Vein interposition cuffs decrease the intimal hyperplastic response of polytetrafluoroethylene bypass grafts Mark Kissin, MD, Nikhil Kansal, MD, Peter.

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Presentation transcript:

Vein interposition cuffs decrease the intimal hyperplastic response of polytetrafluoroethylene bypass grafts Mark Kissin, MD, Nikhil Kansal, MD, Peter J. Pappas, MD, David O. DeFouw, PhD, Walter N. Durán, PhD, Robert W. Hobson, MD Journal of Vascular Surgery Volume 31, Issue 1, Pages 69-83 (January 2000) DOI: 10.1016/S0741-5214(00)70069-3 Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Areas of anastomosis corresponding to heel, base, and toe, where serial 5-μm sections for morphometric measurements and qualitative histologic and immunohistochemistry analyses were performed. Journal of Vascular Surgery 2000 31, 69-83DOI: (10.1016/S0741-5214(00)70069-3) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Verhoeff's elastic stain and van Gieson's counterstain results of mid-anastomotic sections at 4 weeks from each study group showing progressively increasing intimal thickening with vein cuff, end-to-side, and polytetrafluoroethylene (PTFE) grafts compared with control (magnification, 440×). Journal of Vascular Surgery 2000 31, 69-83DOI: (10.1016/S0741-5214(00)70069-3) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Magnitude of intimal hyperplasia (IH) responses at heel, toe, and mid-anastomosis within each study group at 4 weeks. End-to-side grafts showed pronounced IH at the toe compared with polytetrafluoroethylene (PTFE) and vein cuff grafts. PTFE grafts primarily affected the base and heel of anastomosis, whereas vein cuff grafts showed minimal IH at any site. Journal of Vascular Surgery 2000 31, 69-83DOI: (10.1016/S0741-5214(00)70069-3) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Verhoeff's elastic stain and van Gieson's counterstain results of vein cuff anastomosis showing shift of intimal hyperplasia response from artery-vein cuff interface to vein cuff–prosthesis interface. Arrows indicate internal elastic lamina of artery and vein cuff. Triangles indicate external elastic lamina of recipient artery. Thick arrows indicate external elastic lamina of vein cuff. Long downward arrow points to location of suture hole of underlying vein graft (magnification, 74×). PTFE, Polytetrafluoroethylene. Journal of Vascular Surgery 2000 31, 69-83DOI: (10.1016/S0741-5214(00)70069-3) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Bar graph of intima/media (I/M) area ratios from heel of each study group at 1 and 4 weeks. Within each group, there were significant differences between 1 and 4 weeks (P ≤ .001). ES, End-to-side; PC, polytetrafluoroethylene cuff; VC, vein cuff. *VC4 versus ES4 and PC4 (P ≤ .001). #VC4 versus VC1 (P ≤ .001). +VC1 versus PC1 (P ≤ .001). Journal of Vascular Surgery 2000 31, 69-83DOI: (10.1016/S0741-5214(00)70069-3) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Bar graph of intima/media (I/M) area ratios from mid-anastomosis of each study group at 1 and 4 weeks. Within each group, there were significant differences between 1 and 4 weeks (P ≤ .001). Vein cuff (VC) and end-to-side (ES) grafts did not differ at 1 and 4 weeks. PC, Polytetrafluoroethylene cuff. +PC1 and PC4 were significantly elevated compared with VC and ES grafts (P ≤ .001). Journal of Vascular Surgery 2000 31, 69-83DOI: (10.1016/S0741-5214(00)70069-3) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Bar graph of intima/media (I/M) area ratios from toe of each study group at 1 and 4 weeks. Within each group, there were significant differences between 1 and 4 weeks (P ≤ .001). ES, End-to-side; PC, polytetrafluoroethylene cuff; VC, vein cuff. *VC4 versus ES4 and PC4 (P ≤ .001). +PC1 was increased compared with ES1 and VC1 (P ≤ .001). No differences were noted between PC4 and ES4. Journal of Vascular Surgery 2000 31, 69-83DOI: (10.1016/S0741-5214(00)70069-3) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Immunohistochemistry results for transforming growth factor–β1 showing staining of elliptical cells in intima of polytetrafluoroethylene (PTFE) cuff group (inverted arrows) . Diffuse staining is observed in intima of other study groups. Thick arrows indicate location of internal elastic lamina (magnification, 400×). gr, Graft. Journal of Vascular Surgery 2000 31, 69-83DOI: (10.1016/S0741-5214(00)70069-3) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 Immunohistochemistry results for platelet-derived growth factor–BB showing positive staining of elliptical cells in intima (inverted arrows) . Thick arrows indicate location of internal elastic lamina (magnification, 400×). Journal of Vascular Surgery 2000 31, 69-83DOI: (10.1016/S0741-5214(00)70069-3) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 10 Immunohistochemistry results for smooth muscle α-actin showing staining of elliptical cells within intima and media (arrowhead) . Morphologically similar cells in intima similarly showed positive stain results for transforming growth factor–β1 and platelet-derived growth factor–BB in adjacent serial sections. Long arrow points to internal elastic lamina (magnification, 1400×). Journal of Vascular Surgery 2000 31, 69-83DOI: (10.1016/S0741-5214(00)70069-3) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions