Graft Vessels Research Articles

Portal vein wedge resection and patch venoplasty using autologous and homologous vein grafts during surgery for hepatobiliary malignancies

Obtainment of tumor-free resection margins is one of the most important factors for favorable prognosis of patients undergoing resection for hepatobiliary malignancies. In this study, we present our experience of portal vein (PV) wedge resection and patch venoplasty using autologous or homologous vessel grafts used in resection for perihilar cholangiocarcinoma, hepatocellular carcinoma and distal bile duct cancer. Case 1: A 68-year-old male patient with type IV perihilar cholangiocarcinoma underwent central bisectionectomy with caudate lobectomy and bile duct resection, and PV wedge resection and patch venoplasty with a cryopreserved iliac vein allograft patch. This patient survived 14 months after surgery. Case 2: A 77-year-old male patient with type IIIA perihilar cholangiocarcinoma underwent left medial sectionectomy with caudate lobectomy and bile duct resection, and PV wedge resection and patch venoplasty with a cryopreserved iliac vein allograft patch. This patient survived 16 months after surgery. Case 3: A 54-year-old male patient with hepatitis B virus-associated liver cirrhosis and hepatocellular carcinoma with PV tumor thrombus underwent left hepatectomy. The PV wall defect was repaired with an autologous greater saphenous vein patch. This patient survived 11 months after surgery. Case 4: A 65-year-old female patient with distal bile duct cancer underwent pylorus-preserving pancreaticoduodenectomy and main PV wedge resection and patch venoplasty with a cryopreserved iliac artery allograft patch. This patient survived 21 months after surgery. In conclusion, PV wedge resection and patch venoplasty provide a useful option to facilitate complete tumor resection in patients undergoing various extents of surgical resection for hepatobiliary malignancies.

A case report of percutaneous direct injection of N-butyl-2-cyanoacrylate (NBCA) to treat a pancreatic duodenal stump leak after a simultaneous pancreas and kidney transplantation

BackgroundSimultaneous pancreas and kidney transplantation (SPK) is a treatment option for patients with end-stage renal disease due to type 1 diabetes mellitus. We report a patient with a refractory fistula due to leakage from the duodenal stump of the pancreas graft after an SPK with bladder drainage who was successfully treated with a percutaneous direct injection of N-butyl-2-cyanoacrylate (NBCA).Case presentationA 60-year-old female with a 33-year history of type 1 diabetes mellitus and a 10-year history of renal replacement therapy underwent an SPK in 2015. At the time of transplantation, an abdominal aortic aneurysm with a high risk of rupture was treated by a Y-graft replacement prior to the SPK. Bladder drainage of the pancreas graft was chosen to avoid a vessel graft infection. The patient’s postoperative course was uneventful. The patient was discharged on postoperative day 93 with good-functioning pancreas and kidney grafts. One and a half years after the operation, the patient was found to have acute graft pancreatitis and a leak from the duodenal stump of the pancreas graft due to a paralytic neurogenic bladder. The insertion of an indwelling catheter into the bladder and the endoscopic-guided insertion of a catheter into the graft pancreatic duct through the duodenum/bladder anastomosis did not result in the closure of the fistula. Therefore, NBCA was injected at the site of the leak point using CT-guided technique. The fistula was completely closed immediately after the injection, with no recurrences of leaks.ConclusionsA percutaneous direct injection of NBCA is one of the treatment options to treat intractable fistulas.

Clinical application of combined infratemporal fossa approaches for internal carotid artery in petrous bone reconstruction for large lateral skull base tumors

Objective: By summarizing the technical points and therapeutic outcomes of combing infratemporal fossa approach (IFA) and internal carotid artery (ICA) reconstruction for the colossal skull base tumor invading ICA in petrous bone, the clinical application value was discussed. Methods: Five patients (2 males, 3 females,aging from 27 to 55 years old) who received surgeries between July 2015 and May 2017 for lateral skull base pathology involved petrous ICA using technique combined IFA and pre-reconstruction, were reviewed. Results: Among the five patients, three were paraganglioma of head and neck, one was carotid aneurysms, and one was recurrent adenoid cystic carcinoma (ACC). The median tumor size in the largest cross-section was 60 mm × 51 mm (range, 28 mm × 22 mm-72 mm × 58 mm). Complete excision was achieved with IFA and ICA reconstruction. The median blood loss volume was 1 000 ml (range, 600-2 500 ml). Four cases showed no new long-term neurologic sequelae, while one showed hemiplegia due to graft vessel occlusion. Except for the one with ACC having facial nerve cut, others achieved good facial nerve function of HB grade Ⅰ to Ⅱ during 3 to 12 months, follow-up. No tumor recurrence was observed over the median duration of follow-up for above 36 months (range, 36-58 months). Conclusion: For lesions involved superior part of ICA, which is unable to separate from ICA, IFA and ICA reconstruction can achieve complete excision.

612 Uterus Transplantation: An Overview

Abstract Introduction Uterine transplantation (UTx) allows women with abnormal uterine factor infertility (AUFI) to have their own biological children. UTx use both living and deceased donations (LD and DD), and once transplanted, embryos fertilised through IVF are implanted. The aims of this review are to summarise the history of UTx and discuss the ethical issues surrounding immunosuppression and living donations for a ‘life enhancing’ transplant. Method Data on UTx, clinical trials and resulting births was found by conducting a literature search on PubMed and other medical databases. Additionally, newspaper articles, institutional press releases and conference proceedings were used as some of the data is yet to be published. Results 72 UTx have been performed which have resulted in 29 live births. The first LD UTx was performed in 2000 but was removed due to graft thrombosis. The first live births from LD and DD UTx were achieved in 2014 and 2017 respectively. Conclusions Live births provide proofs of concept of UTx. Graft rejection, vessel thrombosis and infection are amongst reasons for graft failure. Development of an international registry for UTx is important to monitor the progress of all transplants in the long term to determine its medical and ethical feasibility as a treatment for AUFI.

Effect of Vessel Tortuosity on Stress Concentration at the Distal Stent-Vessel Interface: Possible Link With New Entry Formation Through Biomechanical Simulation.

A computational approach is used to investigate potential risk factors for distal stent graft-induced new entry (dSINE) in aortic dissection (AD) patients. Patient-specific simulations were performed based on computed tomography images acquired from six AD patients (three dSINE and three non-dSINE) to analyze the correlation between anatomical characteristics and stress/strain distributions. Sensitivity analysis was carried out using idealized models to independently assess the effect of stent graft length, stent tortuosity and wedge apposition angle at the landing zone on key biomechanical variables. Mismatch of biomechanical properties between the stented and nonstented regions led to high stress at the distal stent graft-vessel interface in all patients, as well as shear strain in the neighboring region, which coincides with the location of tear formation. Stress was observed to increase with the increase of stent tortuosity (from 263 kPa at a tortuosity angle of 50 deg to 313 kPa at 30 deg). It was further amplified by stent graft landing at the inflection point of a curve. Malapposition of the stent graft led to an asymmetrical segment within the aorta, therefore changing the location and magnitude of the maximum von Mises stress substantially (up to +25.9% with a +25 deg change in the distal wedge apposition angle). In conclusion, stent tortuosity and wedge apposition angle serve as important risk predictors for dSINE formation in AD patients.

Treg cells in atherosclerosis.

Atherosclerosis involves both innate and adaptive immunity. Here, we provide an overview of the role of regulatory T (Treg) cells in atherosclerotic diseases. Treg cells and their inhibitory cytokines, IL-10 and TGF-β, have been identified in atherosclerotic lesions and to inhibit progression through lipoprotein metabolism modulation. Treg cells have also been found to convert to T follicular helper (Tfh) cells and promote atherosclerosis progression. Treg cell involvement in different stages of atherosclerotic progression and Treg cell-mediated modulation of plaque development occurs via inflammation suppression and atheroma formation has been focused. Moreover, existing knowledge suggests that Treg cells are likely involved in the pathology of other specific circumstances including in-stent restenosis, neointimal hyperplasia, vessel graft failure, and ischemic arterial injury; however, there remain gaps regarding their specific contribution. Hence, advancements in the knowledge regarding Treg cells in diverse aspects of atherosclerosis offer translational significance for the management of atherosclerosis and associated diseases.

In-hospital outcomes and usage of embolic protection devices in percutaneous coronary intervention for coronary artery bypass grafts: Insights from a Japanese nationwide registry.

We evaluated the in-hospital outcomes of percutaneous coronary intervention (PCI) for bypass graft vessels (GV-PCI) compared with those of PCI for native vessels (NV-PCI) using data from the Japanese nationwide coronary intervention registry. We included PCI patients (N=748,229) registered between January 2016 and December 2018 from 1,123 centers. We divided patients into three groups: GV-PCI (n=2,745); NV-PCI with a prior coronary artery bypass graft (pCABG) (n=23,932); and NV-PCI without pCABG (n=721,552). GV-PCI implementation was low, and most cases of PCI in pCABG patients were performed in native vessels (89.7%) in contemporary Japanese practice. The risk profile of patients with pCABG was higher than that of those without pCABG. Consequently, GV-PCI patients had a significantly higher in-hospital mortality than NV-PCI patients without pCABG after adjusting for covariates (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.66-3.36, p < .001). Of note, embolic protection devices (EPDs) were used in 18% (n=383) of PCIs for saphenous vein grafts (SVG-PCI) with a significant variation in its use among institutions (number of PCI: hospitals that had never used an EPD vs. EPD used one or more times=240 vs. 345, p < .001). The EPDs used in the SVG-PCI group had a significantly lower prevalence of the slow-flow phenomenon after adjusting for covariates (OR 0.45, 95% CI 0.21-0.91, p=.04). GV-PCI is associated with an increased risk of in-hospital mortality. EDP use in SVG-PCI was associated with a low rate of the slow-flow phenomenon. The usage of EPDs during SVG-PCI is low, with a significant variation among institutions.

Development of Multi-layer Tubular Vascular Scaffold to Enhance Compliance by Exhibiting a Negative Poisson’s Ratio

Synthetic small diameter vascular grafts frequently fail owing to intimal hyperplasia, results from mismatched compliance between the vascular graft and native vessels. A vascular graft with a negative Poisson's ratio (NPR, materials expand transversely when pulled axially) was suggested to enhance compliance. We produced a three-layer tubular vascular scaffold with NRP properties. The luminal side consisted of nanosized electrospun fibers for endothelial cell (EC) growth. The middle layer was an NPR structure created using 3D printing, and the outer layer was a microsized electrospun fiber layer for vascular smooth muscle cell (VSMC) growth. The developed multi-layer tubular vascular scaffold contained NPR value. And the NPR vascular scaffold showed 1.7 time higher compliance than the PPR scaffold and 3.8 times higher than that of commercial polytetrafluoroethylene (PTFE) vascular graft. In addition, the ECs and VSMCs were well survived and proliferated on the scaffold during 10 days of culture. From the optimized co-culture condition of the VSMCs and ECs that VSMC phenotype changed was inhibited, we successfully generated a thin luminal layer, which consisted of ECs and the proper thickness of the VSMC layer under the ECs. This scaffold may have a potential to replace conventional artificial vascular graft by providing enhanced compliance and improved cell culture environment.

When 7 times angioplasty on Saphenous Vein graft would not compete the Native vessel Percutaneous Coronary intervention

Coronary artery bypass graft (CABG) has been the first option for revascularization in multiple vessel coronary artery disease. One of the most major obstacles after CABGs is atherosclerotic changes of SVGand more than 50 percent ofSVGare occluded at 10 years and 25 percent show severe stenosis at angiographic follow-up. Whether native vessel percutaneous coronary intervention (PCI) on native vessel or saphenous vein graft intervention is of benefit in these patients is still a debate. In this case report we want to clarify a common clinical scenario in a patient with prior CABG seven years ago which a proper decision in the right time could save many futile efforts. The patient underwent 7 PCI on the diseased SVG on OM with frequent occlusion due to stent thrombosis and in-stent restenosis which finally native vessel antegrade CTO PCI alleviated the problem and patient followed up 2 months after the procedure without any chest pain in his ordinary activities.

Successful Implantation of Impella 5.5 Device and Subsequent Recovery in a Pediatric Patient with Small Arterial Vessels

Introduction The Impella 5.5® with SmartAssist System® has short term use (≤14 days) approval for cardiogenic shock. The largest diameter of the device is the 19 Fr pump motor (∼6.33 mm). We discuss a case of successful implantation, wean and explantation in a child with arterial vessels measuring smaller than the pump motor. Case Report A previously healthy 11 year old male presented with severe systolic dysfunction, ventricular arrhythmias and progression to cardiac arrest. Initial left ventricular ejection fraction (LVEF) was 27%. Femoral veno-arterial ECMO support was initiated. Endomyocardial biopsy was negative for myocarditis. He was transitioned to Impella 5.5® as a bridge to decision/recovery after 4 days of support. Pre-implant ultrasound showed the right subclavian artery measured 4.8 mm x 5.1 mm, smaller than the recommended 7 mm for adult implantation of Impella 5.5®. Despite this the 5.5 was implanted due to increased device longevity versus the smaller Impella CP®. A 10 mm diameter graft was anastomosed to the axillary artery and tunneled with an exit site lateral to the pectoralis major. Gentle pressure and external manipulation of the axillary artery allowed stepwise advancement and placement without complication, despite some resistance at the graft vessel junction. Device performed as expected at 4.5 liters on P8. The patient was extubated POD 4 and placed on oral cardiac remodeling and antiarrhythmic therapies with ongoing nutritional support and cardiac rehabilitation. Complications included access site bleeding, wound dehiscence requiring wound VAC and revised surgical closure. He improved over several weeks and tolerated weaning of support. The device developed low purge flow and high purge pressures, despite TPA per protocol, and was explanted POD 29. Post explant, he completed a 4 week antibiotic course for S. epidermidis bacteremia. He underwent subcutaneous ICD implant for gene-negative long QT syndrome and was discharged 2 months after presentation with an LVEF of 51%. Summary The Impella 5.5 can be used in a child with small arterial vessels and expected recoverable cardiac function, avoiding a sternotomy and ventriculotomy, and allowing for recovery and discharge to home.

Establishing a Robot-Assisted Kidney Transplant Program: Independent Evaluation of the Learning Curve and Surgical Nuances

Background Robot assisted kidney transplantation is a technically challenging procedure and there has been limited reporting of its learning curve, mostly by a single surgical working group. The aim of the current study was to perform an independent analysis of learning curve and describe our modifications in technique of robot assisted kidney transplant. Materials and methods All consecutive cases performed at our center from April 2016 till March 2020 were reviewed. Learning curve was analyzed using cumulative summation method for total anastomosis time (technical outcome) and serum creatinine at day seven and 30 (functional outcome). Patient safety was assessed using Shewhart control charts and comparison of safety outcomes before and after achieving learning curve was done using Chi square or Fischer exact test as appropriate. Descriptive review of technical modifications made during our experience was given. Results Ninety patients underwent robot assisted renal transplant during study period. Learning curve was crossed at 24 cases (total anastomosis time) and 15-25 cases (serum creatinine). Shewhart control charts showed that total anastomosis time remained below alert/alarm line in 94.4%/98.9% cases with alert line being crossed significantly greater number of times before the learning curve. Serum creatinine values remained below alert/alarm line in 85.5%/90% cases at day seven and 92.2%/96.7% cases at day 30 with no difference made due to learning curve. Key technical modifications included arterial and ureteric spatulation at bench, use of polypropylene 5-0 holding stitch in graft vessels to facilitate intra-operative handling, keeping anterior arterial wall smaller to visualize posterior arterial wall anastomosis and leaving small amount of fatty tissue on supero-lateral surface of kidney for handling after jacket removal. Conclusion Our learning curve of robot assisted kidney transplant was crossed at 24 cases (technical outcome) and 15-25 cases (functional outcome). We have also detailed valuable technical modifications in the procedure.

