Differences in reendothelialization after balloon catheter removal of endothelial cells, superficial endarterectomy, and deep endarterectomy Steven G.

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Presentation transcript:

Differences in reendothelialization after balloon catheter removal of endothelial cells, superficial endarterectomy, and deep endarterectomy Steven G. Goff, M.D., Hong-De Wu, M.D., Lester R. Sauvage, M.D., Yoshiyuki Usui, M.D., Arlene R. Wechezak, M.S., Daniel E. Coan, B.S., Richard E. Arnell, M.D., Mark W. Walker Journal of Vascular Surgery Volume 7, Issue 1, Pages 119-129 (January 1988) DOI: 10.1016/0741-5214(88)90385-0 Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Three-component model with central aortic test segment separated from aortic ends by impervious prosthetic graft sleeves. Journal of Vascular Surgery 1988 7, 119-129DOI: (10.1016/0741-5214(88)90385-0) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Artist's representation of the three methods of handling the central segment: control; balloon catheter denudation of the endothelial cells only; superficial endarterectomy with removal of the inner 200 to 300 μm, corresponding to half the nonvasal media; deep endarterectomy with removal of the inner 500 to 600 μm, corresponding to all the nonvasal media. B, Histologic specimens explained in A. Journal of Vascular Surgery 1988 7, 119-129DOI: (10.1016/0741-5214(88)90385-0) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Balloon catheter—denuded preparation at 4 weeks shows intimal hyperplasia and demonstrates a band of necrosis in the outer media. In addition, the flow surface was lined by some platelets, lymphocytes, and white blood cells. This was also observed in the superficially endarterectomized specimens at similar time periods. (Hematoxylin-eosin stain; original magnification × 40.) Journal of Vascular Surgery 1988 7, 119-129DOI: (10.1016/0741-5214(88)90385-0) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Control and preimplant scanning electron photomicrographs of balloon catheter—denuded, superficially endarterectomized, and deeply endarterectomized surfaces, show complete absence of endothelium in the test specimens. (Original magnification × 500.) Journal of Vascular Surgery 1988 7, 119-129DOI: (10.1016/0741-5214(88)90385-0) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Scanning electron microscopy views of representative specimens. At 1 week, endothelium is absent in the superficial endarterectomy specimens and present in the deep endarterectomy specimens. Balloon catheter—denuded specimens were not included in this subgroup because preliminary studies had shown that there would be no endothelialization after 1 week. At 2 weeks endothelium is present only in the deep endarterectomy specimens. At 4 weeks endothelium is more apparent in the deep endarterectomy group. At 8 weeks endothelium is evident in both endarterectomized specimens but is still absent in the balloon catheter—denuded specimens. Journal of Vascular Surgery 1988 7, 119-129DOI: (10.1016/0741-5214(88)90385-0) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 A, Factor VIII/vWF immunofluorescent staining of 2-week superficial endarterectomy specimen shows negative staining characteristics of flow surface (original magnification × 300). Appearance is representative of 1-, 2-, and 4-week superficial endarterectomy specimens and of balloon catheter—denuded specimens for all time periods. B, Factor VIII/vWF immunofluorescent staining of 8-week superficial endarterectomy. C, Deep endarterectomy specimen at 4 weeks shows typical positive granular luminal cell fluorescence indicative of endothelial cell coverage (original magnification × 300). Appearances of B and C are representative of 2-, 4-, and 8-week deep endarterectomy specimens and 8-week superficial endarterectomy specimens. Journal of Vascular Surgery 1988 7, 119-129DOI: (10.1016/0741-5214(88)90385-0) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Factor VIII/vWF immunofluorescent staining of 4-week deeply endarterectomized specimen shows streak of granular fluorescence extending from the media toward the luminal surface, suggesting a microvessel sectioned in its longitudinal extent. Journal of Vascular Surgery 1988 7, 119-129DOI: (10.1016/0741-5214(88)90385-0) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Clinical photograph of a deeply endarterectomized carotid artery shows the orifices of vasa vasorum, one of which is actively bleeding. Journal of Vascular Surgery 1988 7, 119-129DOI: (10.1016/0741-5214(88)90385-0) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions