Pericardial patch venoplasty heals via attraction of venous progenitor cells.

Hualong Bai,Ying Xing,Jesse J Hanisch,Takuya Hashimoto,Trenton R Foster,Alan Dardik,Haidi Hu,Jeans M Santana,Mo Wang,Hao He

doi:10.14814/phy2.12841

Abstract

Pericardial patches are commonly used during cardiovascular surgery to close blood vessels. In arteries, patches accumulate arterial progenitor cells; we hypothesized that venous patches would accumulate venous progenitor cells, in the absence of arterial pressure. We developed a novel rat inferior vena cava (IVC) venotomy model and repaired it with a pericardial patch. Cells infiltrated the patch to form a thick neointima by day 7; some cells were CD34+/VEGFR2+ and CD31+/Eph‐B4+ consistent with development of venous identity in the healing patch. Compared to arterial patches, the venous patches had increased neointimal thickness at day 7 without any pseudoaneurysms. Addition of an arteriovenous fistula (AVF) to increase blood flow on the patch resulted in reduced patch neointimal thickness and proliferation, but neointimal thickness was not reversible with AVF ligation. These results show that rat patch venoplasty is a novel model of aggressive venous neointimal hyperplasia.

Highlights

Pericardial patches, either bovine or porcine, are commonly used by surgeons to close blood vessels during cardiovascular surgery (Muto et al 2009; Li et al 2011)
Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society
To determine the response to patch implantation in the low pressure venous circulation, we developed a model of patch venoplasty in the rat inferior vena cava (IVC); pericardial patches were sewn into the rat IVC using standard microsurgical techniques (Fig. 1A)

Summary

Introduction

Pericardial patches, either bovine or porcine, are commonly used by surgeons to close blood vessels during cardiovascular surgery (Muto et al 2009; Li et al 2011). Biasi et al showed that pericardial patch angioplasty reduced the rate of carotid artery restenosis compared to primary closure (Biasi et al 2002); recent series show long-term patch stability and freedom from infection and as well as 98% freedom from restenosis in treated carotid arteries (Papakostas et al 2014) Closure of veins such as the inferior vena cava (IVC) with a pericardial patch is performed in some cases, including oncology resections (Del Campo and Konok 1994; Ohwada et al 1999) and living donor liver transplantation (Mori et al 2012). We hypothesize that the low pressure of the venous environment will reduce pseudoaneurysm formation in venous patches, confirming that pseudoaneurysm formation in the rat patch angioplasty model is a consequence of arterial pressure

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Conclusion