The in vivo characterization of electrospun heparin-bonded polycaprolactone in small-diameter vascular reconstruction.

OBJECTIVE: To evaluate the possibility of using heparin-bonded polycaprolactone grafts to replace small-diameter arteries. METHODS: Polycaprolactone was bonded with heparin. The activated partial thromboplastin time of heparin-bonded polycaprolactone grafts was determined in vitro. Small-diameter grafts were electrospun with heparin-bonded polycaprolactone and polycaprolactone and were implanted in dogs to substitute part of the femoral artery. Angiography was used to investigate the patency and aneurysm of the grafts after transplantation. After angiography, the patent grafts were explanted for histology analysis. The degradation of the grafts and the collagen content of the grafts were measured. RESULTS: Activated partial thromboplastin time tests in vitro showed that heparin-bonded polycaprolactone grafts exhibit obvious anticoagulation. Arteriography showed that two heparin-bonded polycaprolactone and three polycaprolactone grafts were obstructed. Other grafts were patent, without aneurysm formation. Histological analysis showed that the tested grafts degraded evidently over the implantation time and that the luminal surface of the tested grafts had become covered by endothelial cells. Collagen deposition in heparin-bonded polycaprolactone increased with time. There were no calcifications in the grafts. Gel permeation chromatography showed the heparin-bonded polycaprolactone explants at 12 weeks lose about 32% for Mw and 24% for Mn. The collagen content on the heparin-bonded polycaprolactone grafts increased over time. CONCLUSION: This preliminary study demonstrates that heparin-bonded polycaprolactone is a suitable graft for small artery reconstruction. However, heparin-bonded polycaprolactone degrades more rapidly than polycaprolactone in vivo.

[Special issues in endovascular treatment of lower extremities arteriosclerosis obliterans].

OBJECTIVE: To explore the clinical efficacy of endovascular treatment for lower extremity arteriosclerosis obliterans. METHODS: A total of 34 patients (43 limbs) with lower extremity arteriosclerosis obliterans undergoing endovascular treatment from July 2010 to July 2012 were analyzed. The cohort had Fontaine stage II b (n = 16), Fontaine stage III (n = 10) and Fontaine stage III (n = 8). Among them, the lesions were of TASC IIA (n = 4), TASC IIB (n = 8), TASC IIC (n = 9) and TASC IID (n = 13). All patients underwent percutaneous transluminal angioplasty (PTA) plus stents after computed tomographic angiography (CTA) or digital subtraction angiography (DSA). And 9 patients underwent femoral endarterectomy associated with endovascular treatment. RESULTS: The success rate of this technique was 100%. One iliac artery ruptured during endovascular surgery. One patient suffered intraoperatively from arterial perforation. One patient was amputated one week later. One patient had in-stent thrombosis at Week 3 post-treatment. One patient was amputated at Week 4 after endovascular treatment. Thirty patients (38 limbs) were followed up for 13.3 months. During the follow-up, 3, 4 and 4 limbs became occluded at Month 6, 12 and 24 post-treatment respectively. CONCLUSION: Endovascular treatment has an excellent early patency rate. Special issues should be properly handled during endovascular treatment.

Mesocavoatrial shunt for Budd-Chiari syndrome: a case report with long-term follow-up.

BACKGROUND: A case of mesocavoatrial shunting for the treatment of Budd-Chiari syndrome (BCS) with long-term follow-up is reported. METHODS: A 25-year-old man with stage II BCS was treated with a mesocavoatrial shunt to decompress the portal and IVC hypertension. During the 6-year follow-up, the patient was able to resume work as a salesperson and has since led a normal life. His graft remains patent. CONCLUSION: A mesocavoatrial shunt can simultaneously decompress portal and IVC hypertension and has satisfactory long-term patency. A mesocavoatrial shunt can be used to treat patients with severe BCS who could not be successfully treated with medical therapy and intervention.

Case report: Cardiac arrest during carotid body tumor resection indicating carotid sinus hypersensitivity.

Background: Carotid body tumor surgery is associated with various complications. However, intraoperative cardiac arrest is very rare and no more than 10 cases have been reported. Case description: A 58-year-old woman diagnosed with bilateral carotid body tumors underwent right carotid body tumor surgery. Sudden cardiac arrest occurred during the resection and was attributed to carotid sinus hypersensitivity. The patient recovered after prompt treatment and the tumor was removed completely with no complications. Conclusion: Cardiac arrest attributed to carotid sinus hypersensitivity during carotid body tumor resection is very rare. Proper treatments can reverse intraoperative cardiac arrest. If carotid sinus hypersensitivity is detected preoperatively, prophylactic temporary pacemaker implantation may be appropriate.

Surgical treatment of multivessel lesions in Takayasu's arteritis: report of a case.

Takayasu's arteritis (TA) is a chronic vasculitis involving the aorta and its main branches, the pulmonary arteries, and the coronary tree. Here we report a case of TA complicated by severe stenosis of the left coronary ostium with multivessel brachiocephalic involvement. A combination of these abnormalities could complicate underlying illness in patients, posing an increased risk of surgical morbidity. Simultaneous surgical treatment of the ascending aorta to left carotid artery bypass and coronary artery bypass using the great saphenous vein were performed. We discuss the choice of simultaneous surgery and the options for surgical treatment of complicated lesions due to TA.

Mesojugular shunt for Budd-Chiari syndrome: a case report with long-term follow-up.

BACKGROUND: We report a case of a mesojugular shunt for Budd-Chiari syndrome (BCS) with long-term follow-up. METHODS: A 32-year-old woman presented with late stage BCS. She was treated with a mesojugular shunt to relieve her portal hypertension. In a 17-year follow-up, she had a pregnancy, a postpartum period, and was diagnosed with systemic lupus eythematosus. She has resumed work as an operating room nurse and is having a normal life. Her graft remains patent. CONCLUSION: A mesojugular shunt has less surgical trauma and satisfactory long-term patency than other shunts. It can be used to treat severe patients with BCS who are not candidates for intervention.

The in vitro and in vivo biocompatibility evaluation of heparin-poly(ε-caprolactone) conjugate for vascular tissue engineering scaffolds.

Poly(ε-caprolactone) (PCL) was conjugated with heparin and fabricated into nonwoven tubular scaffold by electrospinning. The dynamic contact angle analysis revealed the hydrophilicity improvement due to heparin concentrating on the conjugate surface. The microbicinchoninic acid and quartz crystal microbalance measurements implied that the conjugate can significantly reduce the absorption of plasma protein, such as albumin and fibrinogen, indicative of the good blood biocompatibility. As evidenced by Enzyme Linked Immunosorbent Assay, the electrospun conjugate scaffolds possessed a higher loading capability of vascular endothelial growth factor (VEGF) than that of the blank PCL in aqueous solution via static interaction. The viability of loaded VEGF was evaluated by cell culture and adhesion tests. The amount and morphology of cells were substantially improved after VEGF was loaded into scaffolds exhibiting excellent cell biocompatibility. To assess the in vivo biocompatibility, a tubular scaffold (L = 4 cm, D = 2 mm) was transplanted into dog's femoral artery. The scaffold patency was inspected by carotid artery angiography 4 weeks after implantation. The explanted scaffold was also investigated by histological analysis including hematoxyline eosin, Millere Masson (collagen and elastin), and von Kossa (calcium) stain. Furthermore, von Willebrand factor immunohistochemical stain was performed to examine the formation of endothelial layer. The conjugate shows the potential to be used as scaffold materials in vascular tissue engineering.

Surgical treatment of brachiocephalic vessel involvement in Takayasu's arteritis.

BACKGROUND: Takayasu's arteritis (TA) is a chronic idiopathic inflammatory disease that affects large and medium size arteries. The brachiocephalic trunk is the most frequently involved site in TA, and multi-vessel lesions are common. Surgical treatment includes vessel reconstruction surgery and percutaneous transluminal angioplasty (PTA). Herein, we report our preliminary experience with surgical treatment of cerebral ischemia caused by cervical arterial lesions due to TA. METHODS: From January 2000 to December 2007, 38 patients with cerebral ischemia caused by cervical arterial occlusive lesions due to TA were treated surgically. There were three males and 35 females, with an age range of 15 - 42 years (mean 26.5 years). All patients had operative repairs undertaken. Twenty eight patients received bypass operation and 10 patients received percutaneous transluminal angioplasty. One case with coronary stenosis received coronary artery bypass simultaneously. Patients were followed up for 11 months to eight years. RESULTS: There were no peri-operative deaths in cerebrovascular reconstruction patients. Symptoms of cerebral ischemia were improved or cured in 25 of 38 patients. There was a low incidence of cerebral reperfusion syndrome. Two patients died at five and seven years after surgery due to heart failure. Another 8 patients (20%) required further surgery for stenosis (5 patients) or anastomotic aneurysms (3 patients). Percutaneous transluminal angioplasty was performed successfully for treatment of aortic and renal lesions. Repeated angioplasty for revascularization was performed in six PTA cases with restenosis after 5 - 24 months. CONCLUSIONS: When cerebral perfusion has potential to be affected by TA, a definitive corrective procedure is advised when the patient is relatively stable. Although the recurrence rate is very high, percutaneous transluminal angioplasty is the first choice procedure. Bypass operation is optimal for brachiocephalic-vessel involvement in TA. Cerebral reperfusion syndrome can be avoided by careful selection of the operation method and improved post-operative treatment.