Boundary layer infusion of heparin prevents thrombosis and reduces neointimal hyperplasia in venous polytetrafluoroethylene grafts without systemic anticoagulation

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Presentation transcript:

Boundary layer infusion of heparin prevents thrombosis and reduces neointimal hyperplasia in venous polytetrafluoroethylene grafts without systemic anticoagulation Changyi Chen, MD, Stephen R. Hanson, PhD, Alan B. Lumsden, MB ChB Journal of Vascular Surgery Volume 22, Issue 3, Pages 237-247 (September 1995) DOI: 10.1016/S0741-5214(95)70136-2 Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 ePTFE-based local infusion device. A, Device consists of silicone rubber cuff-reservoir glued in position between two rings of ringed 4 mm ID ePTFE graft (30 μm internodal distance). Hub is attached to 1 mm ID silicone rubber catheter tubing, which is then attached to osmotic pump. B, Soluble agent from osmotic pump will pass through graft wall, enter blood stream in highest concentration at graft wall (boundary layer), and be transported downstream (axially) by blood flow (convection), with slower mixing in radial direction (i.e., toward centerstream blood flow) occurring primarily through diffusive mechanisms. Long arrow indicates direction of blood flow. Journal of Vascular Surgery 1995 22, 237-247DOI: (10.1016/S0741-5214(95)70136-2) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Configuration for device implantation. Journal of Vascular Surgery 1995 22, 237-247DOI: (10.1016/S0741-5214(95)70136-2) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Anastomotic neointimal hyperplasia. Verhoeff-Masson's stain. Collagens are blue, elastin is black, and others are red. A, Upstream anastomosis infused with heparin. B, Downstream anastomosis infused with heparin. L represents lumen; N represents neointima. (Original magnification x40.) Journal of Vascular Surgery 1995 22, 237-247DOI: (10.1016/S0741-5214(95)70136-2) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Anastomotic neointimal hyperplasia. Verhoeff-Masson's stain. Collagens are blue, elastin is black, and others are red. A, Upstream anastomosis infused with heparin. B, Downstream anastomosis infused with heparin. L represents lumen; N represents neointima. (Original magnification x40.) Journal of Vascular Surgery 1995 22, 237-247DOI: (10.1016/S0741-5214(95)70136-2) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Cell proliferation in anastomotic neointimal hyperplasia. Immunoperoxidase staining of BrdU-labeled cells. Dark brown color represents positive staining result. A, Upstream anastomosis infused with heparin. B, Downstream anastomosis infused with heparin. L represents lumen; N represents neointima. (Original magnification x400.) Journal of Vascular Surgery 1995 22, 237-247DOI: (10.1016/S0741-5214(95)70136-2) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Cell proliferation in anastomotic neointimal hyperplasia. Immunoperoxidase staining of BrdU-labeled cells. Dark brown color represents positive staining result. A, Upstream anastomosis infused with heparin. B, Downstream anastomosis infused with heparin. L represents lumen; N represents neointima. (Original magnification x400.) Journal of Vascular Surgery 1995 22, 237-247DOI: (10.1016/S0741-5214(95)70136-2) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions