Reendothelialization of isolated segments of the canine carotid artery with reference to the possible role of the adventitial vasa vasorum Qun Shi, MD,

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Reendothelialization of isolated segments of the canine carotid artery with reference to the possible role of the adventitial vasa vasorum Qun Shi, MD, Hong-De Wu, MD, Lester R. Sauvage, MD, Keith R. Durante, MD, Malay Patel, MD, Arlene R. Wechezak, PhD, Svetlana Kaplan, PhD, Mark Walker Journal of Vascular Surgery Volume 12, Issue 4, Pages 476-487 (October 1990) DOI: 10.1016/0741-5214(90)90050-K Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A Method 1. A 1, Superficial endarterectomy shows inner wall (arrow) removed from everted carotid test segment. A 2, Light microscopy shows removal of approximately 125 μm of the inner wall. A 3, Light microscopy shows the arterial wall that remained after endarterectomy (adventitia is intact). B, Method 2. B 1, Use of balloon catheter for removal of the endothelial lining. B 2, Light microscopy shows the arterial wall of the test segment after balloon denudation. No endothelium remained on the flow surface. The adventitia was left intact. C, Method 3. C 1, Use of balloon catheter for removal of the endothelial lining. C 2, Removal of adventitia (arrow) from the carotid test segment. C 3, a, Light microscopy shows the arterial wall after balloon denudation and removal of adventitia containing vasa vasorum. C 3, b, Light microscopy shows removed adventitia with vasa vasorum present. C 4, Light microscopy shows specimen in which vasa vasorum (arrow) could not be completely removed. (Hematoxylin-eosin stain; original magnification × 40.) Journal of Vascular Surgery 1990 12, 476-487DOI: (10.1016/0741-5214(90)90050-K) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Depiction of sequence of composite graft formation and implanation with placement of protective tubular Gore-Tex shield. Journal of Vascular Surgery 1990 12, 476-487DOI: (10.1016/0741-5214(90)90050-K) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Study of Distribution of vasa vasorum. A, After injection of Microfil into the lumen of the carotid artery, a white network is observed in the adventitia and periarterial tissue. Arrow indicates vagus nerve. B, Rich vasal network filled with Microfil, shown after treatment with methyl salicylate. C, Hematoxylin-cosin stained cross section of carotid wall shows vasa vasorum (arrows) confined to adventitia. (Original magnification × 40.) D, Artist's depiction of dual origin of adventitial vasal network of carotid artery. Arrows indicate luminal estia, which lead to vasal network. Journal of Vascular Surgery 1990 12, 476-487DOI: (10.1016/0741-5214(90)90050-K) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 4-week results. A, Method 1 (superficial endarterectomy with retention of adventitia.) A 1, Scanning electron micrograph of control specimen shows absence of endothelium on the flow surface after superficial endarterectomy. A 2, Scanning electron micrograph shows reendothelialization of carotid specimen after superficial endarterectomy. A 3, Positive Factor VIII/von Willebrand factor (FVIII/vWF) effect on flow surface. A 4, Transmitting electron micrograph shows reendothelialization of the flow surface. B, Method 2 (balloon denudation with retention of adventitia). B 1, Scanning electron micrograph of control specimen shows absence of endothelium on the flow surface after balloon denudation. B 2, Scanning electron micrograph shows reendothelialization of carotid specimen after balloon denudation. B 3, Positive FVIII/vWF effect on flow surface. B 4, Transmitting electron micrograph shows reendothelialization of the flow surface. C, Method 3 (Balloon denudation with removal of the adventitia). C 1, Scanning electron micrograph of control specimen shows absence of endothelium on the flow surface after balloon denudation. C 2, Scanning electron micrograph shows lack of reendothelialization of carotid specimen after balloon denudation and removal of adventitia. C 3, Negative FVIII/vWF effect on flow surface. C 4, Transmitting electron micrograph shows lack of reendothelialization of the flow surface. (Original magnifications: SEM × 1000, FVIII/vWF × 425, TEM × 2500.) Journal of Vascular Surgery 1990 12, 476-487DOI: (10.1016/0741-5214(90)90050-K) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 8-week results. A, Method 1 (superficial endarterectomy with retention of adventitia.) A 1, Scanning electron micrograph of control specimen shows absence of endothelium on the flow surface after superficial endarterectomy. A 2, Scanning electron micrograph shows reendothelialization of carotid specimen after superficial endarterectomy. A 3, Positive factor VIII/von Willebrand Factor (FVIII/vWF) effect on flow surface. A 4, Transmitting electron micrograph shows reendothelialization of the flow surface. B, Method 2 (balloon denudation with retention of adventitia). B 1, Scanning electron micrograph of control specimen shows absence of endothelium on the flow surface after balloon denudation. B 2, Scanning electron micrograph shows reendothelialization of carotid specimen after balloon denudation. B 3, Positive FVIII/vWF effect on flow surface. B 4, Transmitting electron micrograph shows reendothelialization of the flow surface. C, Method 3 (balloon denudation with removal of the adventitia). C 1, Scanning electron micrograph of control specimen shows absence of endothelium on the flow surface after balloon denudation. C 2, Scanning electron micrograph shows lack of reendothelialization of carotid specimen after balloon denudation. C 3, Negative FVIII/vWF effect on flow surface. C 4, Transmitting electron micrograph shows lack of reendothelialization of the flow surface. (Original magnifications: SEM × 1000, FVIII/vWF × 425, TEM × 2500.) Journal of Vascular Surgery 1990 12, 476-487DOI: (10.1016/0741-5214(90)90050-K) Copyright © 1990 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions