Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492006000200002
Jornal Vascular Brasileiro
Original Article

Estudo da resposta tissular à endoprótese recoberta de jugular bovina em veia cava inferior de suínos

Bovine jugular covered stent-graft implanted in swine inferior vena cava - a study of tissue response

Cristina Ribeiro Riguetti Pinto; Celso Luiz Muhlethaler Chouin; Gaudencio Espinosa Lopez

http://dx.doi.org/10.1590/S1677-54492006000200002 J Vasc Bras, vol.5, n2, p.81-88, 2006
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Resumo

OBJETIVO: Avaliar a resposta tissular a uma endoprótese, com cobertura biológica heteróloga, implantada em veia cava inferior de suínos. MÉTODO: Desenvolvemos uma endoprótese auto-expansível, revestida com um segmento de jugular bovina, conservada por processo L-hydro e suturada em um stent de aço inoxidável 316L. O dispositivo introdutor utilizado foi a bainha de liberação da endoprótese aórtica Taheri-Leonhardt (Flórida, EUA). Foram implantadas endopróteses em 10 suínos, todas na veia cava infra-renal. Os animais foram submetidos à flebografia peroperatória. À necropsia, após 2 meses, cada endoprótese foi retirada em bloco e analisada macroscopicamente, visando a avaliação da perviedade, aderência aos tecidos vizinhos e incorporação à parede venosa; e, histopatologicamente, visando a resposta histológica ao enxerto. RESULTADOS: Na análise macroscópica, todas as endopróteses encontravam-se pérvias e totalmente incorporadas à parede venosa, porém seis apresentavam trabeculações grosseiras no seu interior e quatro algum grau de fibrose perivascular. Três animais desenvolveram linfocele, uma retroperitoneal e as outras na parede abdominal. No estudo histopatológico, observamos reação inflamatória granulomatosa tipo corpo estranho em todos os casos, sendo predominante na camada média (80%). CONCLUSÃO: O modelo estudado apresentou baixa trombogenicidade, corroborando com a eficácia do meio de conservação e material escolhidos; porém, baixa biocompatibilidade, provavelmente pelo obstáculo imunológico dos xenoenxertos e resposta tissular exagerada do território venoso.

Palavras-chave

Endoprótese, bioprótese, veias jugulares, bovinos, veia cava inferior, histocompatibilidade

Abstract

OBJECTIVE: To evaluate tissue response to a bovine jugular vein covered stent when implanted in the swine inferior vena cava. METHOD: We developed a self-expanding stent, using a segment of L-hydro conserved bovine jugular vein, which was trimmed and sutured to a 316L stainless steel stent. We used the Taheri-Leonhardt delivery system for aortic stent-graft deployment (Florida, USA). Ten handmade stent-grafts were implanted in 10 swine inferior venae cavae. All animals were submitted to perioperative venography. At necropsy, 2 months later, the stent-grafts were removed en bloc and histopathologic analysis was undertaken, in order to analyze its patency, adherence to neighboring tissues and incorporation to the venous wall, as well as tissue response. RESULTS: All stent-grafts were patent and adherent to venous wall, but six presented with gross trabeculation and four had some degree of perivascular fibrosis at macroscopy. Three animals developed lymphocele, one in the retroperitoneal space and the others in the abdominal wall. At histopathology, we observed chronic inflammatory reaction with foreign body granulomatous response in all cases, with prevalence of the tunica media (80%). CONCLUSION: The model presented low thrombogenicity, which corroborates the efficacy of the chosen means of preservation and material. However, there was low compatibility, probably due to the immunological obstacle of xenografts and exaggerated tissue response of the venous territory.

Keywords

Stent-graft, bioprosthesis, jugular veins, cattle, inferior vena cava, histocompatibility

References

Hurlbert SN, Rutherford RB. Subclavian-axillary vein thrombosis. Vascular surgery. 2000:1208-21.

Raju S, Owen S Jr, Neglen P. The clinical impact of iliac venous stents in the management of chronic venous insufficiency. J Vasc Surg.. 2002;35:8-15.

Yamakado K, Nakatsuka A, Tanaka N. Portal venous stent placement in patients with pancreatic and biliary neoplasms invading portal veins and causing portal hypertension: clinical experience. Radiology. 2001;220:150-6.

Yilmaz S, Erdogan A, Luleci E. Transvenous embolization and stent placement for an internal iliac arteriovenous fistula with central iliac vein occlusion. J Vasc Interv Radiol.. 2004;15:399-404.

Cronin P, McPherson SJ, Meaney JF, Mavor A. Venous covered stent: successful occlusion of a symptomatic internal iliac arteriovenous fistula. Cardiovasc Intervent Radiol. 2002;25:323-5.

Dheer S, Joseph AE, Drooz A. Retroperitoneal hematoma caused by a ruptured pelvic varix in a patient with iliac vein compression syndrome. J Vasc Interv Radiol.. 2003;14:387-90.

Kaneoka Y, Yamaguchi A, Isogai M, Hori A. Intraportal stent placement combined with portal vein embolization against advanced gallbladder carcinoma. Surg Today.. 1998;28:862-5.

Kreienberg PB, Chang BB, Darling RC. Long-term results in patients treated with thrombolysis, thoracic inlet decompression, and subclavian vein stenting for Paget-Schroetter Syndrome. J Vasc Surg. 2001;33:S100-5.

Savader SJ. Inferior vena cava filters. Venous Interventions. 1995:276-92.

Sharafuddin MJ, Sun S, Hoballah JJ, Youness FM, Sharp WJ, Roh BS. Endovascular management of venous thrombotic and occlusive diseases of the lower extremities. J Vasc Interv Radiol.. 2003;14:405-23.

Yamakado K, Nakatsuka A, Tanaka N, Fujii A, Terada N, Takeda K. Malignant portal venous obstructions treated by stent placement: significant factors affecting patency. J Vasc Interv Radiol.. 2001;12:1407-15.

Picard JD, Barrelier MT, Joffre F. Veia normal. A veia: sua imagenologia. 2003:14-40.

Stock KW, Jacob AL, Proske M, Bolliger CT, Rochlitz C, Steinbrich W. Treatment of malignant obstruction of the superior vena cava with the self-expanding wallstent. Thorax. 1995;50:1151-6.

Schachner T, Zou Y, Oberhuber A. Local application of rapamycin inhibits neointimal hyperplasia in experimental vein grafts. Ann Thorac Surg. 2004;77:1580-5.

Schellhammer F, Haberstroh J, Wakhloo AK, Gottschalk E, Schumacher M. Vein graft coated vascular stents: a feasibility study in a canine model. Cardiovasc Intervent Radiol. 1998;21:158-64.

Dolmatch BL. Healing response to vascular stent-grafts. J Vasc Surg. 2000;31:1285-9.

Schellhammer F, Wahkloo AK, Nagursky H, Schumacher M. Vein graft-coated stents for endovascular occlusion of canine experimental arteriovenous fistulae. Invest Radiol.. 1999;34:22-7.

Gomez-Jorge J, Venbrux AC, Magee C. Percutaneous Deployment of a valved bovine jugular vein in the swine venous system: a potential treatment for venous insufficiency. J Vasc Interv Radiol.. 2000;11:931-6.

Schwartz RS, Edelman ER, Carter A. Preclinical evaluation of drug-eluting stents for peripheral applications: recommendations from an expert consensus group. Circulation. 2004;110:2498-505.

Mason RG, Read MS. Some species differences in fibrinolysis and blood coagulation. J Biomed Mater Res.. 1971;5:121-8.

Narayanaswamy M, Wright KC, Kandarpa K. Animal models for atherosclerosis, restenosis, and endovascular graft research. J Vasc Interv Radiol.. 2000;11:5-17.

Dobrin PB, Littooy FN, Endean ED. Mechanical factors predisposing to intimal hyperplasia and medial thickening in autogenous vein grafts. Surgery. 1989;105:393-400.

Morinaga K, Eguchi H, Miyazaki T, Okadome K, Sugimachi K. Development and regression of intimal thickening of arterially transplanted autologous vein grafts in dogs. J Vasc Surg.. 1987;5:719-30.

Miller VM, Reigel MM, Hollier LH, Vanhoutte PM. Endothelium-dependent responses in autogenous femoral veins grafted into the arterial circulation of the dog. J Clin Invest.. 1987;80:1350-7.

Ip JH, Fuster V, Badimon L, Badimon J, Taubman MB, Chesebro JH. Syndromes of accelerated atherosclerosis: role of vascular injury and smooth muscle cell proliferation. J Am Coll Cardiol.. 1990;15:1667-87.

Phillips-Hughes J, Kandarpa K. Restenosis: pathophysiology and preventive strategies. J Vasc Interv Radiol.. 1996;7:321-33.

Rogers C, Edelman ER. Endovascular stent design dictates experimental restenosis and thrombosis. Circulation. 1995;91:2995-3001.

Wakhaloo AK, Schellhammer F, de Vries J, Haberstroh J, Schumacher M. Self-expanding and balloon-expandable stents in the treatment of carotid aneurysms: an experimental study in a canine model. AJNR Am J Neuroradiol. 1994;15:493-502.

Toyota N, Pavcnik D, VanAlstine W. Comparison of small intestinal submucosa-covered and noncovered nitinol stents in sheep iliac arteries: a pilot study. J Vasc Interv Radiol.. 2002;13:489-98.

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