Conformational stress and anastomotic hyperplasia

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Presentation transcript:

Conformational stress and anastomotic hyperplasia Frank Pomposelli, M.D., Frederick Schoen, M.D., Richard Cohen, M.D., Daniel O'Leary, M.D., Webster R. Johnson, Ph.D., Peter N. Madras, M.D. Journal of Vascular Surgery Volume 1, Issue 4, Pages 525-535 (July 1984) DOI: 10.1016/0741-5214(84)90038-7 Copyright © 1984 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 A, Cross section through a typical end-to-side anastomosis. B, Three-dimensional side and cross-sectional views of arterial insert in aorta. Conformational change in arterial segment (Sa) comprising floor of anastomosis is similar to distortion created by inserts. Heavy arrows show direction of blood flow. Journal of Vascular Surgery 1984 1, 525-535DOI: (10.1016/0741-5214(84)90038-7) Copyright © 1984 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Tension curves for arterial walls of diameters between 3 and 5 mm at an end-to-side anastomosis with a 6 mm synthetic graft that has been anastomosed with three different sizes of suture margins. Appendix gives derivation of equation used in graph. Journal of Vascular Surgery 1984 1, 525-535DOI: (10.1016/0741-5214(84)90038-7) Copyright © 1984 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Magnified side and end views of arterial insert. Journal of Vascular Surgery 1984 1, 525-535DOI: (10.1016/0741-5214(84)90038-7) Copyright © 1984 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 A and B, Studies performed in selected rabbits. Translumbar aortograms (anterior, A, and posterior, B, oblique views). Arrow points to insert. Excellent flow is shown past insert, and no thrombus is seen. Journal of Vascular Surgery 1984 1, 525-535DOI: (10.1016/0741-5214(84)90038-7) Copyright © 1984 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 C to E, Studies performed in selected rabbits. C, Real-time ultrasound. Insert can be seen between cursors. (Note elliptic distortion of wall to approximately 3.6 mm.) D, Computed tomogram with contrast in area of insert. (Note elliptic distortion of aortic lumen as compared to that in E.) E, Taken in area of abdominal aorta remote from insert. Journal of Vascular Surgery 1984 1, 525-535DOI: (10.1016/0741-5214(84)90038-7) Copyright © 1984 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Photomicrographs demonstrating histologic features of arterial lesion. Luminal surface is indicated by broad arrows, remnant of vessel media by M, innermost elastic lamina by EL, and intimal proliferation by P. a, Center of lesion indicating thick, moderately cellular intimal fibrous plaque with organizing fibrin cap (F). (Original magnification ×200.) b, Edge of lesion at higher magnification. Widened intima is composed of collagen and cells with features of both fibroblasts and smooth muscle cells. Endothelial cells (EC) clearly cover edge of lesion. Small blood vessels (V) are present. (Original magnification ×500.) c, Junction of intimal proliferation and vessel media demonstrating fragmentation of elastic lamina (between arrows). (Original magnification ×500.) All stains were hematoxylin and eosin. Journal of Vascular Surgery 1984 1, 525-535DOI: (10.1016/0741-5214(84)90038-7) Copyright © 1984 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions