D. Z. Xiang, MD, E. K. Verbeken, MD, PhD, A. T. L. Van Lommel, PhD, M

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Composition and formation of the sleeve enveloping a central venous catheter D.Z. Xiang, MD, E.K. Verbeken, MD, PhD, A.T.L. Van Lommel, PhD, M. Stas, MD, I. De Wever, MD, PhD Journal of Vascular Surgery Volume 28, Issue 2, Pages 260-271 (August 1998) DOI: 10.1016/S0741-5214(98)70162-4 Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Day 3: Some smooth muscle cells in the vein wall close to the catheter show signs of injury: membrane disruption (solid triangle), cytoplasmic debris and autophagocytotic bodies (arrow), pycnotic nuclei (open triangle)(TEM 12600×). Journal of Vascular Surgery 1998 28, 260-271DOI: (10.1016/S0741-5214(98)70162-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Day 1: A pericatheter thrombus (PCT) is present between the vein wall (V) and the catheter mold (C) (original magnification, 25×; HE stain). B, The pericatheter thrombus is negative on Masson's trichrome stain (original magnification, 25×; Trichrome stain). C, In the vein wall (V), a thin continuous layer of α-actin positive cells represents the muscle layer. No α-actin stain can be observed in the pericatheter thrombus (PCT) (original magnification, 25×; α-actin stain). Journal of Vascular Surgery 1998 28, 260-271DOI: (10.1016/S0741-5214(98)70162-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Day 7: The former pericatheter thrombus is populated by numerous cells and can be called a catheter sleeve (CS) (V = vein wall; C = catheter) (original magnification, 25×; HE stain). B, Masson's trichrome stain in the sleeve (CS) is more intense near the vein wall (V) than near the catheter mold (C). In some areas negative on Masson's trichrome stain, almost no α-actin stain is visible (arrow)(original magnification, 400×; Trichrome stain). C, α-actin positive cells are more intense in the zone of the sleeve near the vein wall (arrow) than in the zone near the catheter mold (star) (original magnification, 25×; α-actin stain). Journal of Vascular Surgery 1998 28, 260-271DOI: (10.1016/S0741-5214(98)70162-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Day 7: The α-actin positive cells are distributed in a stream-like pattern from the vein wall (V) along the adherent areas (star) into the catheter sleeve (CS). Cell density is higher in the vicinity of the vessel wall and decreases towards the catheter mold (C) (original magnification 100×; α-actin stain) Journal of Vascular Surgery 1998 28, 260-271DOI: (10.1016/S0741-5214(98)70162-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Day 7: Several connecting bridges (B) divide the barium-filled space (star) between the vein wall (V) and the catheter sleeve (CS). These tiny bridges, filled with α-actin positive cells, indicate the migratory pathway of the smooth muscle cells (original magnification, 200×; α-actin stain). Journal of Vascular Surgery 1998 28, 260-271DOI: (10.1016/S0741-5214(98)70162-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Day 7: This overview picture of the sleeve shows a layer of endothelial cells (EC) at the luminal side, several layers of smooth muscle cells of the synthetic phenotype (star) with collagen (0) in between, and still some fibrin (F) at the catheter side(TEM, 1440×). Journal of Vascular Surgery 1998 28, 260-271DOI: (10.1016/S0741-5214(98)70162-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 A, Day 7: A smooth muscle cell (arrow) migrates from the vein wall (V) into the bridge (B) to the catheter sleeve (CS). (TEM, 2610×). B, Higher magnification of the cell indicated in A shows its synthetic phenotype: large amounts of rough endoplasmatic reticulum, free ribosomes, and only a few filament bundles. The pseudopodia (triangle) are the hallmark of migration (TEM, 12600×). Journal of Vascular Surgery 1998 28, 260-271DOI: (10.1016/S0741-5214(98)70162-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Day 14: The SEM image taken after 14 days of catheterization shows that the bridges (B) between the vein wall (V) and the catheter sleeve (CS) and the surface of the sleeve are covered by nicely oriented endothelial cells (arrow)(SEM, 300×). Journal of Vascular Surgery 1998 28, 260-271DOI: (10.1016/S0741-5214(98)70162-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 The distribution curve of catheter sleeve (CS) and sleeve remnant (SR). Journal of Vascular Surgery 1998 28, 260-271DOI: (10.1016/S0741-5214(98)70162-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 10 Ten months after withdrawal of the catheter, the remnant of the collapsed sleeve (R) is easily recognized by the clot (triangle) in its center, and the bridges (star) linking it with the vein wall (V) (original magnification, 100×; toluidine blue stain). Journal of Vascular Surgery 1998 28, 260-271DOI: (10.1016/S0741-5214(98)70162-4) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions