Procedure for Human Saphenous Veins <em>Ex Vivo</em> Perfusion and External Reinforcement

The mainstay of contemporary therapies for extensive occlusive arterial disease is venous bypass graft. However, its durability is threatened by intimal ...

University of Bordeaux

On the basis of our experience with more than 71 cases of totally laparoscopic aortic surgery by the retrocolic approach, we have developed a new technique by a simple transperitoneal approach. The purpose of this report is to describe that technique and the novel laparoscopic bowel retractor used to ensure stable exposure of the aorta.

Totally laparoscopic aortic repair: a new device for direct transperitoneal approach.

One of the goals of vascular tissue engineering is to create functional conduits for small-diameter bypass grafting. The present biocompatibility study was undertaken to check the ability of cord blood progenitor-derived endothelial cells (PDECs) to take the place of endothelial cells in vascular tissue engineering. After isolation, culture and characterization of endothelial progenitor cells, the following parameters were explored, with a commercial knitted polyester prosthesis (Polymaille C, Laboratoires Pérouse, France) impregnated with collagen: cell adhesion and proliferation, colonization, cell retention on exposure to flow, and the ability of PDECs to be regulated by arterial shear stress via mRNA levels. PDECs were able to adhere to commercial collagen-coated vascular grafts in serum-free conditions, and were maintained but did not proliferate when seeded at 2.0 x 10(5) cm(-2). Cellularized conduits were analyzed by histology and histochemical staining, demonstrating collagen impregnation and the endothelial characteristics of the colonizing cells. Thirty-six hours after cell seeding the grafts were maintained for 6 h of either static conditions (controls) or application of pulsatile laminar shear stress, which restored the integrity of the monolayer. Finally, quantitative real-time RT-PCR analysis performed at 4 and 8 h from cells lining grafts showed that MMP1 mRNA only was increased at 4h whereas vWF, VE-cadherin and KDR were not significantly modified at 4 and 8 h. Our results show that human cord blood PDECs are capable of forming an efficient lining and to withstand shear stress.

Capability of human umbilical cord blood progenitor-derived endothelial cells to form an efficient lining on a polyester vascular graft in vitro.

To evaluate the feasibility of endovascular exclusion of popliteal artery aneurysm (PAA) using stent grafts.

A retrospective multicenter study of endovascular treatment of popliteal artery aneurysm.

Extracranial carotid aneurysm is a rare vascular manifestation of Behçet disease. To our knowledge, only 32 cases have been reported. This article presents a complex case of a 28-year-old man who was first treated by vein graft reconstruction. At 12 months of follow-up, a nonanastomotic false aneurysm of the vein graft occurred and was treated by interposition of prosthetic graft. Two months later, an anastomotic pseudoaneurysm between the two grafts was excluded by two stent grafts. Based on our experience and a review of the literature, we compared the outcomes of prosthetic and autologous vein reconstructions and discussed the role of carotid ligation and immunosuppressive treatment.

Don't trust a vein graft to treat carotid aneurysm in patients with Behçet disease.

We describe two cases of true dorsalis pedis artery aneurysms in men referred for pulsatile mass of the dorsal part of the foot. Both aneurysms were resected and grafted with interposition of a short segment of saphenous vein. Histological analysis showed true aneurysm associated with atherosclerosis. To our knowledge, only 12 cases of true dorsalis pedis artery aneurysm have been reported previously. On the basis of our experience and after reviewing the literature, the management of this uncommon pathology was discussed.

Current management of true aneurysm of the dorsalis pedis artery.

A mycotic pseudoaneurysm of the popliteal artery is usually a consequence of septic embolization and often a result of bacterial endocarditis. Conventional treatment is surgical and avoids the placement of foreign material in infected sites. Here we report our treatment of a 59-year-old man who presented with a rupture of a mycotic pseudoaneurysm of the popliteal artery due to septic embolism from sternoclavicular infectious arthritis. Radiological investigations are included. This is the first documented case of septic arthritis complicated by a rupture of a mycotic popliteal false aneurysm and treated using an endovascular procedure. Combining endovascular stent grafts with evacuation of the joint abscess and antibiotic therapy can offer a safe alternative for frail and unstable patients.

