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Mitsuishi A, Hirose N, Okamoto U, Noguchi T, Kawaguchi J, Miura Y. Thoracic endovascular aortic repair for hemolysis 17 years after insertion of classical elephant trunk: a case report. J Cardiothorac Surg 2023; 18:311. [PMID: 37950275 PMCID: PMC10638693 DOI: 10.1186/s13019-023-02415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The classical elephant trunk (ET) technique is a very useful surgical procedure; however, haemolysis in the aorta associated with ET has been previously reported. It normally occurs within several years after the surgery, and it is a rare case of rapidly progressing haemolysis 10 or more years after aortic arch replacement with ET. CASE PRESENTATION A 53-year-old man with a history of Stanford type A aortic dissection (DeBakey type Is), who was treated with total arch aortic replacement and aorto-femoral bypass using a prosthetic graft 17 years ago, developed severe progressive haemolytic anaemia. The ET used for the initial surgery was narrowed, and mechanical haemolysis was suspected. We assumed that progressive mechanical haemolysis occurred because of degeneration of the prosthetic graft. Thoracic endovascular aortic repair was performed, and haemolysis and anaemia were mitigated postoperatively. CONCLUSIONS Haemolysis occurred 17 years after the initial surgery with ET. When haemolysis is suspected in a patient with ET, it must be identified as a cause of haemolysis even if 10 years or more have passed since the ET was inserted. To prevent this complication, attention should be paid to an appropriate ET length and diameter to avoid folding of the ET, particularly when the true cavity diameter is small.
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Affiliation(s)
- Atsuyuki Mitsuishi
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Okohcho, Nankoku-Shi, Kochi Prefecture, 783-8505, Japan.
| | - Nobuyuki Hirose
- Department of Cardiology, Izumino Hospital, 2-10-53 Azono, Kitamachi, Kochi Prefecture, 781-0011, Japan
| | - Unpei Okamoto
- Department of Cardiovascular Surgery, University Hospital, Kyoto Prefectual Hospital of Medicine, 465, Kajiicho, Kamigyo Ward, Kyoto, 602-8566, Japan
| | - Tatsuya Noguchi
- Department of Cardiology and Geriatrics, Kochi Medical School Hospital, 185-1, Kohasu, Okohcho, Nankoku-Shi, Kochi Prefecture, 783-8505, Japan
| | - Juri Kawaguchi
- Department of Cardiology and Geriatrics, Kochi Medical School Hospital, 185-1, Kohasu, Okohcho, Nankoku-Shi, Kochi Prefecture, 783-8505, Japan
| | - Yujiro Miura
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Okohcho, Nankoku-Shi, Kochi Prefecture, 783-8505, Japan
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Duong VT, Nguyen CT, Phan HL, Le VP, Dang TT, Choi C, Seo J, Cha C, Back SH, Koo KI. Double-layered blood vessels over 3 mm in diameter extruded by the inverse-gravity technique. Biofabrication 2023; 15:045022. [PMID: 37659401 DOI: 10.1088/1758-5090/acf61f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/01/2023] [Indexed: 09/04/2023]
Abstract
One of the most promising techniques for treating severe peripheral artery disease is the use of cellular tissue-engineered vascular grafts (TEVGs). This study proposes an inverse-gravity (IG) extrusion technique for creating long double-layered cellular TEVGs with diameters over 3 mm. A three-layered coaxial laminar hydrogel flow in an 8 mm-diameter pipe was realised simply by changing the extrusion direction of the hydrogel from being aligned with the direction of gravity to against it. This technique produced an extruded mixture of human aortic smooth muscle cells (HASMCs) and type-I collagen as a tubular structure with an inner diameter of 3.5 mm. After a 21 day maturation period, the maximal burst pressure, longitudinal breaking force, and circumferential breaking force of the HASMC TEVG were 416 mmHg, 0.69 N, and 0.89 N, respectively. The HASMC TEVG was endothelialised with human umbilical vein endothelial cells to form a tunica intima that simulated human vessels. Besides subcutaneous implantability on mice, the double-layered blood vessels showed a considerably lower adherence of platelets and red blood cells once exposed to heparinised mouse blood and were considered nonhaemolytic. The proposed IG extrusion technique can be applied in various fields requiring multilayered materials with large diameters.
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Affiliation(s)
- Van Thuy Duong
- Department of Electrical, Electronic and Computer Engineering, University of Ulsan, Ulsan 44610, Republic of Korea
| | - Chanh Trung Nguyen
- Department of Electrical, Electronic and Computer Engineering, University of Ulsan, Ulsan 44610, Republic of Korea
| | - Huu Lam Phan
- Department of Electrical, Electronic and Computer Engineering, University of Ulsan, Ulsan 44610, Republic of Korea
| | - Van Phu Le
- Department of Electrical, Electronic and Computer Engineering, University of Ulsan, Ulsan 44610, Republic of Korea
| | - Thao Thi Dang
- School of Biological Sciences, University of Ulsan, Ulsan 44610, Republic of Korea
| | - Cholong Choi
- Center for Multidimensional Programmable Matter, Department of Materials Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Republic of Korea
| | - Jongmo Seo
- Electrical and Computer Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Chaenyung Cha
- Center for Multidimensional Programmable Matter, Department of Materials Science and Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Republic of Korea
| | - Sung Hoon Back
- School of Biological Sciences, University of Ulsan, Ulsan 44610, Republic of Korea
| | - Kyo-In Koo
- Department of Electrical, Electronic and Computer Engineering, University of Ulsan, Ulsan 44610, Republic of Korea
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Lejay A, Bratu B, Kuntz S, Neumann N, Heim F, Chakfé N. Calcification of Synthetic Vascular Grafts: A Systematic Review. EJVES Vasc Forum 2023; 60:1-7. [PMID: 37416860 PMCID: PMC10320244 DOI: 10.1016/j.ejvsvf.2023.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/03/2023] [Accepted: 05/24/2023] [Indexed: 07/08/2023] Open
Abstract
Objective Calcification of vascular grafts, including polyethylene terephthalate (PET) and expanded polytetrafluoroethylene (ePTFE) grafts may contribute to graft failure, but is under reported. The aim of this study was to review the literature to assess whether vascular graft calcification is deleterious to vascular graft outcomes. Data sources The Medline and Embase databases were searched. Review methods A systematic literature search according to PRISMA Guidelines was performed using a combined search strategy of MeSH terms. The MeSH terms used were "calcification, physiologic", "calcinosis", "vascular grafting", "blood vessel prosthesis", "polyethylene terephthalates", and "polytetrafluoroethylene". Results The systematic search identified 17 cases of PET graft calcification and 73 cases of ePTFE graft calcification over a 35 year period. All cases of PET graft calcification were reported in grafts explanted for graft failure. The majority of cases of ePTFE graft calcification were unexpectedly noted in grafts used during cardiovascular procedures and subsequently removed. Conclusion Calcification of synthetic vascular grafts is under reported but can compromise the long term performance of the grafts. More data, including specific analysis of radiological findings as well as explant analysis are needed to obtain a more sensitive and specific analysis of the prevalence and incidence of vascular graft calcification and the impact of calcification on synthetic graft outcomes.
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Affiliation(s)
- Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France
- Gepromed, Medical Device Hub for Patient Safety, Strasbourg, France
| | - Bogdan Bratu
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France
| | - Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France
- Gepromed, Medical Device Hub for Patient Safety, Strasbourg, France
| | - Nicole Neumann
- Gepromed, Medical Device Hub for Patient Safety, Strasbourg, France
| | - Frederic Heim
- Gepromed, Medical Device Hub for Patient Safety, Strasbourg, France
- Laboratoire de Physique et Mécanique Textiles (LPMT), ENSISA, Mulhouse, France
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France
- Gepromed, Medical Device Hub for Patient Safety, Strasbourg, France
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Lazea C, Al-Khzouz C, Sufana C, Miclea D, Asavoaie C, Filimon I, Fufezan O. Diagnosis and Management of Genetic Causes of Middle Aortic Syndrome in Children: A Comprehensive Literature Review. Ther Clin Risk Manag 2022; 18:233-248. [PMID: 35330917 PMCID: PMC8938167 DOI: 10.2147/tcrm.s348366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Cecilia Lazea
- Department Mother and Child, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
- Department of Pediatrics I, Emergency Pediatric Hospital, Cluj-Napoca, Romania
- Correspondence: Cecilia Lazea, Department Mother and Child, University of Medicine and Pharmacy “Iuliu Hatieganu”, 68, Motilor Street, Cluj-Napoca, 400370, Romania, Tel +40 744353764, Email ;
| | - Camelia Al-Khzouz
- Department Mother and Child, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
- Department of Medical Genetics, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Crina Sufana
- Department of Pediatrics I, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Diana Miclea
- Department of Medical Genetics, Emergency Pediatric Hospital, Cluj-Napoca, Romania
- Department of Molecular Sciences, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Carmen Asavoaie
- Department of Radiology and Medical Imaging, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Ioana Filimon
- Department of Radiology and Medical Imaging, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Otilia Fufezan
- Department of Radiology and Medical Imaging, Emergency Pediatric Hospital, Cluj-Napoca, Romania
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van Steenberghe M, Schubert T, Bouzin C, Caravaggio C, Guiot Y, Xhema D, Gianello P. Decellularized and Secured Porcine Arteries with NaOH-based Process: Proof of Concept. Ann Vasc Surg 2018; 49:179-190. [PMID: 29501598 DOI: 10.1016/j.avsg.2017.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is a need for small caliber vascular prosthesis. Synthetic grafts are hindered by thrombogenicity and rapid occlusion. Decellularized matrices could be an alternative. We assessed in vitro and in vivo the biocompatibility of porcine artery treated with a chemical/physical process for decellularization and graft securitization with non/conventional pathogens inactivation. METHODS Porcine carotid arteries (PCA) were treated. First, biopsies (n = 4/tissue) were performed before/after treatment to assess decellularization (hematoxylin and eosin/-4',6-diamidino-2-phenylindole/DNA/Miller). Second, 5 rats received an abdominal aortic patch of decellularized PCA (DPCA). Four pigs received subcutaneous DPCA implants (n = 2/pig). Half were explanted at day 15 and half at day 30. Finally, 2 pigs received DPCA (n = 2) and polytetrafluoroethylene prosthesis (n = 1), respectively, as carotid interposition. Implants were removed at day 30. Inflammation (CD3 and CD68 immunostaining) calcifications (von Kossa staining), remodeling (hematoxylin and eosin), and vascular characterization (CD31 and alpha-smooth muscle actin immunofluorescent staining) were investigated. RESULTS Ninety-five percentage of decellularization was obtained without structural deterioration. No death occurred. Low inflammatory reaction was found in the 2 models for DPCA. Acquisition of vascular identity was confirmed in the rodent and porcine models. Similarity between native PCA and DPCA was observed after 30 days. In contrast, polytetrafluoroethylene graft showed severe calcifications, higher CD3 reaction, and higher intimal hyperplasia (P < 0.05). CONCLUSIONS The physical and chemical process ensures decellularization of carotid porcine arteries and their in vivo remodeling with the presence of an endothelium and smooth-muscle-like cells as well as a low level of inflammatory cells.
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Affiliation(s)
- Mathieu van Steenberghe
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Brussels, Belgium.
| | - Thomas Schubert
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Service d'orthopédie et de Traumatologie de l'appareil Locomoteur, Brussels, Belgium; Cliniques Universitaires Saint-Luc, Unité de Thérapie Cellulaire et Tissulaire de l'appareil Locomoteur, Banque de Tissus, Brussels, Belgium
| | - Caroline Bouzin
- Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, IREC Imaging Platform (2IP), Brussels, Belgium
| | - Carlo Caravaggio
- Centre Hospitalier de Wallonie Picarde (CHwapi), Site Notre-Dame, Service de Chirurgie Vasculaire, Tournai, Belgium
| | - Yves Guiot
- Cliniques Universitaires Saint-Luc, Service d'anatomopathologie, Brussels, Belgium
| | - Daela Xhema
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Brussels, Belgium
| | - Pierre Gianello
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Brussels, Belgium
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