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

Longchamp, Alban; Alonso, Florian; Dubuis, Céline; Allagnat, Florent; Bérard, Xavier; Meda, Paolo; Saucy, François; Corpataux, Jean-Marc; Déglise, Sebastien; Haefliger, Jacques-Antoine

doi:10.1016/j.biomaterials.2013.12.041

Cited by 41 publications

(41 citation statements)

References 42 publications

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“…This system allows saphenous veins perfusion under defined hemodynamic parameters in the absence of aggravating inflammatory and growth factors released by circulating cells in vivo. Thus, it provides a better understanding of the underlying pathways involved in the control of IH in human veins grafts 5,11,12,15 .…”

Section: Discussionmentioning

confidence: 99%

“…These data demonstrate that the use of an external macroporous tubular polyester mesh is an efficient method to limit the development of IH in vein grafts inserted into an arterial environment 11 . This system can profit several areas of research.…”

confidence: 98%

“…Prepare the medium. Based on previous studies 5, [11][12][13][14] , choose RPMI-1640, supplemented with Glutamax, 12.5% fetal calf serum, and 1% antibiotic-antimycotic solution (10,000 U/ml penicillin G, plus 10 mg/ml streptomycin sulfate, plus 25 mg/ml amphotericin B, plus 0.5 μg/ ml: gentamycin). Shear stress (SS) is given by SS= 4 μQ/π*r 3 Q is the flow rate (ml/sec), r the radius (cm) of the vein segment, and μ is the viscosity of the perfusion medium.…”

Section: Evps Designmentioning

confidence: 99%

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

Longchamp

Allagnat²,

Bérard

et al. 2014

JoVE

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The mainstay of contemporary therapies for extensive occlusive arterial disease is venous bypass graft. However, its durability is threatened by intimal hyperplasia (IH) that eventually leads to vessel occlusion and graft failure. Mechanical forces, particularly low shear stress and high wall tension, are thought to initiate and to sustain these cellular and molecular changes, but their exact contribution remains to be unraveled. To selectively evaluate the role of pressure and shear stress on the biology of IH, an ex vivo perfusion system (EVPS) was created to perfuse segments of human saphenous veins under arterial regimen (high shear stress and high pressure). Further technical innovations allowed the simultaneous perfusion of two segments from the same vein, one reinforced with an external mesh. Veins were harvested using a no-touch technique and immediately transferred to the laboratory for assembly in the EVPS. One segment of the freshly isolated vein was not perfused (control, day 0). The two others segments were perfused for up to 7 days, one being completely sheltered with a 4 mm (diameter) external mesh. The pressure, flow velocity, and pulse rate were continuously monitored and adjusted to mimic the hemodynamic conditions prevailing in the femoral artery. Upon completion of the perfusion, veins were dismounted and used for histological and molecular analysis. Under ex vivo conditions, high pressure perfusion (arterial, mean = 100 mm Hg) is sufficient to generate IH and remodeling of human veins. These alterations are reduced in the presence of an external polyester mesh.

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Section: Discussionmentioning

confidence: 99%

confidence: 98%

Section: Evps Designmentioning

confidence: 99%

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

Longchamp

Allagnat²,

Bérard

et al. 2014

JoVE

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“…While variations in wall shear stress have traditionally been viewed as the key determinant of the phenotype of the arterialized vein wall, 31, 32 we have generated evidence that surgical trauma itself greatly impacts the local milieu by affecting the greatest mass tissue in the area, adipose tissue. Our recently published experiments show that surgery dominates in determining gene expression in murine adipose compared to other clinically relevant parameters.…”

Section: Discussionmentioning

confidence: 99%

Adipose phenotype predicts early human autogenous arteriovenous hemodialysis remodeling

Mauro

Ding

Hou

et al. 2016

Journal of Vascular Surgery

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Objective Substantial proportions of autogenous arteriovenous hemodialysis access fistulas (AVF) fail to mature for unclear reasons. AVFs develop in a large mass of surrounding adipose tissue that is increasingly recognized as an active participant in the vascular response to injury via paracrine and endocrine mechanisms. We thus hypothesized that baseline phenotypic characteristics of the adipose juxtaposed to the developing AVF associate with subsequent inward or outward vein wall remodeling. Methods Clinical data and subcutaneous adipose tissue were collected from consented patients undergoing AVF creation (n=22). Tissue was assayed (protein levels) for IL-6, IL-8, leptin, TNF-α, MCP-1, resistin, and adiponectin. Duplex ultrasound vein dimensions were acquired pre-operatively and 4–6 weeks post-operatively at a point 1cm cephalad to the arteriovenous anastomosis (most common location of AVF stenosis). Results The vein at the assayed location outwardly remodeled 55.7% on average (pre-median 3.7 mm, post-median 4.7 mm; p=0.005). Pre-operative vein diameter failed to correlate with post-operative size at the point of assay (R=0.31, p=0.155) unless two outliers were excluded (R=0.64, p=0.002). After removal of the same outliers, the correlation coefficient between venous diameter change (pre-operative vs. post-operative) and IL-8, TNF-α, MCP-1, resistin, and adiponectin was −0.49, −0.79, −0.66, −0.64, and −0.69 respectively (p<0.05). Post-operative AVF flow volume correlated with MCP-1 (−0.53, p<0.05) and adiponectin (−0.47, p<0.05). Conclusion These data reveal a novel relationship between local adipose phenotype and the eventual venous wall response to hemodynamic perturbation in humans. The predictive value of these mediators generally equaled or exceeded that of pre-operative vein size. Beyond providing mechanistic insights into vascular wall adaptations due to flow perturbations, this discovery suggests that strategies focused on altering adipose tissue biology may improve AVF maturation.

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“…Paraffin sections of adipose tissue were immunostained as previously described 22,23 using the following primary antibody: rabbit anti-mouse UCP1 (10983, abcam, Cambridge, MA, USA) at dilution 1:500 and secondary goat-anti rabbit antibody diluted 1:200 (Vector Laboratories, Inc. Burlingame, CA, USA). Negative controls were performed simultaneously.…”

Section: Immunohistochemistrymentioning

confidence: 99%

Surgical injury induces local and distant adipose tissue browning

et al. 2016

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The adipose organ, which comprises brown, white and beige adipocytes, possesses remarkable plasticity in response to feeding and cold exposure. The development of beige adipocytes in white adipose tissue (WAT), a process called browning, represents a promising route to treat metabolic disorders. While surgical procedures constantly traumatize adipose tissue, its impact on adipocyte phenotype remains to be established. Herein, we studied the effect of trauma on adipocyte phenotype one day after sham, incision control, or surgical injury to the left inguinal adipose compartment. Caloric restriction was used to control for surgery-associated body temperature changes and weight loss. We characterized the trauma-induced cellular and molecular changes in subcutaneous, visceral, interscapular, and perivascular adipose tissue using histology, immunohistochemistry, gene expression, and flow cytometry analysis. After one day, surgical trauma stimulated adipose tissue browning at the site of injury and, importantly, in the contralateral inguinal depot. Browning was not present after incision only, and was largely independent of surgery-associated body temperature and weight loss. Adipose trauma rapidly recruited monocytes to the injured site and promoted alternatively activated macrophages. Conversely, PDGF receptorpositive beige progenitors were reduced. In this study, we identify adipose trauma as an unexpected driver of selected local and remote adipose tissue browning, holding important implications for the biologic response to surgical injury.

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

Cited by 41 publications

References 42 publications

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

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

Adipose phenotype predicts early human autogenous arteriovenous hemodialysis remodeling

Surgical injury induces local and distant adipose tissue browning

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