The impact of gelatin-resorcinol glue on aortic tissue: A histomorphologic evaluation Jürgen Ennker, MD, Ina Carolin Ennker, MD, Doris Schoon, VMD, Heinz.

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Presentation transcript:

The impact of gelatin-resorcinol glue on aortic tissue: A histomorphologic evaluation Jürgen Ennker, MD, Ina Carolin Ennker, MD, Doris Schoon, VMD, Heinz Adolf Schoon, VMD, Sven Dörge, MD, Michael Meissler, VMD, Manfred Rimpler, PhD, Roland Hetzer, MD Journal of Vascular Surgery Volume 20, Issue 1, Pages 34-43 (July 1994) DOI: 10.1016/0741-5214(94)90173-2 Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Polycondensation of gelatin-resorcinol-ethanedial Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Schematic drawing of setting procedure Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Aorta from control group. Wavy configuration of unglued fiber elements in tunica media. L is vascular lumen; arrows indicate internal elastic membrane. a , SEM. (Original magnification ×1000.) b , (Hematoxylin and eosin staining; original magnification×120.) c , Postoperative day 2. Wavy texture of internal elastic membrane. Swelling and extension of collagenous and elastic fibers of tunica media. G is glue; arrows indicate internal elastic membrane. (Hematoxylin and eosin staining; original magnification ×120.) Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Aorta from control group. Wavy configuration of unglued fiber elements in tunica media. L is vascular lumen; arrows indicate internal elastic membrane. a , SEM. (Original magnification ×1000.) b , (Hematoxylin and eosin staining; original magnification×120.) c , Postoperative day 2. Wavy texture of internal elastic membrane. Swelling and extension of collagenous and elastic fibers of tunica media. G is glue; arrows indicate internal elastic membrane. (Hematoxylin and eosin staining; original magnification ×120.) Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Aorta from control group. Wavy configuration of unglued fiber elements in tunica media. L is vascular lumen; arrows indicate internal elastic membrane. a , SEM. (Original magnification ×1000.) b , (Hematoxylin and eosin staining; original magnification×120.) c , Postoperative day 2. Wavy texture of internal elastic membrane. Swelling and extension of collagenous and elastic fibers of tunica media. G is glue; arrows indicate internal elastic membrane. (Hematoxylin and eosin staining; original magnification ×120.) Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 One week after operation. a , Good adaptation (arrow) of glue seam; endothelium is no longer present, and subintimal media tissue is lightly swollen with plaquelike calcification deposit (C) . G indicates glue. (Azan staining; original magnification ×300.) b , Widespread calcification of aortic wall (A) , nuclear and cytoplasmic. In addition, calcification deposits in area of glue (G) . (Von Kossa staining; original magnification ×300.) c , Numerous siderocytes can be seen because of resorption of operation-induced hematoma localized by macrophages. (Turnbull blue staining; original magnification ×300.) d , Disintegration of hyaline glue (G) through ingrowing fibroangioblastic granulation tissue. P indicates prosthesis. (Hematoxylin and eosin staining; original magnification ×120.) e , In area of defect in intima that occurred during operation, fibroangioblastic granulation tissue is growing in direction of glue seam. G indicates glue material within prosthesis (P) . (van Gieson elastic staining; original magnification ×120.) Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 One week after operation. a , Good adaptation (arrow) of glue seam; endothelium is no longer present, and subintimal media tissue is lightly swollen with plaquelike calcification deposit (C) . G indicates glue. (Azan staining; original magnification ×300.) b , Widespread calcification of aortic wall (A) , nuclear and cytoplasmic. In addition, calcification deposits in area of glue (G) . (Von Kossa staining; original magnification ×300.) c , Numerous siderocytes can be seen because of resorption of operation-induced hematoma localized by macrophages. (Turnbull blue staining; original magnification ×300.) d , Disintegration of hyaline glue (G) through ingrowing fibroangioblastic granulation tissue. P indicates prosthesis. (Hematoxylin and eosin staining; original magnification ×120.) e , In area of defect in intima that occurred during operation, fibroangioblastic granulation tissue is growing in direction of glue seam. G indicates glue material within prosthesis (P) . (van Gieson elastic staining; original magnification ×120.) Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 One week after operation. a , Good adaptation (arrow) of glue seam; endothelium is no longer present, and subintimal media tissue is lightly swollen with plaquelike calcification deposit (C) . G indicates glue. (Azan staining; original magnification ×300.) b , Widespread calcification of aortic wall (A) , nuclear and cytoplasmic. In addition, calcification deposits in area of glue (G) . (Von Kossa staining; original magnification ×300.) c , Numerous siderocytes can be seen because of resorption of operation-induced hematoma localized by macrophages. (Turnbull blue staining; original magnification ×300.) d , Disintegration of hyaline glue (G) through ingrowing fibroangioblastic granulation tissue. P indicates prosthesis. (Hematoxylin and eosin staining; original magnification ×120.) e , In area of defect in intima that occurred during operation, fibroangioblastic granulation tissue is growing in direction of glue seam. G indicates glue material within prosthesis (P) . (van Gieson elastic staining; original magnification ×120.) Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 One week after operation. a , Good adaptation (arrow) of glue seam; endothelium is no longer present, and subintimal media tissue is lightly swollen with plaquelike calcification deposit (C) . G indicates glue. (Azan staining; original magnification ×300.) b , Widespread calcification of aortic wall (A) , nuclear and cytoplasmic. In addition, calcification deposits in area of glue (G) . (Von Kossa staining; original magnification ×300.) c , Numerous siderocytes can be seen because of resorption of operation-induced hematoma localized by macrophages. (Turnbull blue staining; original magnification ×300.) d , Disintegration of hyaline glue (G) through ingrowing fibroangioblastic granulation tissue. P indicates prosthesis. (Hematoxylin and eosin staining; original magnification ×120.) e , In area of defect in intima that occurred during operation, fibroangioblastic granulation tissue is growing in direction of glue seam. G indicates glue material within prosthesis (P) . (van Gieson elastic staining; original magnification ×120.) Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 One week after operation. a , Good adaptation (arrow) of glue seam; endothelium is no longer present, and subintimal media tissue is lightly swollen with plaquelike calcification deposit (C) . G indicates glue. (Azan staining; original magnification ×300.) b , Widespread calcification of aortic wall (A) , nuclear and cytoplasmic. In addition, calcification deposits in area of glue (G) . (Von Kossa staining; original magnification ×300.) c , Numerous siderocytes can be seen because of resorption of operation-induced hematoma localized by macrophages. (Turnbull blue staining; original magnification ×300.) d , Disintegration of hyaline glue (G) through ingrowing fibroangioblastic granulation tissue. P indicates prosthesis. (Hematoxylin and eosin staining; original magnification ×120.) e , In area of defect in intima that occurred during operation, fibroangioblastic granulation tissue is growing in direction of glue seam. G indicates glue material within prosthesis (P) . (van Gieson elastic staining; original magnification ×120.) Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 One week after operation. a , Good adaptation of glue seam. Glue material contains blood cells and blood cell imprints (arrows) . Noticeable swelling of internal elastic membrane (EF) and subintimal connective tissue layer. (SEM; original magnification ×2000.) b, Degenerated intima: cell and fiber fragments and fibrin are beside glue (G) . Phagocytized glue component particles inside neutrophilic granulocytes (PMN) . Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 One week after operation. a , Good adaptation of glue seam. Glue material contains blood cells and blood cell imprints (arrows) . Noticeable swelling of internal elastic membrane (EF) and subintimal connective tissue layer. (SEM; original magnification ×2000.) b, Degenerated intima: cell and fiber fragments and fibrin are beside glue (G) . Phagocytized glue component particles inside neutrophilic granulocytes (PMN) . Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Four weeks after operation. a , Prosthesis (P) is firmly affixed by ingrowth of vascular granulation tissue caused by defect of internal elastic membrane (arrows) . Glue is no longer observable. (van Gieson elastic staining; original magnification ×120.) b , Directed, partially interwoven vascular granulation tissue assures firm set of prosthesis (P) ; residual glue (G arrows) is still observable. Note partial integration between loose granulation and prosthesis. (Azar staining; original magnification ×120.) Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Four weeks after operation. a , Prosthesis (P) is firmly affixed by ingrowth of vascular granulation tissue caused by defect of internal elastic membrane (arrows) . Glue is no longer observable. (van Gieson elastic staining; original magnification ×120.) b , Directed, partially interwoven vascular granulation tissue assures firm set of prosthesis (P) ; residual glue (G arrows) is still observable. Note partial integration between loose granulation and prosthesis. (Azar staining; original magnification ×120.) Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Four weeks after operation. a, Residual glue (G) is firmly attached to aortic wall (A) . Tunica media has regular and even arrangement of cell and fiber elements. (SEM; original magnification ×200.) b , Besides remaining degenerated cells (D) , regular ordering of various thicker, newly formed collagenous fiber bundles (CF) can be seen interspersed by individual elastic fibers (EF) and fibroblast with dilated endoplasmic reticulum (arrow) . (TEM; original magnification ×4000.) Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Four weeks after operation. a, Residual glue (G) is firmly attached to aortic wall (A) . Tunica media has regular and even arrangement of cell and fiber elements. (SEM; original magnification ×200.) b , Besides remaining degenerated cells (D) , regular ordering of various thicker, newly formed collagenous fiber bundles (CF) can be seen interspersed by individual elastic fibers (EF) and fibroblast with dilated endoplasmic reticulum (arrow) . (TEM; original magnification ×4000.) Journal of Vascular Surgery 1994 20, 34-43DOI: (10.1016/0741-5214(94)90173-2) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions