A cadaveric perfused model with antegrade arteriovenous pulsatile circulation: a new tool for teaching endovascular skills.

BACKGROUND: The benefits of using cadaveric humans in surgical training are well documented, and knowledge of the latest endovascular techniques is essential in the daily practice of vascular surgeons. Our study explores the feasibility of an affordable human cadaveric model with pulsatile and heated antegrade perfusion for reliable and reproducible endovascular or surgical simulation. METHODS: We undertook cannulation of 7 human cadavers embalmed in a saturated salt solution to create a left-to-right central perfusion with a heated solution, from the ascending thoracic aorta to the right atrium. To that end, we used surgically created carotidojugular and femorofemoral arteriovenous fistulas. Biomedical engineers designed a prototype pump for pulsatile circulation. We monitored invasive blood pressure and temperature. We used this model for training for endovascular thoracic aortic procedures and open vascular surgeries. RESULTS: The prototype pump achieved a pulsatile flow rate of 4.7 L/min. Effective cadaveric perfusion was achieved for several hours, not only with an arterioarterial pathway but also with arteriovenous circulation. The arterial pressures and in situ temperatures accurately restored vascular functions for life-like conditions. This new model made it possible to successfully perform thoracic endovascular aortic repair, subclavian artery stenting and simulation of abdominal open vascular trauma management. The saturated salt solution method and a specifically designed pump improved cost competitiveness. CONCLUSION: Endovascular simulation on human cadavers, optimized with the pulsatile and heated perfusion system, can be a dynamic adjunct for surgical training and familiarization with new devices. This reproducible teaching tool could be relevant in all surgery programs.

Clinical and biochemical data of endothelial function in Women Consuming Combined Contraceptives.

The data presented in this article are associated with the research article entitled "Heme-Nitrosylated Hemoglobin and Oxidative Stress in Women Consuming Combined Contraceptives. Clinical Application of the EPR Spectroscopy" (Lobysheva et al., 2017 [1]), and describe the characteristics of redox status in blood, as well as biochemical and clinical parameters of young female subjects consuming (or not) contraceptive pills (CP). Erythrocyte concentration of reduced thiols reflecting erythrocyte redox capacity was measured before and after sample deproteinization by electron paramagnetic resonance spectroscopy (EPR) using a nitroxide biradical spin probe specifically interacting with reduced thiols; additional data were obtained by a colorimetric method using Ellman׳s reagents in the same samples. The products of nitric oxide oxidation, nitrite and total NOx (in presence of nitrate reductase) were measured in the plasma of study subjects by a colorimetric assay based on the detection of red-violet colored azo dye after reaction of nitrite with the Griess reagent. Biochemical and clinical parameters reflective of cardiovascular risk factors (diastolic blood pressure, C-reactive protein, triglycerides and homocysteine concentrations in venous blood) were compared in subgroups of consumers of CP containing ethinyl estradiol and different types of synthetic progestogens. Parameters reflective of the integrity of the vasculature, - erythrocyte concentration of heme-nitrosylated hemoglobin (5-coordinate α-heme-FeII-NO, HbNO) measured directly by the EPR subtraction method; index of reactive hyperemia response (FRHI) measured by digital pulse tonometry using EndoPAT; oxidative vascular stress measured as total plasma peroxide concentration were compared in subgroups of young women taking CP containing ethinyl estradiol at different concentrations and for various durations.

Heme-nitrosylated hemoglobin and oxidative stress in women consuming combined contraceptives. Clinical application of the EPR spectroscopy.

An increased risk of venous thromboembolism was identified in young women consuming combined contraceptive pills (CP) suggesting a disturbance of vascular homeostasis but the impact of CP on endothelial function and redox status of the vasculature was not thoroughly analyzed. We measured the bioavailability of nitric oxide (NO), a main mediator of vascular homeostasis in a cohort of young female subjects (n=114) and compared the results in users or not of CPs containing ethinyl estradiol and synthetic progestogens. Vascular NO availability was measured by quantification of the heme-nitrosylated hemoglobin (5-coordinate-α-HbNO) concentrations in venous erythrocytes using Electron Paramagnetic Resonance spectroscopy (EPR). Vascular oxidative status was assessed by measurement of peroxides in plasma, and of the thiol redox state in erythrocytes. In addition, endothelial function was assessed by digital reactive hyperemia pulse tonometry using EndoPAT. We observed that the HbNO level was significantly lower in erythrocytes of subjects consuming CPs versus controls (162±8 and 217±12 nmol/L). This correlated with significantly increased levels of plasma peroxides (1.8±0.1mmol/L versus 0.8±0.1mmol/L in controls) and decreased concentrations of erythrocyte reduced thiols (by 12%). Interestingly, the level of oxidized ceruloplasmin-Cu(II) was also significantly higher in the group consuming CPs. The EndoPAT index showed a trend towards impairment in CP users, and was significantly lower in subjects that consumed CPs containing drospirenone, and had lowest erythrocyte HbNO levels. CONCLUSION: This cross-sectional cohort study demonstrates that a decrease of HbNO measured by quantitative EPR in human venous erythrocytes is correlated with the development of endothelial dysfunction under CPs consumption, in parallel with increased vascular oxidative stress.