Human ex-vivo model of Stanford type B aortic dissection

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Presentation transcript:

Human ex-vivo model of Stanford type B aortic dissection Elsa Madeleine Faure, MD, Ludovic Canaud, MD, PhD, Philippe Cathala, MD, Isabelle Serres, MD, Charles Marty-Ané, MD, PhD, Pierre Alric, MD, PhD Journal of Vascular Surgery Volume 60, Issue 3, Pages 767-775 (September 2014) DOI: 10.1016/j.jvs.2013.06.083 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 Benchtop closed-system pulsatile flow model. The model consisted of a (1) high pressure pump, (2) pressure regulator, (3) proximal aortic connector, (4) fixed round pivot, (5) distal aortic connector, (6) graft anastomosed to the distal part of the aortic branch vessels (including the celiac trunk (CT), superior mesenteric artery (SMA), and renal arteries). The distal end of the graft was connected to the reservoir to ensure an antegrade circulation into the aortic branch vessels, (7) reservoir. Journal of Vascular Surgery 2014 60, 767-775DOI: (10.1016/j.jvs.2013.06.083) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Intimal-medial layer detached from the adventitia and loosely fixed by a suture to the opposite aortic wall, opening the false lumen (FL) channel. Journal of Vascular Surgery 2014 60, 767-775DOI: (10.1016/j.jvs.2013.06.083) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 Two views of the primary entry tear using a 5-mm 30° lens (Richard Wolf, Vernon Hills, Ill) connected to a video camera. (1) False lumen (FL) initiated before propagation of the dissection. (2) Loose stitch fixing the intimo-medial layer to the opposite aortic wall. (3) FL after propagation of the dissection. (4) True lumen. Journal of Vascular Surgery 2014 60, 767-775DOI: (10.1016/j.jvs.2013.06.083) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 Angioscopy. Views of the false lumen (FL) (A) and the true lumen (B) of a dissected aorta. A, FL. (1) Ostia of the left renal artery (LRA) on the dissected aortic wall; (2) Ostia of the superior mesenteric artery (SMA) on the dissected aortic wall; (3) Ostia of the celiac trunk (CT) on the dissected aortic wall; (4) intimomedial flap. B, True lumen. (1) The dissection flap prolapse within the true lumen; (2) Right renal artery (RRA) supplied by the true lumen. Journal of Vascular Surgery 2014 60, 767-775DOI: (10.1016/j.jvs.2013.06.083) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 5 Macroscopic examination of aorta. A, The dissected layer is open. Dissection end with a distal re-entry located at the left renal artery (LRA) level. B, Dissection end with two distal re-entries located at the celiac trunk (CT) and the right renal artery (RRA) level. C, Dissection ended with a distal re-entry located at the LRA level. Journal of Vascular Surgery 2014 60, 767-775DOI: (10.1016/j.jvs.2013.06.083) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 6 Cross-section of aorta on macroscopic examination. A, The right renal artery (RRA) originated from the false lumen (FL). B, The celiac trunk (CT) originated from the FL. Journal of Vascular Surgery 2014 60, 767-775DOI: (10.1016/j.jvs.2013.06.083) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 7 Sections of a dissected aorta. On microscopic examination, the dissected layer is located within the media layer (hematoxylin and eosin stain; ×1 magnification). Journal of Vascular Surgery 2014 60, 767-775DOI: (10.1016/j.jvs.2013.06.083) Copyright © 2014 Society for Vascular Surgery Terms and Conditions