 1644-1651.e4DOI: (10.1016/j.jvs.2013.02.005) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 9, online only TUNEL analysis of cross-sections of the aortic wall. A, Numerous apoptotic cells with green fluorescence can be seen in group B (magnification, ×4). B, No apoptotic cells can be seen in a cross-section from the control group (magnification, ×10). Journal of Vascular Surgery 2013 58, 1644-1651.e4DOI: (10.1016/j.jvs.2013.02.005) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 10, online only Incorporation of the stent graft and neointimal formation. A, Proximal view showing integration of the endoprosthesis around most of the aortic circumference. B, Proximal view showing partial adherence of the endoprosthesis to the aortic circumference. C, Distal view showing neointima formation on the stent and inner lumen of the aorta. Journal of Vascular Surgery 2013 58, 1644-1651.e4DOI: (10.1016/j.jvs.2013.02.005) Copyright © 2013 Society for Vascular Surgery Terms and Conditions