Abstract
The aim of this study was to evaluate and compare the efficacy of 4-hexylresorcinol (4-HR)-incorporated silk as a vascular patch scaffold to that of the commercial polytetrafluoroethylene (PTFE) vascular patch (GORE® ACUSEAL). The expression of the vascular endothelial cell growth factor-A (VEGF-A) after application of 4-HR was studied in RAW264.7 and HUVEC cells. In the animal study, a carotid artery defect was modeled in Sprague Dawley rats (n = 30). The defect was directly closed in the control group (n = 10), or repaired with the PTFE or 4-HR silk patch in the experimental groups (n = 10 per group). Following patch angioplasty, angiography was performed and the peak systolic velocity (PSV) was measured to evaluate the artery patency. The application of 4-HR was shown to increase the expression of VEGF-A in RAW264.7 and HUVEC cells. The successful artery patency rate was 80% for the 4-HR silk group, 30% for the PTFE group, and 60% for the control group. The PSV of the 4-HR silk group was significantly different from that of the control group at one week and three weeks post-angioplasty (p = 0.005 and 0.024). Histological examination revealed new regeneration of the arterial wall, and that the arterial diameter was well maintained in the 4-HR silk group in the absence of an immune reaction. In contrast, an overgrowth of endothelium was observed in the PTFE group. In this study, the 4-HR silk patch was successfully used as a vascular patch, and achieved a higher vessel patency rate and lower PSV than the PTFE patch.
Highlights
Injury to an artery in the head and neck regions can occur during facial trauma, deformity, cancer, and reconstruction surgeries [1]
The expression level of vascular endothelial cell growth factor-A (VEGF-A) was dependent on the dose and time of the
Cross-linking of the silk fiber can be observed in the 4-HR silk patch image
Summary
Injury to an artery in the head and neck regions can occur during facial trauma, deformity, cancer, and reconstruction surgeries [1]. Branching from the common carotid artery can be damaged during neck dissection, malignant tumor resection, and microvascular free flap transfer in head and neck cancer patients [2]. The primary closure method is relatively simple and easy, this technique to repair an arterial defect can increase the risks of postoperative artery aneurysm and restenosis [3]. Patch angioplasty is a common procedure that follows carotid endarterectomy (CEA), which is the removal of the atherosclerotic plaque to reduce the risk of stroke in a patient with internal carotid stenosis [5]. As compared to the primary closure method, patch angioplasty reduces the risks of postoperative stroke, aneurysm, and restenosis [6,7]
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