Status of Internal Jugular Veins in Patients with Carcinomas of the Head and Neck Area

OBJECTIVE: To assess the status of internal jugular veins (IJV) in patients with head and neck carcinomas.

STUDY DESIGN AND SETTING: This study included 108 IJV of 54 cancer patients who were prospectively evaluated between September 1994 and February 1997. Patency, presence of thrombosis, characteristics of vein wall, compressibility, area of the veins both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were registered in all cases. Also, 30 IJV of 15 normal volunteers were used as a control group. The study was performed in a tertiary care referral center.

RESULTS: Right expiratory flow speed was higher in volunteers ( P = 0.0280), and left basal area was bigger in oncologic patients ( P = 0.0394). No significant changes were found between cancer patients and controls in the remaining parameters ( P > 0.05).

CONCLUSIONS AND SIGNIFICANCE: According to these results, head and neck carcinomas do not seem to affect the ultrasonographic characteristics of IJV. Thus, preoperative evaluation of IJV is not mandatory in these patients.

Ultrastructure of internal jugular vein defective valves

OBJECTIVES

To study the ultrastructure of intraluminal defects found in the internal jugular vein by using a scanning electron microscopy.

METHODS

Using a scanning electron microscopy, intraluminal septa and/or defective valves blocking the flow in the distal internal jugular vein of seven patients were studied together with the adjacent wall and compared with control specimen.

RESULTS

The internal jugular veins' wall showed a significant derangement of the endothelial layer as compared to controls. Surprisingly, no endothelial cells were found in the defective cusps, and the surface of the structure is covered by a fibro-reticular lamina.

CONCLUSIONS

Although the lack of endothelial cells in the internal jugular vein intraluminal obstacles is a further abnormality found in course of chronic cerebrospinal venous insufficiency, our investigation cannot clarify whether this finding is primary or caused by progressive loss of endothelium in relation to altered haemodynamic forces and/or to a past post-thrombotic/inflammatory remodelling.

In vivo nanoparticle assessment of pathological endothelium predicts the development of inflow stenosis in murine arteriovenous fistula

OBJECTIVE

In vivo assessment of pathological endothelium within arteriovenous fistula (AVF) could provide new insights into inflow stenosis, a common cause of AVF primary failure in end-stage renal disease patients. Here we developed nanoparticle-based imaging strategies to assess pathological endothelium in vivo and elucidate its relationship to neointimal hyperplasia formation in AVF.

APPROACH AND RESULTS

Jugular-carotid AVFs were created in C57BL/6 mice (n=38). Pathological endothelium in the AVF was visualized and quantified in vivo using dextranated magnetofluorescent nanoparticles (CLIO-VT680 [cross-linked iron oxide-VivoTag680]). At day 14, CLIO-VT680 was deposited in AVF, but only minimally in sham-operated arteries. Transmission electron microscopy revealed that CLIO-VT680 resided within endothelial cells and in the intimal extracellular space. Endothelial cells of AVF, but not control arteries, expressed vascular cell adhesion molecule-1 and showed augmented endothelial permeability near the anastomosis. Intravital microscopy demonstrated that CLIO-VT680 deposited most intensely near the AVF anastomosis (P<0.0001). The day 14 intravital microscopy CLIO-VT680 signal predicted the subsequent site and magnitude of AVF neointimal hyperplasia at day 42 (r=0.58, P<0.05). CLIO-VT680 deposition in AVF was further visualized by ex vivo MRI.

CONCLUSIONS

AVF develop a pathological endothelial response that can be assessed in vivo via nanoparticle-enhanced imaging. AVF endothelium is activated and exhibits augmented permeability, offering a targeting mechanism for nanoparticle deposition and retention in pathological endothelium. The in vivo AVF nanoparticle signal identified and predicted subsequent inflow neointimal hyperplasia. This approach could be used to test therapeutic interventions aiming to restore endothelial health and to decrease early AVF failure caused by inflow stenosis.

[Histomorphologic properties of bovine jugular vein conduit treated withdye-mediated photooxidation following decellularization]

OBJECTIVE

To determine the histocompatibility and histoconstancy of bovine jugular vein conduit (BJVC) treated by dye-mediated photooxidation following decellularization before and after implantation in Wistar rats.

METHODS

Each of 20 fresh bovine jugular veins with a retained native valve procured from a slaughterhouse was cut into 4 trial patches with valves, which were randomly divided into 4 groups. The 4 groups were treated respectively by dye-mediated photooxidation(DMP), glutaraldehyde(GA), decellularization(DC), and dye-mediated photooxidation following decellularization (DC+DMP). One of the trial patches in each group was implanted subcutaneously in the same Wistar rat. Two months later, all trial rats were killed and the specimens were retrieved. Tissue protein extraction was used to estimate the cross-linked degree of BJVC treated by dye-mediated photooxidation following decellularization. To observe the morphologic properties of the specimens, HE staining and electron microscopes were used.

RESULTS

Compared with others, the patches in the DC+DMP group were flexible, stretched, and relatively intact; lining endothelium was comparatively smooth; collagen fiber structure was slightly loose intact; and many cells were uniformly infiltrated in all layers.

CONCLUSION

BJVC treated by dye-mediated photooxidation following decellularization is superior to others in histocompatibility, and the rate of degradation can be regulated by the degree of dye-mediated photooxidation.

[Comparison between effects of small intestinal submucosa graft and inside-out vein graft on repairing peripheral nerve defects]

OBJECTIVE

To make a comparison between the effects of the small intestinal submucosa (SIS) graft and the inside-out vein graft on repairing the peripheral nerve defects.

METHODS

SIS was harvested from the fresh jejunum of the quarantined pig by curetting the musoca, the tunica serosa, and the myometrium; then, SIS was sterilized, dried and frozen before use. Thirty-six male SD rats were divided into 3 groups randomly, with 12 rats in each group. Firstly, the 10-mm defects in the right sciatic nerves were made in the rats and were respectively repaired with the SIS graft (Group A), the inside-out autologous vein graft (Group B), and the auto-nerve graft (Group C). At 6 weeks and 12 weeks after the operations, the right sciatic nerves were taken out, and the comparative evaluation was made on the repairing effects by the histological examination, the neural electrophysiological examination, the computerized imaging analysis, and the Trueblue retrograde fluorescence trace.

RESULTS

The histological examination showed that the regenerated nerve fibers were seen across the defects in the three groups at 6 weeks after the operations. The nerve fibers were denser, the formed nerve myelin was more regular, and the fibrous tissue was less in Group A than in Group B; the nerve regeneration was more similar between Group A and Group C. At 12 weeks after the operations, the neural electrophysiological examination showed that the neural conductive rate was significantly lower in Group B than in Groups A and C (P<0.05), but no statistically significant difference was found between Group A and Group C (P > 0.05); the component potential wave amplitude was not statistically different between Group A and Group B; however, the amplitude was significantly lower in Groups A and B than in Group C (P < 0.05). At 6 weeks and 12 weeks after the operations, the computerized imaging analyses showed that the axis-cylinder quantity per area and the nerve-tissue percentage were significantly greater in Group A than in Group B (P < 0.05); the average diameter of the regenerated axis cylinder, the axis-cylinder quantity per area, and the nerve-tissue percentage were significantly lesser in Group B than in Group C (P < 0.05). At 12 weeks after the operations, the Trueblue retrograde fluorescence trace revealed that the positively-labeled neurons were found in the lumbar 3-6 dorsal root ganglion sections in the three groups.

CONCLUSION

The small intestinal submucosa graft is superior to the autologous inside-out vein graft in repairing the peripheral nerve defects and it is close to the auto-nerve graft in bridging the peripheral nerve defects. Therefore, the small intestinal submucosa is a promising biological material used to replace the auto-nerve graft.

Effect of head rotation on vascular anatomy of the neck: An ultrasound study

Carotid artery injury is a serious complication of landmark-guided internal jugular catheterization. Studies have determined that the internal jugular vein (IJV) frequently overlaps the carotid artery (CA), which has been postulated to increase the rate of arterial injury. The purpose of this study was to define the anatomic relationship of the IJV and CA by describing CA overlap by the more superficial IJV. We also seek to determine the effect of head rotation on the amount of overlap, which may have implications for IJV catheter placement. We prospectively studied the vascular anatomy of the neck in 156 Emergency Department patients. The primary intervention was head rotation to the left, as if the patient was positioned for right IJV catheterization. The patient's head was positioned at 0, 45 and 90 degrees of rotation. Ultrasound images were obtained in a transverse orientation. The percentage overlap of the CA by the IJV was measured. We also measured the distance between the jugular vein and the carotid artery. In neutral position, there was a mean overlap of 29% at the apex of the sternocleidomastoid. As the head was turned, the percent overlap increased. At 90 degrees, there was a mean overlap of 72%. Differences were determined to be significant by analysis of variance (ANOVA) with a p < 0.001. Furthermore, we found a distance of 10 mm between IJV and CA when the head is in neutral position. As the head was turned, the jugular-carotid distance decreased to 1 mm in the far lateral head position. These differences were also found to be significant by ANOVA with a p < 0.001. We concluded that the IJV overlaps the CA in the neutral position to a significant degree. This overlap increases until the head is fully turned, where most of the CA is overlapped by the IJV. This may help explain the mechanism of CA puncture. We propose two modifications to standard IJV line technique: minimize the patients' head rotation; and use ultrasound guidance for IJV catheterization.

Endovascular Delivery of Vein Segments With Valves Versus Direct Anastomosis

PURPOSE

To demonstrate an experimental model designed to allow placement of a vein segment containing a valve into a femoral vein without the need for anastomoses or surgical incision on the target limbs.

METHODS

Segments of jugular veins containing valves were harvested bilaterally from 7 female dogs weighing 30 to 40 kg. One of the vein segments was then interposed into one femoral vein, using a standard surgical end-to-end anastomosis. Another segment was loaded into a self-expanding nitinol stent, everted, and secured outside of the stent. This vein-coated stent was then deployed from the jugular approach into the opposite common femoral vein. The endpoint of the study was thrombosis of one of the veins segments or patency at 120 days. The function of the valves was tested prior to completion of the study by instilling dye under incremental pressures and recording the pressure necessary to cause reflux. Light microscopy and electron microscopy were utilized to evaluate structure of the valves at study endpoint.

RESULTS

Both grafts in one dog occluded during the second week after surgery. Anastomotic and vein-stented sites remained patent in the remaining 6 animals for 120 days. Retrograde phlebography demonstrated valve competency bilaterally in all cases. The reflux pressures on the stented side averaged 70 mmHg while the transplanted vein segment averaged 55 mmHg. Light microscopy and electron microscopy showed intact vein valve structure in all segments at the completion of the study.

CONCLUSIONS

This experimental work demonstrates that endovascular delivery of a native canine vein containing a competent valve is feasible and effective.

Bovine Valved Xenograft in Pulmonary Position: Medium-Term Follow-Up With Excellent Hemodynamics and Freedom From Calcification

BACKGROUND

This study was designed to evaluate the outcome of Contegra xenograft valved conduit (Contegra, Medtronic Inc, Minneapolis, MN).

METHODS

From April 1999 to December 2003, 67 patients with a mean age of 16.1 +/-15.0 years (2 months to 53 years) and a mean weight of 39.7 +/- 27.1 kg (4 to 95 kg) were discharged after implantation of a Contegra conduit. The diagnosis contained the following: pulmonary valve replacement during Ross operation (n = 27), pulmonary valve regurgitation (n = 9), tetralogy of Fallot (n = 7), pulmonary atresia with ventricular septal defect (n = 7), double outlet right ventricle (n = 7), truncus arteriosus (n = 5), Taussig-Bing (n = 2), obstructed conduit (n = 2), and double discordance (n = 1). Conduit size was 14 mm in 2, 16 mm in 7, 18 mm in 12, 20 mm in 13, and 22 mm in 33 patients. Mean cardiopulmonary bypass was 155 +/- 48 min (65 to 337 min) and mean aortic cross clamping was 69 +/- 38 min (0 to 146 min). All patients underwent echocardiography, 23 of 67 (34%) patients had cardiac catheterization, and 23 of 67 (34%) patients had electrocardiograph-gated multislice computer tomography.

RESULTS

In a mean follow-up of 26.4 months (1 to 56 months) there was one late death (1 of 67 patients; 1.5% mortality) unrelated to the conduit. Five patients underwent reoperation; four were nonconduit-related and one was to replace a twisted conduit. Five patients underwent interventional cardiology; three were nonconduit-related and two were to stent a twisted or stenotic conduit. Echocardiography showed absent valve regurgitation in 30 of 67 (45%) patients, trivial in 21 of 67 (31%) patients, mild in 16 of 67 (24%) patients. The transconduit pressure gradient remained stable during follow-up, with peak pressure gradient 17 +/- 11 mm Hg and mean gradient 8 +/- 6 mm Hg. Internal diameters corresponded to 110% +/- 20% of the implanted diameter at level of proximal anastomosis, 112% +/- 18% at valve level, and 110% +/- 14% at distal anastomosis. Calcifications were not found, with the exception of a minimal (2.3 mm) parietal calcification.

CONCLUSIONS

The Contegra valved conduit provided excellent morphology and hemodynamics, and freedom from calcification in a medium-term follow-up.

A long term comparison between Denacol EX-313-treated bovine jugular vein graft and ultrafine polyester fiber graft for reconstruction of tight ventricular outflow tract in dogs

A Denacol EX-313 (Denacol)-treated bovine venous graft and an ultrafine polyester fiber (UFPF) graft were transplanted as patch graft into the right ventricular outflow tract under extracorporeal circulation in six dogs each experimentally. Hemodynamics in right heart and histological findings around the graft were compared between both groups over a period of one year after grafting. Pressure measurements and angiocardiography were performed through a cardiac catheter. Right ventricular pressure, pulmonary artery pessure, and right ventricle to pulmonary artery gradient were within normal limits in both groups at 1, 2, 3, 4, 6, and 12 months or more after grafting. No difference were seen between the values for the Denacol and the UFPF group. Histologically, the medial surface at the site of grafting was covered with vascular endothelial cells at one month after grafting in both groups. The density of the vascular endothelial cells increased with time after grafting, showing no clear difference between the two groups. Subendothelial layers comprised of collagen fibers, elastic fibers, and inflammatory cells decreased with time in both groups, but there was less cell infiltration in the Denacol group than in the UFPF group at all time points after grafting. In addition, the central cut thickness value of the graft tended to be thinner in the Denacol group than in the UFPF group at all observation time points after grafting. In the Denacol group, very slight metaplasia of cartilage was noted in a portion of the graft margin at six months or more after grafting, but no other abnormalities were observed. These results suggest that the Denacol-treated bovine venous graft has better grafting characteristics than the UFPF graft with easier intra-operative handlings and less tissue reactions after grafting.

Overexpression of G protein-coupled receptor kinase-2 in smooth muscle cells reduces neointimal hyperplasia

The activation of vascular smooth muscle cells (SMCs) in neointimal hyperplasia involves signaling through receptor tyrosine kinases as well as G protein-coupled receptors. Overexpression of G protein-coupled receptor kinase-2 (GRK2) in SMCs can attenuate mitogenic signaling and proliferation in response to not only several G protein-coupled receptor agonists, but also platelet-derived growth factor (PDGF). To test whether overexpression of GRK2 could inhibit other SMC responses implicated in neointimal hyperplasia, we assessed SMC chemotaxis and mitogenic signaling evoked by PDGF and G(q)-coupled receptor agonists. To test the effects of GRK2 overexpression on neointimal hyperplasia in vivo, we employed a rabbit autologous vein graft model system. GRK2 overexpression reduced PDGF-promoted SMC chemotaxis by 85% (P<0.01), but had no effect on chemotaxis promoted by epidermal growth factor (EGF). Congruently, GRK2 overexpression reduced by approximately 50% (P<0.05) the [(3)H]thymidine incorporation induced by combinations of PDGF and Gq-coupled receptor agonists, but had no effect on that induced by PDGF plus EGF. PDGF-, but not EGF-promoted phosphoinositide 3-kinase activity in SMCs was also inhibited by GRK2 overexpression. In rabbit vein grafts, we achieved GRK2 overexpression in medial SMCs, reduced cell proliferation during the first week after graft implantation, and reduced steady state neointimal thickness by 29% (P<0.01), without affecting medial thickness or potentiating SMC apoptosis. Because of its ability to dampen chemotactic and mitogenic signaling through PDGF and Gq-coupled receptors, GRK2 overexpression in SMCs may be a useful therapeutic approach for neointimal hyperplasia.

PhotoPoint photodynamic therapy with local drug delivery eliminates vessel wall cells in arteriovenous graft models

PURPOSE

To demonstrate the feasibility of PhotoPoint photodynamic therapy (PDT) with local drug delivery, optimize dosimetry in a rabbit jugular vein model, and investigate its ability to deplete potential neointimal precursor cells in the vessel wall in a canine arteriovenous graft (AVG) model.

METHODS AND MATERIALS

Photosensitizer MV2101 was administered locally in rabbit veins, incubated for 0-40 min and activated with external laser light. In canine veins, MV2101 was incubated for 30 min and activated by light. Tissues were excised at acute and chronic timepoints.

RESULTS

PhotoPoint PDT reduced cell populations in both models with maximum depletions occurring at 20 min (> or = 100 J/cm2) in rabbit veins (> 90% depletion) and 30 min (200 J/cm2) in canine veins (> 85% depletion). Chronic veins revealed no evidence of PhotoPoint PDT-related abnormalities.

CONCLUSIONS

PhotoPoint PDT with local MV2101 dramatically depleted potential neointimal precursor cells in the vessel wall. This suggests local drug delivery is feasible and that PhotoPoint PDT may be an efficacious treatment that could prolong AVG patency in the clinic.

Inside-out vs. standard vein graft to repair a sensory nerve in rats

Nerve regeneration in a sensory nerve was obtained by the application of different techniques: inside-out vein graft (IOVG group) and standard vein graft (SVG group). These techniques provide a good microenvironment for axon regeneration in motor nerves, but their efficiency for regeneration of sensory nerves is controversial. The saphenous nervtce was sectioned and repaired by the inside-out and standard vein graft techniques in rats. After 4, 12, and 20 weeks the graft and the distal stump were observed under electron microscopy. In each studied period, the pattern, diameters, and thickness of the myelin sheaths of the regenerated axons were measured in the graft and distal stump. A comparative study about the regenerated nerve fibers by these two different techniques was performed. Regenerated nerve fibers were prominent in both vein grafts 4 weeks after the surgical procedures. On the other hand, in the distal stump, regenerated nerve fibers were observed only from 12 weeks. In both inside-out vein graft and standard vein graft statistical difference was not observed about the diameters and thickness of the myelinated fibers after 20 weeks. On the other hand, the inside-out group had greater regenerated axon number when compared to the standard group. There is a capillary invasion in both graft and distal stump, especially in the IOVG group. The regenerated axons follow these capillaries all the time like satellite microfascicles. After 20 weeks, the diameters of regenerated fibers repaired by the standard vein graft technique were closer to the normal fibers compared to the inside-out vein graft. On the other hand, the pattern of these regenerated axons was better in the IOVG group.

Early morphology of accelerated vein graft atheroma in experimental vein grafts

Vein grafts fail because of the development of intimal hyperplasia and atheroma. Recent experimental evidence suggests that the presence of hypercholesterolemia induces a three-fold increase in intimal hyperplasia with early atheroma development within 4 weeks of implantation. We have previously demonstrated endothelial cell preservation and a short-lived (3-day) polymorphonuclear leukocyte infiltrate in vein grafts. The aim of this study is to define the early morphology and ultrastructure of vein grafts implanted into a hyperlipidemic environment to provide a pathological foundation on which to examine the cellular and molecular events that determine this accelerated response. Twenty-one male New Zealand White rabbits underwent a right carotid interposition bypass graft using the ipsilateral external jugular vein; all animals received a 1% cholesterol diet for 4 weeks prior to surgery and continuing postoperatively until harvest. Animals (n = 3 per time point) were sacrificed at 60 min, 1 day, 3 days, 5 days, 7 days, 14 days, and 28 days postoperatively for scanning and transmission electron microscopy of the vein grafts. No concurrent controls were employed. The results of this study suggest that in the presence of hypercholesterolemia, the pathophysiological processes involved in the vein graft are similar to those reported for noncholesterol-fed animals. There is a sustained subendothelial response with the prolonged presence of macrophages and cellular debris and the accumulation of foam cells.

Controlling transplant vasculopathy in cryopreserved vein grafts with polyethylene glycol and glutathione during transport

BACKGROUND

the biological characteristics of cryopreserved allografts are poorly understood, although many factors are known to influence their outcome. This study examines the development of transplant vasculopathy in both fresh and cryopreserved vein allografts and specifically assesses the efficacy of a transport solution containing 10% polyethylene glycol and 10 microM glutathione (PEG/GSH).

METHODS

jugular veins were harvested from control donor rabbits and transplanted as interposition carotid bypass grafts in 30 New Zealand White (NZW) rabbits. Ten received the fresh jugular veins (fresh). Ten animals received jugular veins which had been harvested, transported in a physiological solution, cryopreserved and stored in a standard fashion (cryopreserved). Ten animals received jugular veins which had been harvested, transported in the same solution with the addition of PEG/GSH, cryopreserved and stored in a standard fashion (PEG/GSH). Cryopreserved jugular veins were stored for 6 weeks before transplantation. All animals were sacrificed 28 days postoperatively. Vein grafts were perfusion-fixed and wall dimensions were determined by planimetry.

RESULTS

all transplanted grafts were patent at harvest. The control cryopreserved vein grafts showed a 54% increase in mean intimal thickness (63+/-10 micron vs. 41+/-3 micron p<0.05) but no change in mean medial thickness (125+/-9 micron vs. 119+/-13 micron; p = N.S. ) compared to the fresh allograft. Transport of the grafts in PEG/GSH solution resulted in the abolition of the increase in intimal thickness (41+/-4 micron; p <0.01) associated with cryopreservation without a change in medial thickness (140+/-15 micron; p = N.S.) compared to the cryopreserved allograft.

CONCLUSION

cryopreserved vein grafts develop significant intimal hyperplasia compared to freshly transplanted grafts. The use of PEG/GSH in the transport solution significantly reduces this transplant graft intimal hyperplasia to that which develops in fresh grafts and may lead to improvements in the clinical use of cryopreserved veins.

[The relation-ship between apoptosis, apoptosis related-gene expression and proliferative activity in smooth muscle cell after autogenous vein grafting]

OBJECTIVE

To study the mechanism of graft vein stenosis.

METHODS

A rat experimental model of autogenous vein graft was established by transplanting the right external jungular vein into the infrarenal abdominal aorta in 100 Wister rats. Electric microscope, TUNEL and immunohistochemical S-P technique were used to detect the apoptosis, the expression of apoptosis related-gene bcl-2 and bax and proliferation cell nuclear antigen (PCNA) of smooth muscle cells(SMCs) in vein graft.

RESULTS

From 1 to 8 weeks after replacement, the expression of apoptosis and PCNA of SMCs was continuously higher than the control group (P < 0.01). From 1 to 2 weeks, the expression of TUNEL and PCNA showed peak value. From 1 to 2 weeks, the positive rate of apoptosis was lower than that of PCNA, but from 4 to 8 weeks, the positive rate of TUNEL was higher than that of PCNA. There was obvious positive correlation between the expression of TUNEL and PCNA (r = 0.813 P < 0.05). One to 2 weeks after vein grafting, bcl-2 positive rate increased and was more different than the control group and the group of 4 to 8 weeks after vein grafting (P < 0.010).

CONCLUSIONS

The imbalance of proliferation and apoptosis may be related to the vessel remodeling and vein graft stenosis, and bcl-2 and bax protein may involve in the regulation of apoptosis of VSMC. Adopting the mixed strategy to regulate the balance between proliferation and apoptosis may be useful to prevent vein graft stenosis.

Antagonistic effects of FR 173657 on human, pig, rabbit, and guinea pig kinin receptors: an in vitro study

The pharmacodynamic features of the new nonpeptide kinin B2 receptor antagonist FR 173657 were evaluated on pig, rabbit, guinea pig, and human native kinin B2 receptors. FR 173657 exerted high antagonistic activity in all preparations examined. In particular, it acts as a competitive antagonist in the rabbit jugular vein (pA2 8.9) and in the human umbilical vein (pA2 8.2) but as a noncompetitive antagonist in the pig coronary artery (pKB 9.2) and in the guinea pig ileum (pKB 9.2) stimulated with the selective B2 receptor agonist bradykinin (BK). In contrast, FR 173657 failed to antagonize the biological effects of the selective B1 receptor agonist LysdesArg9BK in the pig renal vein, rabbit aorta, and human umbilical vein, three kinin B1 receptor systems. Moreover, this compound was inactive against the effects induced by noradrenaline, 5-hydroxytryptamine, endothelin-1, angiotensin II, substance P, acetylcholine, and histamine in the B2 receptor preparations. Taken together, these results demonstrate that FR 173657 is the first potent nonpeptide B2 receptor antagonist with high affinity, selectivity, and specificity for kinin B2 receptors of different species, including man.

Functional and morphological evaluation of canine veins following preservation in different storage media

Injuries of endothelial and smooth muscle cells of autologous vein due to preservation in standard storage media may be responsible for graft failure. The effects of vein preservation with University of Wisconsin solution (UWs) on endothelial and smooth muscle cell function and morphology were compared to the effects of preservation with autologous whole blood (AWB) and normal saline (NS), which are frequently used in cardiovascular surgery. Canine external jugular and common femoral vein segments were preserved in the different solutions at 4 degrees C for 45 min and 24 hr. Rings (4-5 mm in length) from control and preserved veins were evaluated by isometric tension studies at 37 degrees C and by scanning and transmission electron microscopy. Differences between groups were evaluated by Student's t test or Mann-Whitney U test and by analysis of the variance, and considered to be significant at P < 0.05. Sensitivities to norepinephrine (NE) showed that a 45-min vein storage in AWB (5.7 +/- 0.2 mumol/L) but not in NS (5.8 +/- 0.2 mumol/L) or UWs (6.5 +/- 0.2 mumol/L) had a deleterious effect on function of smooth muscle (P < 0.05) when compared to control veins (6.6 +/- 0.2 mumol/L). Maximum contractile responses and sensitivities to NE were significantly altered (P < 0.05) after 24-hr vein storage in AWB (0.09 +/- 0.02 g/mm2 and 5.4 +/- 0.07 mumol/L) and NS (0.12 +/- 0.03 g/mm2 and 5.6 +/- 0.08 mumol/L) but not in UWs (0.36 +/- 0.06 g/mm2 and 6.4 +/- 0.07 mumol/L). With both storage times, acetylcholine-induced endothelium-dependent maximum relaxations and sensitivities were significantly reduced (P < 0.05) in veins stored in AWB and NS, but not in UWs, compared with controls. Similarly, transmission electron microscopy revealed marked neutrophil migration beneath the intimal surface of vessels and extensive separation and desquamation of endothelial cells with exposure of subendothelial structures in veins stored in AWB and NS. The results suggest that UWs is a suitable storage medium when compared to AWB and NS.

Influence of perioperative catheter injury on the long-term vein graft function and morphology

BACKGROUND

It has been shown that suboptimal preparation of a vein graft prior to its insertion results in immediate morphological and functional damage to both endothelial cells and underlying smooth muscle cells. This study examines the influence of perioperative balloon catheter injury on the subsequent development of intimal hyperplasia and vasomotor function in experimental vein grafts.

METHODS

Twenty New Zealand White rabbits had a carotid vein bypass graft performed: 10 were controls and 10 had a balloon catheter passed through their lumen which resulted in deendothelialization and intramural injury (4Fr Fogarty catheter, 0.6-0.75 ml H20 inflation, three passes). All grafts were harvested after 28 days for either morphology (n = 6) or functional studies (n = 4; four 5-mm rings/graft).

RESULTS

Perioperative balloon injury of the vein graft resulted in a 23% increase in the intimal thickness (102 +/- 7 microm vs 83 +/- 2 microm, deendothelialized vs control; mean +/- SEM, P < 0.01) and a 67% increase in medial thickness (144 +/- 19 microm vs 86 +/- 8 microm; mean +/- SEM, P < 0.01) of the vein grafts. Both the sensitivity and maximal contraction of the responses elicited by norepinephrine, serotonin, and bradykinin were increased in the deendothelialized group compared to controls.

CONCLUSION

Perioperative denuding balloon injury of the vein graft results in the increased development of intimal hyperplasia with an overall enhanced contractility. This study demonstrates the long-term structural and functional effects of perioperative balloon catheter injury on vein grafts that may contribute to decreased graft patency.

Efficiency of an external support to reduce lipid infiltration into venous grafts: in vitro evaluation

Excessive distension of venous grafts due to arterial pressure enhances the convective water transport (filtration flow) through the vessel wall, and thus might affect the infiltration of macromolecules such as lipoproteins. In this paired experimental study, filtration velocities were measured at 100 mm Hg for canine jugular veins with or without external supports of expanded polytetrafluoroethylene (ePTFE) arterial prostheses. In addition, to assess the effect of filtration velocity on lipid infiltration or uptake, canine jugular veins were wrapped over half of their lengths with ePTFE arterial prostheses and perfused with dog serum containing 3H-cholesterol at a pressure of 100 mm Hg. At 100 mm Hg, the average filtration velocity of the wrapped jugular veins was 7.9 +/- 1.3 x 10(-6) cm/s whereas the average filtration velocity of the unwrapped veins was 27.3 +/- 2.7 x 10(-6) cm/s (p < 0.005). Moreover, the unwrapped veins had a significantly higher uptake rate of labeled cholesterol than the wrapped veins (10.9 +/- 7.3 x 10(-4) cm/h and 5.0 +/- 1.6 x 10(-4) cm/h, respectively, p < 0.005). In conclusion, under arterial pressure, veins experience excessive distention, which leads to significant increases in both filtration flow and cholesterol uptake. An external wrap or support of ePTFE material protects veins from excessive distension and thus may prevent atherosclerosis in venous grafts by reducing cholesterol uptake.

Comparison of endothelial function between in situ and reversed vein graft: differences in endothelium-dependent responses

BACKGROUND

The endothelium releases endothelium-derived relaxing factors that are potent vasodilators and inhibitors of platelet aggregation. Experiments were performed to determine whether the endothelium-dependent responses differed between in situ and reversed vein grafts. The influence of valve disruption or of dissection of the adventitia was also examined.

METHODS

Segments of canine jugular veins were grafted into the carotid arteries during procedures such as reversed grafting, in situ grafting with valve disruption, in situ grafting without valve disruption, and in situ grafting with dissection of adventitia. After 4 weeks the endothelium-dependent responses of the grafts were examined by isometric tension recording.

RESULTS

In the reversed and in situ vein graft with valve disruption, acetylcholine caused endothelium-independent contractions, whereas in the in situ vein graft without valve disruption acetylcholine-induced endothelium-dependent relaxations were preserved. Adenosine diphosphate (ADP) caused comparable endothelium-dependent relaxations in the in situ vein graft irrespective of valve disruption. In the reversed vein graft ADP-induced relaxations were significantly impaired. In the in situ vein graft with dissection of the adventitia, relaxations in response to acetylcholine and ADP were significantly reduced.

CONCLUSIONS

These results suggest that endothelial function, in terms of endothelium-derived relaxing factors in the in situ vein graft, can be preserved and that adventitial dissection in the in situ vein graft should be minimized to preserve endothelial function.

Variable tissue reactions and endocrine responses to a jugular catheter

Although the use of soft catheter materials allows for safe long-term venous access in humans and animals, a significant percentage of individuals react adversely. We have studied a group of 52 male rats over 30 days (d) for the category and degree of tissue responses to silicone-based catheters implanted in the jugular vein. Included in this evaluation was blood withdrawal at multiple intervals for assay of plasma hormones corticosterone (CORT) and prolactin (PRL) as they were correlated with the immune phenomena associated with early (5-7d) obstruction of the catheter tip. The intravascular portion of all catheters were covered with a transparent sheath which was composed of endothelial cells, smooth muscle cells, fibroblasts and numerous collagen fibers. Early blockage of catheters was the result of large white masses (wm) enclosing the tip which were continuous with the sheath. The wm consisted of: a) an inner zone nearest the catheter in some regions predominantly composed of numerous platelets and in others granulocytes and platelets; b) a middle zone containing numerous neutrophils; c) an outer zone containing a few inflammatory cells and many spaces filled with red blood cells. Rats that developed a wm blockage 7-10d after catheter placement had higher plasma CORT levels (3-5d post implant) when compared to those of animals with catheters remaining open 3-4 weeks. When viewed together, these observations describe a subset of a larger population of rats that have a local intravascular inflammatory reaction to silicone-based catheters. This preparation may be a useful model for investigating reported differences in human reactivity to silicone-based prostheses.

Diabetes mellitus and experimental vein graft structure and function

PURPOSE

Diabetes mellitus is a known risk factor for accelerated atherosclerosis and for postangioplasty restenosis.

METHODS

This study examines the effect of chronic, uncontrolled, alloxan-induced diabetes on the structure and vasomotor function of vein bypass grafts in 20 male New Zealand white rabbits with diabetes and in 10 controls. After 8 weeks of diabetes, a common carotid vein bypass graft was performed. Four weeks after operation, vein grafts and contralateral jugular veins were harvested.

RESULTS

Diabetes induced a twofold increase in the vein graft intimal thickness compared with control. There was no change in medial thickness. Electron microscopy of the vein grafts in diabetes revealed intercellular gaps in the endothelium lining and abnormal endothelial cell junctions compared with controls. Diabetes significantly increased the maximal contractions generated in vein grafts to all contractile agonists tested without any change in sensitivity.

CONCLUSIONS

This study demonstrates that diabetes alters endothelial cell structure and increases the development of intimal hyperplasia with increased maximal contractility in vein grafts and therefore suggests that the vein grafts in diabetes are more susceptible to early stenosis.

Long-term cryopreservation of autologous veins in rabbits

This study was undertaken to determine the effect of long-term cryopreservation on graft ultrastructure and endothelial cell viability in an animal model. The jugular veins from 12 New Zealand White rabbits were excised with a 'no-touch' technique and divided into four groups: control group (fresh veins); group 1, veins cryopreserved for 1 month; group 2, veins cryopreserved for 2 months; and group 3, veins cryopreserved for 3 months. Cryopreservation was accomplished by rapid freezing (-5 degrees C s-1 to -196 degrees C) in a solution of 17.5% dimethylsulphoxide and 20% fetal bovine serum and by storage in liquid nitrogen. Veins were then implanted as a carotid autograft (three grafts/group). At the time of graft implantation a segment of the paired matched vein was perfusion-fixed and evaluated by scanning and transmission electron microscopy, whereas the remainder were subjected to endothelial cell culture techniques to determine cell viability. Autografts were removed 1 month after implantation and subjected to similar evaluations. Histological changes seen in cryopreserved veins were dependent on preservation time and included focal endothelial cell blebbing, cytoplasmic vacuolization and disruption of cell-to-cell contacts. Smooth muscle cells showed mitochondrial swelling. Patency was identical in all groups (66.6%). Explants at 1 month were similar in histological appearance to fresh veins with a smooth endothelial cell lining arranged longitudinally and intact cell junctions. Endothelial cells could be cultured from fresh veins and 1-month-old explants but not from the cryopreserved graft surface before implantation. the present technique of cryopreservation leads to some damage of graft architecture and loss of endothelial cell viability.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac musculature of the cranial and caudal venae cavae and the pulmonary vein in the fowl

The cardiac musculature of cranial and caudal venae cavae and pulmonary vein was examined to clarify its distribution pattern in the fowl using both light and electron microscopies. The musculature was distributed from the heart to the root of subclavian vein in the cranial vena cava, to the cranial margin of the liver in the caudal vena cava, and to the left and right distal pulmonary veins in the pulmonary vein, respectively. Judging from the morphology and distribution pattern in the venous wall, the cardiac musculature in the fowl is thought to share the same phylogenic origin with that in mammals. The ultrastructure of cardiac myocytes including transitional cells in the cranial vena cava and the pulmonary vein resembled that of atrial myocytes. While, the typical specialized myocytes such as Purkinje fiber were found in the caudal vena cava of the fowl.

Non-selectivity of new bradykinin antagonists for B1 receptors

Two new B1 receptor antagonists, [Hyp3,Thi5,DTic7,Oic8]desArg9-BK and DArg[Hyp3,Thi5,DTic7,Oic8]desArg9-BK were tested in vitro on the rabbit jugular vein and the guinea pig ileum (preparations containing B2 receptors) and on the rabbit aorta (preparation containing B1 receptors) for pharmacological characterization. The results indicate that both compounds are antagonists on both B1 and B2 receptors, are competitive and discriminate between B2A and B2B receptor subtypes.

Quantitation of collagen fibril cross-section profiles in aging human veins

The cross-section profiles and the diameter distribution of collagen fibrils were examined quantitatively in normal human internal jugular veins at different ages (first, fifth, and eighth decades). All fibrils showed a regular cross-striation pattern of native-type collagen fibrils irrespective of their cross-section profiles. Irregularly outlined ("dysplastic") fibrillar profiles were observed among the normally occurring circular cross-section profiles. The frequency of such unusual fibrils significantly increased with age. This increase was more pronounced in the tunica media as compared with the tunica adventitia. In the tunica media diameters of collagen fibrils also generally increased with age. In the tunica adventitia, on the other hand, fibrillar diameters were not significantly altered at different ages. The results of this study indicate that the frequency of both the irregularly outlined fibrillar cross-section profiles and increased fibrillar diameters depends on age in normal vascular walls. Therefore, it is concluded that the occurrence of "dysplastic" fibrils is a physiologic age-related phenomenon rather than a morphologic sign of pathologic alteration of collagen. The higher frequency of irregularly outlined collagen fibrils in the tunica media may indicate a higher and/or altered synthetic behavior of smooth muscle cells when compared with fibroblasts of the tunica adventitia.

Intimal thickening of jugular and femoral veins vs arteries in the rabbit following investment

The authors induced intimal thickening in the jugular and femoral veins and in the common carotid and femoral arteries of rabbits by placement of a polyethylene tube cuff. The comparative effects on the intima were studied by light and electron microscopy. Even in the veins, thickening resulted from the migration of medial smooth muscle cells into the intima with subsequent proliferation. Thickening in the arteries consisted of tightly packed smooth muscle cells and a few elastic fibers, whereas that in the veins was characterized by an abundance of collagen fibers, layers of smooth muscle cells, and a few elastic fibers. Capillaries were often observed in the thickened intima of the veins but not of the arteries.

The effect of rigid external support on vein graft adaptation to the arterial circulation

In previous experiments vein graft wall thickening stopped when the ratio of lumen radius to wall thickness equaled that of a normal artery. This led us to postulate that wall stress, which this ratio determines, regulates wall structure. To test this hypothesis we studied the effect of decreasing lumen radius and acutely diminishing wall stress with a rigid, external support. Jugular vein grafts were interposed into the carotid artery of rabbits. The proximal half of the grafts was wrapped with a polytetrafluoroethylene graft. Twelve veins received a tight wrap (2.5 or 3 mm diameter) that decreased the graft diameter, and four received a loose wrap (5 mm diameter) that did not. These grafts were fixed by perfusion after 1 day, 11 days, or 12 weeks. Wall thickness was slightly less in all tight-wrap segments. Total cross-sectional wall area, smooth muscle cell volume, and matrix deposition were significantly reduced in tight-wrap segments. These differences were greatest at 11 days. The observation that narrowing and external support of these vein grafts causes reduction of wall area supports the hypothesis that increased wall stress might be an important stimulus for wall thickening.

Leukocyte mediated vein injury and thrombosis is reduced by a lipoxygenase inhibitor

We have previously demonstrated an in vivo model of deep vein thrombosis which suggests that the neutrophil promotes vascular injury and thrombosis following blood flow stasis. Since leukotrienes are potent mediators of vascular injury and neutrophil (PMN) chemotaxis, we wished to determine if in vivo inhibition of 5-lipoxygenase would reduce neutrophil mediated events in our model. Lipoxygenase was inhibited in vivo with 2,3-diethyl-4-methoxy,1-naphthalenol acetate (U-66,855). The in vivo activity of U-66,855 was demonstrated in 4 cats. Each animal was treated with 5 mg/kg of U-66,855 intravenously. Blood cell leukotriene B4 (LTB4) and thromboxane A2, via its metabolite thromboxane B2 (TBX2) was assessed before and 30, 60, and 120 min after dosing. Blood cell LTB4 and TBX2 production was stimulated by A23187 (24 microM) and assayed by radioimmunoassay. We exposed and isolated a 3-cm segment of the jugular veins from 10 additional cats 5 of which were treated with U-66,855 (5 mg/kg, iv). In order to assess the effect of stasis, the jugular veins were ligated at the thoracic inlet for 2 hr after which the veins were perfused, fixed in 2.5% glutaraldehyde, and prepared for electron microscopy. U-66,855 reduced LTB4 production significantly (P less than 0.01), but not TBX2. In untreated cats, PMNs adhered to and migrated underneath the venous endothelium. Additionally, platelets, fibrin and formed thrombi were found on the basement membrane exposed by the migrating neutrophils. In contrast, we observed significantly reduced PMN adhesion as well as no fibrin deposition in veins obtained from cats treated with U-66,855. The results suggest that 5-lipoxygenase inhibition can significantly reduce undesirable neutrophil/vessel wall interactions.

Thrombin uptake and inhibition on heparinized polytetrafluoroethylene (PTFE) grafts and native sheep vessels

Non-heparinized and covalently-heparinized PTFE grafts, sheep aorta, carotid artery and jugular vein were evaluated according to their ability to adsorb and inactivate thrombin. All surfaces, except non-heparinized PTFE caused considerable losses of enzymatically active thrombin from the solution. Covalently-heparinized PTFE and jugular veins adsorbed thrombin, which was inactivated on subsequent contact with antithrombin III. Despite the same loss from the solution as was encountered with veins arteries adsorbed significantly smaller amounts of thrombin. Protamine treatment of covalently-heparinized PTFE almost totally abolished the ability to adsorb thrombin. It is concluded that 1) arteries possess a stronger thrombin inhibitory capacity than veins, possible explanations to this being a different glucosaminoglycan or the presence of antithrombin III in the arterial wall and 2) that heparinizing PTFE results in a pronounced ability to inactivate thrombin.

[Experimental studies of autologous vein grafts for arterial defect, using fibrin glue]

Compared with end-to-end anastomosis, the procedure for veingrafting is time-consuming and troublesome. The purpose of this study was to resolve these problems. The common carotid artery of the rats was grafted by the jugular vein. The principle of sleeve anastomosis was applied at the proximal suture site and fibrin glue was used at both suture sites to prevent leakage. This method was performed in 67 rats, and conventional veingrafts were done in 41 rats. A high patency rate of 98% and a shortened operating time were obtained in this method. An advantage of this procedure was a reduction in the number of stitches, which reduced the operating time and ensured good vascular healing.

Combined dihydroergotamine and heparin prophylaxis of postoperative deep vein thrombosis: proposed mechanism of action

The cause of postoperative DVT is considered to be changes in blood coagulation, stasis of blood within the veins, and injury to the vein wall. The coagulation changes have been investigated and documented and involve platelet activation, stimulation of the coagulation cascade, and blunting of endogenous fibrinolytic activity. Stasis has been objectively identified by retention of contrast material in soleal sinuses and marked changes in venous flow velocity in patients in the supine position and in those under general anesthesia. Vein wall injury is more controversial, but has been shown to be directly related to venodilation. Such dilation of veins occurs in response to operative trauma, hence venous endothelial damage most likely plays a part in the milieu responsible for postoperative DVT. The prophylaxis provided by the combination of dihydroergotamine and heparin appears to affect each of the three limbs of Virchow's triad. Heparin achieves its prophylactic benefit by activating antithrombin III. Activated antithrombin III affects numerous sites in the coagulation cascade. It has been shown that 1 micrograms of antithrombin III inhibits the formation of 1 unit of thrombin; however, in the presence of heparin, 1 micrograms of activated antithrombin III inhibits 750 units of thrombin. Dihydroergotamine increases venous smooth muscle tone without affecting arteriolar smooth muscle. Hence, it has the effect of preventing stasis without increasing blood pressure. It also affects the platelet membrane, prostaglandin synthesis, and blood distribution, although these findings need to be elucidated. The combination of dihydroergotamine and heparin seems to have a synergistic prophylactic effect in preventing postoperative DVT. Heparin modifies the coagulation changes, whereas dihydroergotamine minimizes stasis and potentially prevents the endothelial damage caused by excessive operative venodilation. Such a combination of effects can explain the synergistic prophylactic efficacy found when dihydroergotamine and heparin were employed in combination in the multicenter trial [42].

The relationship between vessel wall injury and venous thrombosis: an experimental study

The relative importance of stasis, vessel wall damage and hypercoagulability in the pathogenesis of venous thrombosis remains disputed. While the combination of local vascular stasis and systemic hypercoagulability can be shown to produce experimental thrombi within a few minutes, it has been claimed that vessel wall damage is also a necessary component of venous thrombogenesis. In this experimental study, mechanical crushing of the jugular veins produced patchy areas of denuded endothelium, with underlying vessel wall oedema, as seen by ultrastructural examination. While the exposed subendothelium became covered with activated platelets following restored blood flow, there was no fibrin formation after 5 min. When blood flow was restored for 60 min following the crush injury, white cells could be seen adhering to and migrating through the vessel wall, although there was still no visible fibrin. The addition of venous stasis for 20 min did not lead to the formation of stasis thrombi in association with the damaged areas. The present experiments demonstrate that, far from there being subtle endothelial damage contributing to acute venous thrombosis, even readily demonstrable damage is a poor stimulus to fibrin formation at local sites of vessel wall injury.

Comparative evaluation of the effects of an ionic vs. a nonionic contrast medium on the venous endothelium. Preliminary scanning electron microscopic observations

Isolated segments of the right jugular veins of six mongrel dogs were exposed to solutions of 60% diatrizoate (3 dogs) and 60% iopamidol (3 dogs) in vivo. Normal blood flow was re-established after 3 minutes of exposure to the contrast material. The left jugular veins served as controls. Veins were harvested at 1, 24, and 48 hours and studied by light and scanning electron microscopy. Changes consisting of cellular swelling, denudation, platelet aggregation and fibrin deposition were uniform and prominent with diatrizoate. Response to iopamidol was minimal consisting only of cellular swelling. The study suggests that post-phlebographic thrombophlebitis may be reduced by the use of nonionic contrast materials.

Scanning electron-microscopic study of experimentally induced intimal tears in rabbit arteries

A scanning electron-microscopic study of the intimal surface of anastomosed arteries of experimental arteriovenous fistulae in 20 rabbits was conducted to determine the effect of altered haemodynamics on the arterial wall. Control arteriotomies were performed on 12 animals on the contralateral common carotid arteries. The rabbits were killed from 1 to 447 days postoperatively. Transverse intimal tears involving the internal elastic lamina developed in both proximal and distal segments of the anastomosed artery as early as 5 days postoperatively. Some were covered with thrombus and attenuated endothelial cell remnants, but all tears became endothelialised by 7 days. Endothelial cells in the floor of the tears had prominent nuclei and were smaller and more plentiful than the normal intima but, in longstanding fistulae, they resumed a more elongated spindle shape. Tears similar to those in the experimental arteries were found in most control arteriotomies, being confined to the suture zone. The results reveal the profound effect of altered haemodynamics on the arterial wall.

Intimal hyperplasia in arterial autogenous vein grafts: a new animal model

A new animal model is presented, in which the changes in arterial autogenous vein grafts in rabbits can be studied. Intimal hyperplasia has developed four weeks after grafting. The thickness of the intima has been measured at this time. The potential uses of the model are discussed.

Total hip replacement induces injury to remote veins in a canine model

The effects of total hip replacement on the condition of the luminal surface of the jugular and femoral veins and the carotid and femoral arteries were studied in healthy dogs. Four hours after the completion of surgery, most of the blood was removed by whole-body perfusion and the vessels were partially fixed in situ by glutaraldehyde perfusion, harvested, and prepared for scanning electron microscopy. In control dogs (held under anesthesia) the luminal surfaces of the veins (including valves and confluences) and arteries were covered by intact endothelium and were free of adhering blood cells. The arteries from dogs that were operated on were also free of damage. In contrast, the veins from dogs that were operated on showed a series of roughly parallel microtears around 70 to 80 per cent of the confluences of the side branches with the jugular or femoral vein. The basement membrane as well as the endothelial sheet was torn, thereby exposing underlying connective-tissue fibers and smooth muscle cells. The endothelium separated along intercellular junctions. The tears were infiltrated with many leukocytes and platelets and some erythrocytes. Subtle endothelial changes and patchy leukocyte adhesion occurred away from the side branches. The mechanism or mechanisms remain to be elucidated.

The effects of embolectomy-thrombectomy catheters on vascular architecture

The purpose of this report is to describe the evolution of an embolectomy-thrombectomy catheter (ETC) injury over a six week period. Carotid arteries and jugular veins in six adult dogs were subjected to ETC withdrawals at a standard velocity and balloon size. Vascular segments were excised as early as one hour and as late as six weeks. The specimens were prepared for light, scanning electron and transmission electron microscopic examination. In early specimens, arteries and veins showed endothelial denudation followed by regeneration. In later specimens, the arteries showed progressive disruption of the internal elastic lamina and marked subendothelial proliferation (arteriosclerosis). By the sixth week the artery's intima was equal in thickness to the media. The veins showed only regenerating endothelium without alterations of the subendothelium. Exposure of canine vasculature to ETC procedures caused pronounced transmural damage in the arteries and only endothelial alterations in the veins.

Ultrastructure of human and transplanted canine veins: effects of different preparation media

Human saphenous veins were studied to determine alterations resulting from preparation by moist gauze wrapping, balanced salt solution immersion, and heparinized whole blood storage at 4 degrees C. Morphologic derangements of endothelial cells, smooth muscle cells, and adventitial tissues were pronounced in the nonblood preparations. In a second study, 20 canine jugular vein segments were interposed into the iliofemoral arterial circulation, with half the grafts prepared in balanced salt solution and half in whole blood. Veins were harvested monthly for 10 months, being subjected to light and electron microscopic examinations. No thromboses or stenoses occurred. Diffuse graft dilatation affected veins three times more often when stored in lactated Ringer's solution than when stored in heparinized blood. Medial thinning, ranging from 20% to 54%, occurred in veins stored in the balanced salt solution. Endothelial regeneration was complete in all grafts within 30 days after implantation. However, medial and adventitial injury to veins prepared in balanced salt solution appeared progressive, with fibrodysplastic tissue replacing smooth muscle cells. Plasmacytosis and neutrophil infiltrates, consistent with chronic active inflammation, often accompanied fibroproliferative changes. Alterations in medial structures, rather than endothelial injury, may have an important influence on the long-term durability of transplanted vein grafts.

Scanning electron-microscopic study of the inner surface of experimental aneurysms in rabbits

A scanning electron-microscopic study of the inner surface of experimental saccular aneurysms in rabbits was conducted to demonstrate the effects of haemodynamics on the aneurysmal wall. Animals with aneurysms were killed from 2 to 83 weeks postoperatively, and the controls from 7 to 51 weeks. In both series, re-endothelialization was complete in approximately 2 weeks. In control tissue endothelium was normal, and sutures caused mild distortion of the luminal surface. In the aneurysms, there were tracts of spindle-shaped cells, often arranged in whorl-like patterns and interspersed with regions of polyhedral cells with thickened intercellular borders, prominent stomata and numerous microvilli. In some areas, long filamentous intercellular processes were prominent. The few jet lesions seen were covered with polyhedral cells and were less complex than those in arteriovenous fistulae. Ridges, caused by elevated subendothelial connective tissues were crescentic or circular, outlining depressions and craters, as if delineating vortices. The carotid artery opposite the aneurysm exhibited endothelium similar to normal tissue, except in older aneurysms where corrugations caused by the internal elastic lamina were completely or partially absent. The experiments demonstrate the effect of intra-aneurysmal haemodynamics on the topography of the endothelium and subendothelial tissues of the sac wall, and support the concept that endothelial topography in the vascular system under physiological conditions is haemodynamically determined.

Aggressive meningioma with jugular vein extension. Case report with ultrastructural observations

A meningioma that was seen initially as a mass in the upper portion of the neck in a 44-year-old woman was studied by light and electron microscopy. Light microscopy demonstrated that the tumor was within the lumen of the internal jugular vein. Ultrastructural features led to the diagnosis of meningioma. The clinical findings indicate that the tumor arose within the cranial cavity, invaded a venous sinus, and extended down the internal jugular vein into the upper portion of the neck.

Autogenous vein graft thrombosis following exposure to calcium-free solutions (calcium paradox)

The morphological and functional effects of calcium-free and calcium-containing solutions on canine jugular vein intima were examined under conditions which closely resemble those techniques currently employed in peripheral vascular and aortocoronary bypass surgery. Veins that had been exposed only to calcium-containing solutions remained patent for the duration of the experimental period. Vein perfusion with a calcium-free solution, however, resulted in disruption of the jugular vein intima once calcium ions were reintroduced. Autogenous as a femoral arterial graft became thrombosed within 60 minutes. It is therefore suggested that vein grafts of autogenous origin be irrigated with calcium-containing solutions to prevent intimal damage and thrombosis.

Passage of extravascular tracers into canine jugular veins and carotid arteries

Biologically active substances arising in the interstitial space (cell-fiber matrix) of a medium-sized blood vessel or in surrounding tissue might reach the lumen by diffusion. Substances so delivered to the vessel wall-blood interface would be situated to effectively influence the endothelium and to initiate deposition of blood elements on the luminal surface of vessels, thereby contributing to thrombosis and atherosclerosis. This study showed that 125I, 125I-albumin and 125I-fibrinogen passed across the walls of segments of canine jugular veins and carotid arteries that were maintained under 20 cm H2O presure while being suspended in solutions containig the radioactive substances. The ratio of 125I to 125I-protein (albumin, fibrinogen) was predictably greatly increased by diffusion across the vessel wall. Frozen sections cut parallel with the luminal surface of flattened segments of vessels showed a gradient of radioactivity from adventitial to luminal surface of the vessels. Part of the fibrogen (but no albumin) that had reached the inside of the vessel had been broken down into fragments. These observations show that ions and proteins originating in perivascular fluid transverse the wall of medium-sized veins and arteries, presumably by diffusion across complex water-filled channels. Thus biologically active substances arising in perivascular tissue or in the vessel wall itself can be expected to reach the luminal surface of the vessel wall where they can influence endothelium and/or initiate deposition of blood elements on the vessel wall. Furthermore, the action of proteolytic enzymes on protein molecules such as zymogens might give rise to active substances not previously present.

Inhibition of leukocyte locomotion by tocainide, a primary amine analog of lidocaine: at study with 111indium-labeled leukocytes and scanning electron microscopy

The ability of tocainide (a primary amine derivative of lidocaine, 2-amino 2, 6-propionoxylidide) to inhibit leukocyte adhesion to and invasion of canine jugular veins was investigated. Leukocyte adhesion and migration were quantitated by use of 111indium-labeled leukocytes, and the morphologic characteristics of leukocytes and vessel lumen were studied by scanning electron microscopy. The morphologic characteristics of adhering and migrating 111indium-labeled leukocytes were similar to leukocytes that had not been manipulated, thus establishing their suitability for use as a marker for flammation. Exposure of leukocytes to 200 micrograms. per ml. of tocainide in autologous plasma in vitro inhibited adhesion and migration by 68 per cent. When labeled leukocytes were returned to the donor and exposed to intravenously infused tocainide the extent of reduction in adhesion and migration depended on whether tocainide infusion was started before or after neck dissection. Inhibition was only 46 per cent when dissection and injection of 111indium-labeled leukocytes preceded the start of infusion of tocainide but was 87 per cent when tocainide infusion was started before dissection and injection of leukocytes. The plasma level ranged from 25 to 47 microM over the 3 hour, 20 minute-infusion period, being 35 to 40 microM for the last hour. Migration of leukocytes across interendothelial junctions and their accumulation between the endothelial sheet and the basement membrane caused extensive damage to the endothelial lining of these veins. This was reduced when leukocyte migration was reduced. These observations suggest that the leukocyte-induced damage occurring in some sterile inflammations might be reduced by the use of local anesthetic drugs.

The influence of systemic aspirin on rat small diameter vein grafts: a scanning electron microscopic study

Small diameter vein grafts have been shown previously to have a poor patency rate unmedicated rats. Oral aspirin administered to male and female rats for one week pre-operatively reduced the number of platelets laid down on the luminal surface of their grafts, and resulted in a greater number of grafts remaining patent up to one hour after the blood flow through them had been established. The patency rate of grafts examined one to 17 weeks after operation was significantly better in female rats than in males given aspirin pre- and post-operatively. The different effect of aspirin in preventing thrombosis of the vein grafts of the two sexes makes its clinical usefulness for this purpose suspect.

The endothelial surface of large veins of rabbit: scanning electron microscopic observations

The following veins of the rabbit were fixed by perfusion and studied systematically by scanning electron microscopy: sagittal sinus, confluence of sinuses, external jugular vein, superior vena cava, inferior vena cava, greater saphenous, and femoral veins. One result is that the shape and arrangement of endothelial cells of the veins are obviously influenced by hemodynamic shear forces. Two types of subendothelial fibres were demonstrated: "cross-fibers" which correspond to the circular inner muscle cells of the media, and "longitudinal fibers" which correspond to the intimal meshwork of connective tissue fibers. Regional differences are demonstrated in the occurrence of these fibres. Moreover, five morphologically different venous valve types are observed. The functional significance of these different valve types is not yet known.