Long-term reduction of medial and intimal thickening in porcine saphenous vein grafts with a polyglactin biodegradable external sheath Vikram Vijayan,

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Long-term reduction of medial and intimal thickening in porcine saphenous vein grafts with a polyglactin biodegradable external sheath Vikram Vijayan, FRCS, Nilima Shukla, PhD, Jason L. Johnson, MSc, Patricia Gadsdon, PhD, Gianni D. Angelini, FRCS, Frank C.T. Smith, FRCS, Roger Baird, FRCS, Jamie Y. Jeremy, PhD Journal of Vascular Surgery Volume 40, Issue 5, Pages 1011-1019 (November 2004) DOI: 10.1016/j.jvs.2004.08.047 Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 1 Top, External polyester sheath. Bottom, Purpose-built polyglactin sheath from Vascutek Ltd. Both are 8 mm in diameter. Previous studies have established that the polyester sheath inhibits saphenous vein graft thickening in the pig model. Journal of Vascular Surgery 2004 40, 1011-1019DOI: (10.1016/j.jvs.2004.08.047) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 2 Planimeteric analysis at 1 month of porcine saphenous vein grafts fitted with polyglactin external sheaths (n = 6). Difference in thickness between unstented and stented vein grafts statistically significant for both neointimal and medial thickness. P = .0012, Mann-Whitney U test. *Statistically significant reduction in thickness. Journal of Vascular Surgery 2004 40, 1011-1019DOI: (10.1016/j.jvs.2004.08.047) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 3 Planimeteric analysis at 6 months of porcine saphenous vein grafts fitted with polyglactin external sheaths (n = 6). Difference in thickness between unstented and stented vein grafts statistically significant for both neointimal and medial thickness. P = .0012, Mann-Whitney U test. *Statistically significant reduction in thickness. Journal of Vascular Surgery 2004 40, 1011-1019DOI: (10.1016/j.jvs.2004.08.047) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 4 Representative photomicrographs of hematoxylin-eosin–stained transverse sections of unsheathed graft 1 month after implantation (a), sheathed graft 1 month after implantation (b), unsheathed graft 6 months after implantation (c), and sheathed graft 6 months after implantation (d). Large arrow, External elastic lamina; small arrow, internal elastic lamina. L, Lumen; NI, neointima; M, media. Scale bar represents 1 mm; magnification ×12.5. Journal of Vascular Surgery 2004 40, 1011-1019DOI: (10.1016/j.jvs.2004.08.047) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 5 Representative photomicrographs of porcine vein grafts demonstrate different degrees of microvessel density in sheathed graft 1 month after implantation (a), sheathed graft 6 months after implantation (b), unsheathed graft 1 month after implantation (c), and unsheathed graft 6 months after implantation (d). L, Lumen; NI, neointima; M, media; ADV, adventitia. Scale bar in c represents 250 μm for all slides; magnification ×40. Journal of Vascular Surgery 2004 40, 1011-1019DOI: (10.1016/j.jvs.2004.08.047) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 6 Representative photomicrographs of histocytochemical staining (brown) for lectin (a) and vascular endothelial growth factor (b) in microvessels in neoadventitial region of sheathed vein grafts 1 month after implantation, which indicates presence of endothelial cells lining microvessels and active angiogenesis. Note: blood cells filling microvessels (black arrow) and smooth muscle cells surrounding endothelial cells (white arrow) indicate that genuine arterioles have developed. Scale bar in a represents 50 μm for both slides; magnification ×200. Journal of Vascular Surgery 2004 40, 1011-1019DOI: (10.1016/j.jvs.2004.08.047) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 7 Photomicrograph of externally stented porcine vein graft 1 month after implantation demonstrates a multilobed giant cell (arrows) with dark blue nuclei associated with remnants of polyglactin material. Scale bar represents 50 μm; magnification ×400. Journal of Vascular Surgery 2004 40, 1011-1019DOI: (10.1016/j.jvs.2004.08.047) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions