J Korean Surg Soc.  2010 Nov;79(5):377-385. 10.4174/jkss.2010.79.5.377.

Effect of Anastomotic Method on Intimal Hyperplasia in Rabbit Aorta

• Kim H
• Kwon TW
• Cho YP
• Ko GY
• Yun SS
• Hong HN
• Park SW

• KMID: 2212045
• DOI: http://doi.org/10.4174/jkss.2010.79.5.377

Abstract

PURPOSE
The clinical advantages of end-to-end (ETE) anastomosis have not been clear despite its biomechanical advantage over end-to-side (ETS) anastomosis. We compared the histomorphometric features of intimal remodeling after ETE and ETS anastomosis in a rabbit aortic bypass model.
METHODS
Thirty-two bypass operations, 16 with ETS and 16 with ETE anastomoses, were performed using aortic allografts of donor rabbits (15 per group) and polytetrafluoroethylene (PTFE) grafts (1 per group). To minimize bias from the immunologic response to aortic allografts or graft size, a long aortic tissue obtained from one donor was divided into 2 pieces and shared between each ETE and ETS bypass. PTFE graft bypasses, which are commonly used in clinical practice, were performed to provide comparison results for an allograft with a different compliance. Vessels were harvested at 1 day (1 per group), 5 days (1 per group), and 4 weeks (14 per group, including the PTFE bypass group) after surgery. Intimal thickening was evaluated with hematoxylin-eosin, van Gieson, immunohistochemical staining and Western blot analysis of TNF-alpha and proliferative cell nuclear antigen (PCNA) expression.
RESULTS
Mean intimal thickness and volume (0.721+/-0.047 mm, 5.734+/-0.387 mm3 vs. 0.883+/-0.048 mm, 9.068+/-0.462 mm3) and intima/media volume ratio (0.70+/-0.05 vs 1.08+/-0.06) were significantly smaller in ETE (P<0.05). Western blotting showed a marked increase in TNF-alpha (203.15+/-5.29 vs. 494.49+/-6.11) and PCNA concentrations (152.66+/-7.37 vs. 175.53+/-4.36) in the ETS group.
CONCLUSION
ETE anastomosis results showed significantly decreased inflammatory reaction and volume of intimal hyperplasia, and therefore seemed to be associated with better long-term graft patency.

Keyword

Intimal hyperplasia; Anastomosis; Bypass inflammation

MeSH Terms

Aorta
Bias (Epidemiology)
Blotting, Western
Compliance
Humans
Hyperplasia
Imidazoles
Nitro Compounds
Polytetrafluoroethylene
Proliferating Cell Nuclear Antigen
Rabbits
Tissue Donors
Transplantation, Homologous
Transplants
Tumor Necrosis Factor-alpha
Imidazoles
Nitro Compounds
Polytetrafluoroethylene
Proliferating Cell Nuclear Antigen
Tumor Necrosis Factor-alpha

Figure

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  Fig. 1 Operative field. (A) End-to-side anastomosis. (B) End-to-end anastomosis. The white arrow indicates the ligated end of the host artery.

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  Fig. 2 Analysis of anastomoses 4 weeks after implantation. H-E (A) and van Gieson staining (B), showing thicker neointima in the end-to-side anastomosis group. Arrowheads indicate the internal elastic lamina (Original magnification: ×400).

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  Fig. 3 End-to-side anastomosis 4 weeks after implantation. Side walls (A) and ventral surface (B, C) of the grafts. Thicker cellular layer containing abundant extracellular matrix were observed on the ventral surfaces. Arrowheads indicate the internal elastic lamina (H-E, Original magnification: A, C, ×400; B, ×100).

• 

  Fig. 4 Van Gieson staining of proximal anastomoses of the polytetrafluoroethylene (PTFE) bypass group. Thicker neointima in end-to-side (B) than endto-end anastomosis graft (A) was observed. Arrowheads indicate theneointima (Original magnification: left two panels ×100; right two panels ×400).

• 

  Fig. 5 Immunohistochemical staining for proliferating cell nuclear antigen (PCNA) and tumor necrosis factor-alpha (TNF-α) in proximal anastomoses of rabbit aortic grafts 4 weeks after implantation. PCNA-positive cells (black arrow) were more abundant in the end-to-side (B) than end-to-end (A) anastomosis group, as was diffuse immunostaining for TNF-α throughout the neointima/media. Arrowheads indicate internal elastic lamina (PCNA = proliferating cell nuclear antigen; TNF-α = tumor necrosis factor-alpha) (Original magnification: left two panels, ×200, and right four panels, ×400).

• 

  Fig. 6 Western blotting of proteins of three aortic grafts containing proximal anastomosis 4 weeks after implantation. Quantitative analysis showed that expression of proliferating cell nuclear antigen (PCNA) (A) and tumor necrosis factor-alpha (TNF-α) (B) was higher in the end-to-side (ETS) group than in the end-to-side (ETS) group. Results are expressed as means±SEMs (PCNA = proliferating cell nuclear antigen; TNF-α = tumor necrosis factor-alpha).

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