Interventions for preventing thrombosis in solid organ transplant recipients.

Interventions for preventing thrombosis in solid organ transplant recipients.

The early and midterm results of coronary endarterectomy combined with coronary artery bypass grafting for diffuse coronary artery stenosis

Objective: To examine the early and mid-term results of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) in the treatment of diffuse coronary artery stenosis. Methods: The clinical data and follow-up results of 248 patients who underwent CE+CABG surgery from January 2010 to January 2019 at Department of Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University was analyzed retrospectively. There were 201 males and 47 females, aged (65.6±8.5) years (range: 43 to 79 years). The on-pump group included 156 patients and the off-pump group included 92 patients. CABG was performed after CE. CE was performed on 248 patients who represented 269 target coronary lesions, of which 108 were located on the left anterior descending artery and sub-branches, 140 were located on the right coronary artery and sub-branches, and 21 were located on the left circumflex artery and obtuse marginal artery. A total of 872 bypass grafts were performed, including 248 left internal thoracic arteries, 48 radial arteries, and 576 great saphenous veins, with (3.5±0.8) grafts (range:2 to 6 grafts) per patient.The grafts had satisfactory bridge blood flow after CE, with the graft flow rates of (26±8) ml/min (range: 13 to 59 ml/min) and the pulsatility index value of 3.1±0.8 (range: 2.0 to 6.7). The t test and χ2 test was used to compare the surgical results and graft patency rate between patients in on-pump and off-pump group, respectively. Results: The number of graft vessels of on-pump group and off-pump group was 3.6±0.9 and 3.2±0.7, respectively(t=1.637, P=0.085). There were 3 deaths during the perioperative period, with a mortality rate of 1.2%. Two people died of renal failure, and one case was due to postoperative refractory low cardiac output. Perioperative myocardial infarction occurred in 9 cases. The follow-up time was (41.8±21.4) months (range:1 to 68 months). The all graft patency rate was 78.4%(812/232) in 1 year and 69.8%(162/232) in 3 years postoperatively. The left coronary graft patency rate was significantly higher than the right coronary graft patency rate(1-year: 87.4% vs.73.1%, χ²=6.533, P=0.011, 3-year: 78.2% vs. 64.8%, χ²=4.588, P=0.032). There was no significant difference in graft patency rates between the on-pump group and off-pump group (1-year: 80.0% vs. 76.9%, χ²=0.277, P=0.599, 3-year:71.5% vs. 67.9%, χ²=0.300, P=0.584). Conclusions: CE+CABG is a safe and feasible technique for patients with diffuse coronary artery disease to get more satisfied complete revascularization, with good early and medium-term results and graft patency rates. The outcomes of on-pump or off-pump CE+CABG are similar.

Surgical treatment for anomalous origin of the right coronary artery from the pulmonary artery: a case report with five-year follow-up

BackgroundAnomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital heart disease affecting about 0.002% of the population. Knowledge of ARCAPA is almost collected from case reports. The aim of this study was to provide a rare case to better understand this rare congenital coronary anomaly.Case presentationWe report a rare case of an 18-year-old male who was initially referred because of heart murmur. Dilated and tortuous coronary arteries were detected by echocardiography and congenital coronary anomaly was suggested. Further coronary CT angiography confirmed the diagnosis of ARCAPA. Although dual coronary system provides favorable long-term outcome, bypass surgery was considered technically difficult due to the huge mismatch of caliber between the right coronary artery and graft vessels. Eventually, simple right coronary artery ligation was performed. The patient was followed up for about 5 years without evidence of atherosclerosis or myocardial ischemia.ConclusionsARCAPA presents as a rare congenital heart disease with variable clinical manifestations. Surgical treatment is highly recommended to re-establish dual coronary system and prevent further complications. To our best knowledge, only about 200 cases of ARCAPA has been reported.

Feasibility Assessment in Animal Models for Peritoneum Use as Interposition Vessel Graft Substitutes during Living Donor Liver Transplantation

Purpose: Most of the grafts used as interposition conduits for the middle hepatic vein (MHV) in living donor liver transplantation (LDLT) have been allografts and autografts. Recently, peritoneum has been used for vessel substitutes during surgery. Thus, we performed animal lab tests to assess the feasibility of interposition vessel graft substitutes for MHV.

Study of the expression of genes associated with post-translational changes in histones in the internal thoracic artery and the saphenous vein grafts used in coronary artery bypass grafting procedure

Abstract Coronary artery disease (CAD) is one of the leading causes of mortality in the world. The most advanced forms of CAD are usually treated by means of coronary artery bypass grafting (CABG). The selection of the appropriate vessels as aortocoronary conduits is of paramount importance. The internal thoracic artery (ITA) or the great saphenous vein (SV) are often harvested. Furthermore, epigenetic processes have been recently associated with atherosclerosis, hypertension, and heart failure, and post-translational histone processes may play a key role in understanding the genetic predisposition of vessels to vascular diseases. In the experiment performed, the transcript levels of JHDM1D, PHF8, and HDAC 1-3 in SV and ITA used for CABG procedures with RT-qPCR were examined. Total RNA was isolated by the method of Chomczyński and Sachi. RNA samples were reverse transcribed into cDNA using a commercial kit. The determination of the level of the transcripts of the mentioned genes was performed using the Light Cycler® 96 Real-Time PCR kit. Our analyzes confirmed that the studied genes related to post-translational modifications of histones are expressed in SV and ITA. In the saphenous vein, the expression of each of the individual genes was higher. The most considerable difference in transcript levels was recorded for HDAC1 and the smallest difference in expression for HDAC2. Our research suggests that more processes related to histone demethylation and acetylation occur in the saphenous vein, which may affect the selection of a vessel for CABG, but this research requires more research and additional analysis. Running title: Histone regulating gene expression in common coronary artery bypass graft vessels

The effect of the number of vessel grafts used in coronary artery bypass grafting surgery to short-term mortality

Purpose: The study aimed to share the short-term mortality rates of coronary artery bypass grafting (CABG) experience in a private hospital and to evaluate parameters affecting the clinical outputs following the CABG who were divided according to the number of vessel graft.&#x0D; Materials and Methods: The study is a longitudinal-term observational clinical study, with a patient follow-up period of 7 years in Turkey. We analyzed 3027 cases with outcomes and short-term mortality according to the number of vessel grafts that we used as 1 (n:608), 2-3 (n:1359), and four or more (n:1060) grafts.&#x0D; Results: The short-term mortality was found as 1.1% (36/3027) in all the patients. The male population was the highest in the group with the highest number of vascular grafts and its percentage to females was correlated with vessel grafts that we performed. Mean aortic cross-clamp time was 36.6±17.2 minutes, while bypass time was 66.4±21 minutes. The mean number of vessels revascularized was 3.17±0.9 (1-7). The amount of drainage was 419±286 ml. The period of intensive care was 1.2±1.1 days, while the hospital period was 5.2±1.5days. In comparison according to the number of vascular grafts, positive inotrope agent, drainage, blood supply, cross-clamp and pump period showed significant difference.&#x0D; Conclusion: The number of vessel grafts was related to clinical outputs of CABG operations and Our CABG in the private hospital reached the short-term mortality rates that were below the averages of Turkey and international operations.

Anatomical Study of the Descending Branch of the Lateral Femoral Circumflex Artery and Veins in Vascular Grafting in Japanese Cadavers.

Background:In microsurgery development, autologous vein grafting is necessary when there are no suitable blood vessels for anastomosis around the flap recipient site or when the vascular pedicle of the flap is short. The descending branches of the lateral femoral circumflex artery (LFCA) and vein have been used as a vascular bundle instead of vein grafts, but to our knowledge, there have been no reports on the relationship between thigh length and vessel length. In this study, we performed a macroscopic examination of the LFCA descending branch length required for grafting.Methods:The length of the LFCA descending branches and veins as well as thigh length were measured in 16 preserved cadaveric legs.Results:The average length of the thigh was 42.6 cm. It was possible to harvest a mean length of 14.2 cm of the descending branches of the lateral femoral circumflex vessels. Descending branches of the LFCA and veins were identified in all cases. It was estimated that the length of the LFCA descending branch and veins could be collected in 20% of the thigh length in 98% of cases.Conclusion:When preparing a preoperative plan, it is important to thoroughly consider the required length of blood vessels for grafting and whether it is possible to harvest vessels with sufficient length.

Reconstruction of the middle hepatic vein using a vein graft from the resected portion of the liver

BackgroundThe middle hepatic veins are often infiltrated by intrahepatic cholangiocarcinoma. Reconstruction of the hepatic vein plays a critical role in preserving more of the residual liver volume and reducing the risk of postoperative liver failure in extreme hepatectomy. We here report a novel way to reconstruct middle hepatic vein by using vessel grafts from wasted liver.Case presentationCase 1: A 64-year-old man was diagnosed with intrahepatic cholangiocarcinoma. The bifurcation and left branch of the portal vein were stenosed, and the root of the middle hepatic vein was infiltrated by the tumor. An extended left hepatectomy was performed, the portal vein was resected and reconstructed, and the middle hepatic vein was reconstructed by anastomosing the proximal left hepatic vein to the distal middle hepatic vein. Case 2: A 69-year-old woman was diagnosed with intrahepatic cholangiocarcinoma. The tumor was located in the left lobe of the liver and the left and middle hepatic veins were infiltrated by the tumor. An extended left hepatectomy was performed, and the left portal vein was used as a vein graft to reconstruct the middle hepatic vein. Both of the two patients’ postoperative ultrasound showed vessel graft patency.ConclusionUsing a vein graft from the resected portion of the liver to reconstruct the middle hepatic vein was a useful technique and showed good result.

Preparation of PU/Fibrin Vascular Scaffold with Good Biomechanical Properties and Evaluation of Its Performance in vitro and in vivo.

PurposeThe development of tissue-engineered blood vessels provides a new source of donors for coronary artery bypass grafting and peripheral blood vessel transplantation. Fibrin fiber has good biocompatibility and is an ideal tissue engineering vascular scaffold, but its mechanical property needs improvement.MethodsWe mixed polyurethane (PU) and fibrin to prepare the PU/fibrin vascular scaffolds by using electrospinning technology in order to enhance the mechanical properties of fibrin scaffold. We investigated the morphological, mechanical strength, hydrophilicity, degradation, blood and cell compatibility of PU/fibrin (0:100), PU/fibrin (5:95), PU/fibrin (15:85) and PU/fibrin (25:75) vascular scaffolds. Based on the results in vitro, PU/fibrin (15:85) was selected for transplantation in vivo to repair vascular defects, and the extracellular matrix formation, vascular remodeling, and immune response were evaluated.ResultsThe results indicated that the fiber diameter of the PU/fibrin (15:85) scaffold was about 712nm. With the increase of PU content, the mechanical strength of the composite scaffolds increased, however, the degradation rate decreased gradually. The PU/fibrin scaffold showed good hydrophilicity and hemocompatibility. PU/fibrin (15:85) vascular scaffold could promote the adhesion and proliferation of mesenchymal stromal cells (MSCs). Quantitative RT-PCR experimental results showed that the expression of collagen, survivin and vimentin genes in PU/fibrin (15:85) was higher than that in PU/fibrin (25:75). The results in vivo indicated the mechanical properties and compliance of PU/fibrin grafts could meet clinical requirements and the proportion of thrombosis or occlusion was significantly lower. The graft showed strong vasomotor response, and the smooth muscle cells, endothelial cells, and ECM deposition of the neoartery were comparable to that of native artery after 3 months. At 3 months, the amount of macrophages in PU/fibrin grafts was significantly lower, and the secretion of pro-inflammatory and anti-inflammatory cytokines decreased.ConclusionPU/fibrin (15:85) vascular scaffolds had great potential to be used as small-diameter tissue engineering blood vessels.