Stent graft exclusion of a ruptured mycotic popliteal pseudoaneurysm complicating sternoclavicular joint infection.

Human saphenous vein grafts are one of the salvage bypass conduits when endovascular procedures are not feasible or fail. Understanding the remodeling process that venous grafts undergo during exposure to arterial conditions is crucial to improve their patency, which is often compromised by intimal hyperplasia. The precise role of hemodynamic forces such as shear stress and arterial pressure in this remodeling is not fully characterized. The aim of this study was to determine the involvement of arterial shear stress and pressure on vein wall remodeling and to unravel the underlying molecular mechanisms.

Role of hemodynamic forces in the ex vivo arterialization of human saphenous veins.

New data suggest that arteriovenous fistulas compared with prosthetic grafts may not be a superior predialysis approach to vascular access for haemodialysis in patients aged ≥80 years. However, the use of catheters as the first vascular access was associated with significantly increased mortality in these patients and should be avoided.

Dialysis: 'catheter last' not 'fistula first' in elderly patients.

In arterial replacement there is a clear clinical need for a functional substitute possessing appropriate haemocompatible properties to be implanted as small diameter artery. Endothelial cell seeding constitutes an appreciated method to improve blood compatibility on the condition that cells firmly adhere to the support. Along this way, an innovative technique based on multilayered polyelectrolyte films (PEM) as cell adhesive substrate was previously validated in vitro and in vivo in a small-animal model. In this study, we extended the work on a larger animal (sheep) to validate furthermore the paradigm of PEM functionalization for vascular substitutes. We tested in vitro: the efficiency of PEM to induce endothelial progenitor differentiation in sheep endothelial cells; the ability of PEM to sustain cell proliferation and allow resistance to shear stress; the fate of PEM-coated de-endothelialized human saphenous veins under flow conditions, a prerequisite step before in vivo experiments. Despite in vitro differences we were encouraged by testing in vivo PEM-coated prosthesis as carotid replacement in sheep, but without success. In order to explain the implantation failure, an in vitro haemocompatibility evaluation was performed that highlighted interspecies differences able to explain, at least in part, the graft failure obtained.

Interspecies differences with in vitro and in vivo models of vascular tissue engineering.

The saphenous vein is the conduit of choice in bypass graft procedures. Haemodynamic factors play a major role in the development of intimal hyperplasia (IH), and subsequent bypass failure. To evaluate the potential protective effect of external reinforcement on such a failure, we developed an ex vivo model for the perfusion of segments of human saphenous veins under arterial shear stress. In veins submitted to pulsatile high pressure (mean pressure at 100 mmHg) for 3 or 7 days, the use of an external macroporous polyester mesh 1) prevented the dilatation of the vessel, 2) decreased the development of IH, 3) reduced the apoptosis of smooth muscle cells, and the subsequent fibrosis of the media layer, 4) prevented the remodelling of extracellular matrix through the up-regulation of matrix metalloproteinases (MMP-2, MMP-9) and plasminogen activator type I. The data show that, in an experimental ex vivo setting, an external scaffold decreases IH and maintains the integrity of veins exposed to arterial pressure, via increase in shear stress and decrease wall tension, that likely contribute to trigger selective molecular and cellular changes.

The use of external mesh reinforcement to reduce intimal hyperplasia and preserve the structure of human saphenous veins.

Use of 18F-fluorodeoxyglucose positron emission tomography-computed tomography and sonication for detection of infection after peripheral stent fracture.

Xavier Berard

Department of Vascular Surgery,
Pellegrin Hospital

University of Bordeaux

Procedure for Human Saphenous Veins Ex Vivo Perfusion and External Reinforcement

Xavier Berard

.css-o250i3{font-size:18px;font-family:Open Sans,sans-serif;line-height:21.6px;}Department of Vascular Surgery,Pellegrin Hospital

University of Bordeaux

Procedure for Human Saphenous Veins Ex Vivo Perfusion and External Reinforcement

Department of Vascular Surgery,
Pellegrin Hospital