Modification of the descending thoracic aortic anastomotic site using biodegradable felt: Study in a canine model with or without basic fibroblast growth.

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Modification of the descending thoracic aortic anastomotic site using biodegradable felt: Study in a canine model with or without basic fibroblast growth factor Hidenori Fujiwara, MD, Yoshikatsu Saiki, MD, Mitsuru Sato, MD, Naoya Sakamoto, PhD, Toshiro Ohashi, PhD, Masaaki Sato, PhD, Yasuhiko Tabata, PhD, Koichi Tabayashi, MD Journal of Vascular Surgery Volume 51, Issue 1, Pages 194-202 (January 2010) DOI: 10.1016/j.jvs.2009.08.078 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Schematic diagrams illustrating the experimental procedures. A, The anastomotic site of the aorta. The aorta was anastomosed with an 8-mm prosthetic vascular graft using a 5-0 polypropylene over-and-over running suture. The anastomotic site was reinforced with a 10-mm-wide felt strip. B, Cross-section of the aorta. The cross-sectional area of the media (Am) and the outer (Do) and inner (Di) circumference of the media were measured. Using these values, the mean thickness of the media in each section was calculated. To calculate the adventitia-media ratio, the cross-sectional area of the adventitia (Aa) was measured. C, The tensile testing apparatus used for the longitudinal extension of the aortic specimens. Am, Cross-sectional area of the media; Aa, Cross-sectional area of the adventitia; Do, outer circumference of the media; Di, inner circumference of the media. Journal of Vascular Surgery 2010 51, 194-202DOI: (10.1016/j.jvs.2009.08.078) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Features of the aortic wall at the anastomotic site 1 month after anastomosis. A-C, Histologic sections of the aortic wall at the anastomotic site (original magnification ×40, elastica-Masson staining; scale bar, 200 μm). The sites were reinforced with PTFE felt (A), PGA felt (B), or PGA felt with 100 μg bFGF (C). D, Thickness of the media at the anastomotic site (expressed as a percentage of the thickness of the intact descending thoracic aorta). E, Collagen-smooth muscle ratio in the media at the anastomotic site. Values in (D) and (E) are given as mean ± SEM. n.s., Not significant. Journal of Vascular Surgery 2010 51, 194-202DOI: (10.1016/j.jvs.2009.08.078) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Features of the aortic wall at the anastomotic site 3 months after anastomosis. A-D, Histologic sections of the aortic wall at the anastomotic site (original magnification: ×40, elastica-Masson staining; scale bar, 200 μm). In the controls, anastomotic sites were not reinforced (A). In the experimental groups, the sites were reinforced with PTFE felt (B), PGA felt (C), or PGA felt with 100 μg bFGF (D). E, Thickness of the media at the anastomotic site (expressed as a percentage of the thickness of the intact descending thoracic aorta). F, Collagen-smooth muscle ratio in the media at the anastomotic site. G, Adventitia-media ratio (AMR) at the anastomotic site (calculated as AMR = Aa/Am, where Aa is the cross-sectional area of the adventitia, and Am is the cross-sectional area of the media). Values in (E, F, and G) are given as mean ± SEM. n.s., Not significant. Journal of Vascular Surgery 2010 51, 194-202DOI: (10.1016/j.jvs.2009.08.078) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Vascularization of the aortic wall at the anastomotic site 3 months after anastomosis. A-D, Aortic wall sections from the anastomotic site stained using anti-factor VIII antibody. Distinct vessels can be seen in the adventitia of the aortic wall. Control (no felt) (A), PTFE felt (B), PGA felt (C), PGA felt with 100 μg bFGF (D). In the PGA + bFGF group, a marked angiogenic effect was observed relative to the other groups (original magnification ×100; scale bar, 100 μm). E, Vessel density in the adventitia at the anastomotic site (expressed as number of vessels per mm2). In the PTFE group, the number of adventitial vessels was less than half the number in the control. In the PGA + bFGF group, significantly more vessels were seen in the adventitia. Values are given as mean ± SEM. Journal of Vascular Surgery 2010 51, 194-202DOI: (10.1016/j.jvs.2009.08.078) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 5 Tensile testing data for the anastomotic sites. The failure force and failure stress were assessed at 1 month (A, B) and 3 months (C, D) after anastomosis. No significant differences were seen between any groups at either of the time points. Values are given as mean ± SEM. n.s., Not significant. Journal of Vascular Surgery 2010 51, 194-202DOI: (10.1016/j.jvs.2009.08.078) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 6 Evaluation of vascular compliance. A, Vascular compliance is assessed in the three-dimensional directions (θ, γ, z). During cardiac systolic and diastolic phase, the vessel wall is displaced to accommodate dynamic component. Magnitude of displacement in the z direction is relatively small. Displacement in the γ direction is reflected on that in the θ direction. B, The vascular compliance was evaluated 3 months after anastomosis using two different reinforcing techniques (PTFE vs PGA). Local compliance at the anastomotic site was significantly higher in the PGA group than the PTFE group. Values are given as mean ± SEM. Journal of Vascular Surgery 2010 51, 194-202DOI: (10.1016/j.jvs.2009.08.078) Copyright © 2010 Society for Vascular Surgery Terms and Conditions