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Ex vivo proof-of-concept of end-to-end scaffold-enhanced laser-assisted vascular anastomosis of porcine arteries  Dara R. Pabittei, MD, PhD, Michal Heger,

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Presentation on theme: "Ex vivo proof-of-concept of end-to-end scaffold-enhanced laser-assisted vascular anastomosis of porcine arteries  Dara R. Pabittei, MD, PhD, Michal Heger,"— Presentation transcript:

1 Ex vivo proof-of-concept of end-to-end scaffold-enhanced laser-assisted vascular anastomosis of porcine arteries  Dara R. Pabittei, MD, PhD, Michal Heger, PhD, Sjoerd van Tuijl, BSc, MSc, Marc Simonet, BSc, MSc, Wadim de Boon, BSc, MSc, Allard C. van der Wal, MD, PhD, Ron Balm, MD, PhD, Bas A. de Mol, MD, PhD  Journal of Vascular Surgery  Volume 62, Issue 1, Pages (July 2015) DOI: /j.jvs Copyright © 2015 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Illustration of the lasing regimens used in the first substudy. The black arrow points to the position of the solder-drenched scaffold, and the white arrows indicate the transverse incision plane along which the vessel segments were coapted. L, Arterial lumen; LS, laser spot. In the lower right corner, a scaffold- and solder-enhanced laser-assisted vascular anastomosis (ssLAVA) artery enveloped around a glass rod is shown (black arrow). The white arrow is pointing to the coagulated solder–scaffold at the anastomosis site. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

3 Fig 2 A, Schematic drawing of the closed-loop pulsatile pressure setup, modified from van den Broek et al.26 B, Photograph of the organ bath. Typical pressure (C) and flow (D) waveforms generated by the closed-loop pulsatile pressure setup are shown. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Schematic drawings of some steps of the scaffold- and solder-enhanced laser-assisted vascular repair (ssLAVR) and BioGlue procedure. A, Aortic strip cut in half along the longitudinal axis. B, After realignment of the opposing ends, poly(lactic-co-glycolic acid) (PLGA) ssLAVR was performed by applying approximately 50 μL of solder and scaffold to the adventitial surface before laser irradiation. C, The BioGlue repairs were performed by applying approximately 1 mL of BioGlue to the adventitial surface. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Mean ± standard deviation bursting pressure (BP) of (A) poly(ε-caprolactone) (PCL) and (B) poly(lactic-co-glycolic acid) (PLGA) scaffold- and solder-enhanced laser-assisted vascular anastomosis (ssLAVA) arteries plotted as a function of the number of lasing spots. An asterisk indicates the level of significance vs the group that obtained the highest mean ± standard deviation BP within the same scaffold group. The table (C) presents the level of significance between PCL and PLGA ssLAVA arteries lased with the same number of spots. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

6 Fig 5 A, Representative pressure trace of an artery welded by poly(ε-caprolactone) (PCL) scaffold- and solder-enhanced laser-assisted vascular anastomosis (ssLAVA) that was intact at 24 hours after lasing (red trace) or that had failed 12 hours after lasing (blue trace). B, Kaplan-Meier-type plots of the percentage of intact arteries as a function of pulsatile perfusion time. C-F, Representative macroscopic images of intact and leaked PCL and poly(lactic-co-glycolic acid) (PLGA) ssLAVA arteries. The arrows in E and F, point to the stream of phosphate-buffered saline (PBS) seeping through the failed anastomoses under continuous pressure. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

7 Fig 6 Scanning electron microscopy (SEM) images of the cross-sectional areas of intact (A, A.1, B, and B.1) and failed (C, C.1, D, and D.1) poly(ε-caprolactone) (PCL) and poly(lactic-co-glycolic acid) (PLGA) scaffold- and solder-enhanced laser-assisted vascular anastomosis (ssLAVA) arteries. The arrowheads point to the solder (S)–tissue (T) interface, whereas the arrows point to the site where the solder-scaffold coagulum had torn (C and C.1) and to the site where the solder-scaffold coagulum had detached from the vessel surface (D and D.1). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

8 Fig 7 Photomicrographs of native arteries and poly(ε-caprolactone) (PCL) and poly(lactic-co-glycolic acid) (PLGA) scaffold- and solder-enhanced laser-assisted vascular anastomosis (ssLAVA) arteries stained with picrosirius red (PR; A-F), Masson trichrome (MT; G-I), and hematoxylin and eosin (H&E; J-L). Low-magnification images of PR-stained samples exposed full-thickness thermal damage in both PCL and PLGA ssLAVA arteries (B and C) with considerable thinning/compression of the vessel wall. A higher magnification image of PR-stained control artery (D) showed intact, birefringent collagen in the adventitia (arrow) and media (circle and inset), as opposed to the ssLAVA-treated arteries (E and F), which exhibited partial loss of collagen birefringence in the adventitia (arrows) and partial loss of yellow- and green-stained collagen type I and III, respectively, in the media (circles and insets). The normal MT-stained artery (G) was characterized by intact smooth muscle cells with normal nuclei (circle and arrowhead, respectively), whereas the thermally damaged arteries (H and I) were characterized by shrunken smooth muscle cells (circles) and pyknotic nuclei (arrows). The H&E-stained thermally damaged arteries (K and L) revealed vacuolization of smooth muscle cells (arrows) and compression of elastin fibers (arrowheads), which were absent in nonirradiated smooth muscle cells (arrows) and elastin fibers (arrowheads) in the control artery (J). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

9 Fig 8 Mean ± standard deviation breaking strength (BS) of aortic repairs made with poly(lactic-co-glycolic acid) (PLGA) scaffold- and solder-enhanced laser-assisted vascular repair (ssLAVR) and BioGlue. ssLAVR was performed with PLGA scaffold, semisolid genipin solder, and single-spot pulsed lasing, whereas BioGlue repairs were performed by applying approximately 1 mL of BioGlue onto the coaptation. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

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