Effects of thrombolysis and venous thrombectomy on valvular competence, thrombogenicity, venous wall morphology, and function Jae-Sung Cho, MD, Eugenio.

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Presentation transcript:

Effects of thrombolysis and venous thrombectomy on valvular competence, thrombogenicity, venous wall morphology, and function Jae-Sung Cho, MD, Eugenio Martelli, MD, Geza Mozes, MD, Virginia M. Miller, PhD, Peter Gloviczki, MD Journal of Vascular Surgery Volume 28, Issue 5, Pages 787-799 (November 1998) DOI: 10.1016/S0741-5214(98)70053-9 Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Diagram shows balloon thrombectomy. Journal of Vascular Surgery 1998 28, 787-799DOI: (10.1016/S0741-5214(98)70053-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Platelet (left) and fibrin (right) deposition in canine femoral veins after sham operation, thrombolysis, and thrombectomy. Data are shown as mean ± standard error of the mean of platelet counts (platelet/cm2 and μg/cm2, for platelet and fibrin deposition, respectively). *, Statistical significance by analysis of variance, thrombectomy versus all others (P < .05). Journal of Vascular Surgery 1998 28, 787-799DOI: (10.1016/S0741-5214(98)70053-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Contractions to serotonin (5HT) in rings of canine femoral veins with and without endothelium 48 hours after untreated experimental deep venous thrombosis in the absence of (left) and presence of (right) NG-monomethyl-l-arginine. Data are expressed as percentage to maximal contraction to norepinephrine (104 mol/L) and are shown as mean ± standard error of the mean. *, Statistical significance by Student t test of area under curve (P < .05). Journal of Vascular Surgery 1998 28, 787-799DOI: (10.1016/S0741-5214(98)70053-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Contractions to serotonin (5HT) in rings of canine femoral veins with endothelium 48 hours after experimental DVT that was not treated (NT), treated by thrombectomy (TX), or thrombolysis (TL). Sham-operated veins (SH) are also shown. Data are expressed as percentage to maximal contraction to norepinephrine (10-4 mol/L) and are shown as mean ± standard error of the mean. No statistical significance was observed by analysis of variance of area under curve. Journal of Vascular Surgery 1998 28, 787-799DOI: (10.1016/S0741-5214(98)70053-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Relaxations to adenosine diphosphate (ADP) in rings of canine femoral veins with untreated thrombus. Data are expressed as percent change in tension from contraction to PGF2α and are expressed as mean ± standard error of the mean. *, Statistical significance by Student t test of area under curve (P < .05). Journal of Vascular Surgery 1998 28, 787-799DOI: (10.1016/S0741-5214(98)70053-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Relaxations to adenosine diphosphate (ADP) in canine femoral veins in the presence of (left) and absence of (right) endothelium. Data are expressed as percent change in tension from contraction to PGF2α and are expressed as mean ± standard error of the mean. Thrombolysis (TL) maintained greatest relaxations compared with all other groups in presence of endothelium. When endothelium was removed, thrombolysis maintained greater relaxations compared with thrombectomy (TX). *, Statistical significance by analysis of variance of area under curve. P < .05 for thrombectomy versus urokinase in the presence of endothelium (left), and thrombolysis versus all others in in absence of endothelium (right). Journal of Vascular Surgery 1998 28, 787-799DOI: (10.1016/S0741-5214(98)70053-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Relaxations to calcium ionophore A23187 in rings of canine femoral vein with endothelium. Data are expressed as percent change in tension from contraction to PGF2α and are shown as mean ± standard error of the mean. *, Significantly decreased relaxation in thrombectomized and thrombolysed rings by analysis of variance of area under curve. P < .05 for thrombectomy versus sham and thrombolysis versus sham. Journal of Vascular Surgery 1998 28, 787-799DOI: (10.1016/S0741-5214(98)70053-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Relaxations to nitric oxide in rings of canine femoral veins without endothelium. Data are expressed as percent change in tension from contraction to prostaglandin F2α and are shown as mean ± standard error of the mean. *, Significantly decreased relaxation in thrombectomized and thrombolysed rings by analysis of variance of area under curve. P < .05 for thrombectomy versus thrombolysis, versus sham, and thrombectomy versus no treatment. Journal of Vascular Surgery 1998 28, 787-799DOI: (10.1016/S0741-5214(98)70053-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 Representative light microscopy of canine femoral veins stained with methylene blue. A, After thrombolysis, smooth muscle layer is intact. B, Deep injury to media of vein is shown with thrombus on surface after thrombectomy. Magnification: ×40. Journal of Vascular Surgery 1998 28, 787-799DOI: (10.1016/S0741-5214(98)70053-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 10Endothelial injury assessment by means of scanning electron microscopy on scale of 1 to 5: 1, 0 to 1% cell loss; 2, 2% to 25% loss; 3, 26% to 50% loss; 4, 51% to 75% loss; and 5, 76% to 100% loss. *, Statistical significance by analysis of variance. P < .05 for thrombectomy versus sham and thrombolysis versus sham. Journal of Vascular Surgery 1998 28, 787-799DOI: (10.1016/S0741-5214(98)70053-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 11 Representative scanning electron micrographs of canine femoral veins. A, Grade 1. Femoral vein freshly removed from normal dog. Endothelial layer is intact. B, Grade 2. Note mild disruption of endothelial layer with leukocyte and platelet adhesion. C, Grade 3. Patchy endothelial denudation with exposure of subendothelial matrix is evident. D, Grade 4. Significant sloughing of endothelium with swelling is noted. E, Grade 5. Severe endothelial denudation with underlying subendothelial matrix. Magnification: ×1000. Journal of Vascular Surgery 1998 28, 787-799DOI: (10.1016/S0741-5214(98)70053-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions