Pseudoaneurysm formation in a subset of patients with small intestinal submucosa biologic patches after carotid endarterectomy Robert A. McCready, MD,

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Presentation transcript:

Pseudoaneurysm formation in a subset of patients with small intestinal submucosa biologic patches after carotid endarterectomy Robert A. McCready, MD, Jason Hodde, Randy J. Irwin, MD, Arthur C. Coffey, MD, Janet L. Divelbiss, RN, M. Ann Bryant, MSN, RN, CS, ACNP, Richard W. Chitwood, MD, Douglas S. Paget, MD, Bart A. Chess, MD Journal of Vascular Surgery Volume 41, Issue 5, Pages 782-788 (May 2005) DOI: 10.1016/j.jvs.2005.02.035 Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 1 A, Cerebral angiogram shows a pseudoaneurysm at the endarterectomy site. B, Exclusion of the pseudoaneurysm after placement of two Wallgrafts. Journal of Vascular Surgery 2005 41, 782-788DOI: (10.1016/j.jvs.2005.02.035) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 2 Cerebral angiogram shows thrombus (arrow), which was lysed with thrombolytic therapy, in a branch of the middle cerebral artery. Journal of Vascular Surgery 2005 41, 782-788DOI: (10.1016/j.jvs.2005.02.035) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 3 A, Biopsy specimen (hematoxylin and eosin, ×100) from a section of native artery that had undergone carotid endarterectomy 8 weeks before shows an arterial wall composed of normal-appearing arterial muscle with no neointima, minimal inflammatory changes, and discontinuous endothelium. B, Same specimen at ×200. L, Lumen; p, remnants of vascular patch. Journal of Vascular Surgery 2005 41, 782-788DOI: (10.1016/j.jvs.2005.02.035) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 4 A biopsy specimen from a section of arterial wall that had been replaced with the small intestinal submucosa (SIS) vascular patch after carotid endarterectomy 8 weeks before shows newly formed arterial tissue overlying the remnants of the vascular patch. Luminal to the SIS layer, the replaced arterial wall is composed of a new layer of connective tissue circumferentially arranged around the lumen and consisting of spindle-shaped fibroblasts and more mature fibrocytes (arrows) minimally separated by collagenous ground substance. Scant numbers of neutrophils are present in the most luminal portions of the section, but inflammatory changes are generally minimal. Immunohistochemistry confirmed the presence of actin-positive myofibroblasts or smooth muscle cells. Endothelium is absent. (Actin ×400.) Journal of Vascular Surgery 2005 41, 782-788DOI: (10.1016/j.jvs.2005.02.035) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 5 Testing of the material lots from which the patches were made showed that Lot 2 was much thinner than the average population of devices (A) and that Lot 1 was highly variable in the properties of tensile strength (B) and suture retention strength (C) compared with the controls. Journal of Vascular Surgery 2005 41, 782-788DOI: (10.1016/j.jvs.2005.02.035) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions