Vein patching reduces neointimal thickening associated with prosthetic graft implantation

Andrew T. Gentile, Joseph L Mills, Michael A. Gooden, R. Daniel Hagerty, Scott S. Berman, John D Hughes, Leigh B. Kleinert, Stuart K. Williams

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

PURPOSE: Modified anastomotic techniques utilizing autogenous vein- cuffs or patches have been devised with the hope of improving prosthetic graft patency. The mechanisms of the presumed improvement in patched anastomoses have never been elucidated and remain speculative. We characterized the healing response of the Taylor vein patch in prosthetic arteriovenous fistulae in a canine model of intimal hyperplasia. METHODS: Six adult dogs underwent placement of bilateral (6 patched, 6 control) 4-mm diameter expanded polytetrafluoroethylene loop femoral artery-vein fistulae. Serial duplex ultrasound examinations confirmed graft patency until explant at 6 weeks. Differential light microscopy with computerized image analysis was performed on serial 5-μm sections. Intimal thickness through the venous anastomosis and outflow veins of Taylor patch and control (nonpatched) grafts were compared. Cell type-specific immunocytochemical antibody stains for smooth muscle cells (α SMC actin) and endothelial cells (von Willebrand factor) were performed. RESULTS: Eleven of 12 grafts remained patent for 6 weeks, 1 control graft thrombosed. Mean duplex-derived peak systolic velocities of patched (96 cm/sec) and control (108 cm/sec) grafts were similar. Microscopy revealed more intimal pannus anastomotic suture line ingrowth in controls (mean thickness = 178 μm) than Taylor patched grafts (mean 147 μm, p = 0.0002). Significantly less intimal thickening was present in the outflow vein of patched (mean thickness = 90 μm) versus control grafts (mean 195 μm, P <0.0001). The intima maintained a single cell layer of vWF + endothelial cells, while the majority of the cells comprising the lesion expressed α SMC actin. CONCLUSION: Perianastomotic pannus is primarily composed of intimal smooth muscle cells. Neointimal thickening is significantly reduced in prosthetic arteriovenous fistulae created with the Taylor vein patch in a canine model. Reduction in perianastomotic intimal thickening may explain the reported clinical improvement in prosthetic bypass graft patency when modified with vein patch techniques.

Original languageEnglish (US)
Pages (from-to)601-607
Number of pages7
JournalAmerican Journal of Surgery
Volume176
Issue number6
DOIs
StatePublished - 1998

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Tunica Intima
Veins
Transplants
Arteriovenous Fistula
Smooth Muscle Myocytes
Canidae
Actins
Microscopy
Endothelial Cells
Femoral Vein
Polytetrafluoroethylene
von Willebrand Factor
Femoral Artery
Sutures
Fistula
Hyperplasia
Thrombosis
Coloring Agents
Dogs
Light

ASJC Scopus subject areas

  • Surgery

Cite this

Vein patching reduces neointimal thickening associated with prosthetic graft implantation. / Gentile, Andrew T.; Mills, Joseph L; Gooden, Michael A.; Hagerty, R. Daniel; Berman, Scott S.; Hughes, John D; Kleinert, Leigh B.; Williams, Stuart K.

In: American Journal of Surgery, Vol. 176, No. 6, 1998, p. 601-607.

Research output: Contribution to journalArticle

Gentile, Andrew T. ; Mills, Joseph L ; Gooden, Michael A. ; Hagerty, R. Daniel ; Berman, Scott S. ; Hughes, John D ; Kleinert, Leigh B. ; Williams, Stuart K. / Vein patching reduces neointimal thickening associated with prosthetic graft implantation. In: American Journal of Surgery. 1998 ; Vol. 176, No. 6. pp. 601-607.
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title = "Vein patching reduces neointimal thickening associated with prosthetic graft implantation",
abstract = "PURPOSE: Modified anastomotic techniques utilizing autogenous vein- cuffs or patches have been devised with the hope of improving prosthetic graft patency. The mechanisms of the presumed improvement in patched anastomoses have never been elucidated and remain speculative. We characterized the healing response of the Taylor vein patch in prosthetic arteriovenous fistulae in a canine model of intimal hyperplasia. METHODS: Six adult dogs underwent placement of bilateral (6 patched, 6 control) 4-mm diameter expanded polytetrafluoroethylene loop femoral artery-vein fistulae. Serial duplex ultrasound examinations confirmed graft patency until explant at 6 weeks. Differential light microscopy with computerized image analysis was performed on serial 5-μm sections. Intimal thickness through the venous anastomosis and outflow veins of Taylor patch and control (nonpatched) grafts were compared. Cell type-specific immunocytochemical antibody stains for smooth muscle cells (α SMC actin) and endothelial cells (von Willebrand factor) were performed. RESULTS: Eleven of 12 grafts remained patent for 6 weeks, 1 control graft thrombosed. Mean duplex-derived peak systolic velocities of patched (96 cm/sec) and control (108 cm/sec) grafts were similar. Microscopy revealed more intimal pannus anastomotic suture line ingrowth in controls (mean thickness = 178 μm) than Taylor patched grafts (mean 147 μm, p = 0.0002). Significantly less intimal thickening was present in the outflow vein of patched (mean thickness = 90 μm) versus control grafts (mean 195 μm, P <0.0001). The intima maintained a single cell layer of vWF + endothelial cells, while the majority of the cells comprising the lesion expressed α SMC actin. CONCLUSION: Perianastomotic pannus is primarily composed of intimal smooth muscle cells. Neointimal thickening is significantly reduced in prosthetic arteriovenous fistulae created with the Taylor vein patch in a canine model. Reduction in perianastomotic intimal thickening may explain the reported clinical improvement in prosthetic bypass graft patency when modified with vein patch techniques.",
author = "Gentile, {Andrew T.} and Mills, {Joseph L} and Gooden, {Michael A.} and Hagerty, {R. Daniel} and Berman, {Scott S.} and Hughes, {John D} and Kleinert, {Leigh B.} and Williams, {Stuart K.}",
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T1 - Vein patching reduces neointimal thickening associated with prosthetic graft implantation

AU - Gentile, Andrew T.

AU - Mills, Joseph L

AU - Gooden, Michael A.

AU - Hagerty, R. Daniel

AU - Berman, Scott S.

AU - Hughes, John D

AU - Kleinert, Leigh B.

AU - Williams, Stuart K.

PY - 1998

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N2 - PURPOSE: Modified anastomotic techniques utilizing autogenous vein- cuffs or patches have been devised with the hope of improving prosthetic graft patency. The mechanisms of the presumed improvement in patched anastomoses have never been elucidated and remain speculative. We characterized the healing response of the Taylor vein patch in prosthetic arteriovenous fistulae in a canine model of intimal hyperplasia. METHODS: Six adult dogs underwent placement of bilateral (6 patched, 6 control) 4-mm diameter expanded polytetrafluoroethylene loop femoral artery-vein fistulae. Serial duplex ultrasound examinations confirmed graft patency until explant at 6 weeks. Differential light microscopy with computerized image analysis was performed on serial 5-μm sections. Intimal thickness through the venous anastomosis and outflow veins of Taylor patch and control (nonpatched) grafts were compared. Cell type-specific immunocytochemical antibody stains for smooth muscle cells (α SMC actin) and endothelial cells (von Willebrand factor) were performed. RESULTS: Eleven of 12 grafts remained patent for 6 weeks, 1 control graft thrombosed. Mean duplex-derived peak systolic velocities of patched (96 cm/sec) and control (108 cm/sec) grafts were similar. Microscopy revealed more intimal pannus anastomotic suture line ingrowth in controls (mean thickness = 178 μm) than Taylor patched grafts (mean 147 μm, p = 0.0002). Significantly less intimal thickening was present in the outflow vein of patched (mean thickness = 90 μm) versus control grafts (mean 195 μm, P <0.0001). The intima maintained a single cell layer of vWF + endothelial cells, while the majority of the cells comprising the lesion expressed α SMC actin. CONCLUSION: Perianastomotic pannus is primarily composed of intimal smooth muscle cells. Neointimal thickening is significantly reduced in prosthetic arteriovenous fistulae created with the Taylor vein patch in a canine model. Reduction in perianastomotic intimal thickening may explain the reported clinical improvement in prosthetic bypass graft patency when modified with vein patch techniques.

AB - PURPOSE: Modified anastomotic techniques utilizing autogenous vein- cuffs or patches have been devised with the hope of improving prosthetic graft patency. The mechanisms of the presumed improvement in patched anastomoses have never been elucidated and remain speculative. We characterized the healing response of the Taylor vein patch in prosthetic arteriovenous fistulae in a canine model of intimal hyperplasia. METHODS: Six adult dogs underwent placement of bilateral (6 patched, 6 control) 4-mm diameter expanded polytetrafluoroethylene loop femoral artery-vein fistulae. Serial duplex ultrasound examinations confirmed graft patency until explant at 6 weeks. Differential light microscopy with computerized image analysis was performed on serial 5-μm sections. Intimal thickness through the venous anastomosis and outflow veins of Taylor patch and control (nonpatched) grafts were compared. Cell type-specific immunocytochemical antibody stains for smooth muscle cells (α SMC actin) and endothelial cells (von Willebrand factor) were performed. RESULTS: Eleven of 12 grafts remained patent for 6 weeks, 1 control graft thrombosed. Mean duplex-derived peak systolic velocities of patched (96 cm/sec) and control (108 cm/sec) grafts were similar. Microscopy revealed more intimal pannus anastomotic suture line ingrowth in controls (mean thickness = 178 μm) than Taylor patched grafts (mean 147 μm, p = 0.0002). Significantly less intimal thickening was present in the outflow vein of patched (mean thickness = 90 μm) versus control grafts (mean 195 μm, P <0.0001). The intima maintained a single cell layer of vWF + endothelial cells, while the majority of the cells comprising the lesion expressed α SMC actin. CONCLUSION: Perianastomotic pannus is primarily composed of intimal smooth muscle cells. Neointimal thickening is significantly reduced in prosthetic arteriovenous fistulae created with the Taylor vein patch in a canine model. Reduction in perianastomotic intimal thickening may explain the reported clinical improvement in prosthetic bypass graft patency when modified with vein patch techniques.

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