Prevention of neointimal hyperplasia associated with modified stretch expanded polytetrafluoroethylene hemodialysis grafts (Gore) in an experimental preclinical.

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Presentation transcript:

Prevention of neointimal hyperplasia associated with modified stretch expanded polytetrafluoroethylene hemodialysis grafts (Gore) in an experimental preclinical study in swine Massimiliano Gessaroli, MD, PhD, Cristiano Bombardi, DVM, PhD, Massimo Giunti, DVM, PhD, Maria Laura Bacci, DVM, PhD Journal of Vascular Surgery Volume 55, Issue 1, Pages 192-202 (January 2012) DOI: 10.1016/j.jvs.2011.07.076 Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 1 A, Bilateral carotid-jugular arteriovenous graft (AVG) in a pig: one side with an unmodified standard graft (G) and contralateral modified standard graft (MG). B, G and MG before implant. C, Standard stretch expanded polytetrafluoroethylene (ePTFE) Gore graft or heparin-bonded stretch ePTFE Gore graft. D, Modified standard stretch ePTFE Gore graft or modified heparin-bonded stretch ePTFE Gore graft. 1: unmodified graft, 2: little segment of graft cut transversally, 2a: segment 2 cut longitudinally, 3: segment 2a with two oblique cuts, 4: segment 3 sewn longitudinally after rotation, 4a: segment 4 sewn with segment 1 to obtain modified graft. Journal of Vascular Surgery 2012 55, 192-202DOI: (10.1016/j.jvs.2011.07.076) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Handmade modified Propaten graft (MPG) with a radial stretch expanded polytetrafluoroethylene (ePTFE) cuff at one end. B, Carotid-jugular arteriovenous graft (AVG) with MPG in situ. Journal of Vascular Surgery 2012 55, 192-202DOI: (10.1016/j.jvs.2011.07.076) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 3 A, Postoperative Doppler ultrasound scan follow-up. B, An example of carotid-jugular arteriovenous graft (AVG) explanted en bloc at death. Journal of Vascular Surgery 2012 55, 192-202DOI: (10.1016/j.jvs.2011.07.076) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 4 Schematic diagram of external jugular vein and expanded polytetrafluoroethylene (ePTFE) graft anastomosis with histologic levels, sections, points of vein wall, and neointimal hyperplasia (NH) measures. AVL, Anastomized vein level; DVL, distal vein level; PVL, proximal vein level. Journal of Vascular Surgery 2012 55, 192-202DOI: (10.1016/j.jvs.2011.07.076) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 5 Histogram showing the vein wall thickness at distal, proximal, and anastomized vein levels (distal vein level [DVL], proximal vein level [PVL], anastomized vein level [AVL]) in experimental pigs. G, Unmodified standard graft; MG, modified standard graft; MPG, modified Propaten graft; PG, unmodified Propaten graft. *P < .001. Journal of Vascular Surgery 2012 55, 192-202DOI: (10.1016/j.jvs.2011.07.076) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 6 Histogram showing the neointimal hyperplasia (NH) thickness at anastomized vein level (AVL), measured on vein wall (NHvw) and on graft wall (NHgw) in experimental pigs. G, Unmodified standard graft; MG, modified standard graft; MPG, modified Propaten graft; PG, unmodified Propaten graft. *P < .001. Journal of Vascular Surgery 2012 55, 192-202DOI: (10.1016/j.jvs.2011.07.076) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 7 Pig #5. Bright field photomicrographs of transverse section (anastomized vein level [AVL], neointimal hyperplasia graft wall [NHgw]). Note numerous α-smooth-muscle actin – immunoreactive cells in brown. These cells correspond to smooth muscle cells and myofibroblasts. Scale bar = 100 μm. Journal of Vascular Surgery 2012 55, 192-202DOI: (10.1016/j.jvs.2011.07.076) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 8 A and B, Pig #4, hematoxylin and eosin stains; A, Anastomized vein level (AVL), unmodified graft (G). Neointimal hyperplasia (NH) involves both graft wall (gw) and vein wall (vw); B, AVL, modified graft (MG). NH develops itself only on gw. C and D, Pig #5, hematoxylin and eosin stains; C, AVL, G. NH involves both gw and vw; D, AVL, MG. Almost complete lack of NH development. E and F, Pig #6, hematoxylin and eosin stains; E, AVL, unmodified Propaten graft (PG). NH involves both gw and vw; F, AVL, modified Propaten graft (MPG). Almost complete lack of NH development. Scale bars = 500 μm in A, B, C, E, and F; 1000 μm in D. Journal of Vascular Surgery 2012 55, 192-202DOI: (10.1016/j.jvs.2011.07.076) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 9 A and B, Pig #5, Masson's trichrome stains: arrangement of expanded polytetrafluoroethylene (ePTFE) fibrils in unmodified graft (G) with longitudinal stretch. Neointimal hyperplasia (NH), graft wall (gw), and vein wall (vw). C and D, Pig #5, Masson's trichrome stains: new arrangement of ePTFE fibrils in modified standard graft (MG) with radial stretch. NH, gw, and vw. Scale bars = 200 μm in A and D; 500 μm in B; 1000 μm in C. Journal of Vascular Surgery 2012 55, 192-202DOI: (10.1016/j.jvs.2011.07.076) Copyright © 2012 Society for Vascular Surgery Terms and Conditions