Cold-Stored Venous Allografts In Different Preserving Solutions: A Study On Changes In Vein Wall Morphology.

BACKGROUND:: The saphenous vein is the most frequently used bypass conduit for vascular reconstructions, which may need to be stored for a prolonged time. The aim of this study was to compare the effect of different preservation solutions on the morphology of saphenous veins during the long-term cold storage. DESIGN:: An in vitro study. MATERIAL AND METHODS:: Saphenous vein samples, collected from 29 patients undergoing varicose vein surgery, were stored at +4°C in (1) 10% formalin, (2) isotonic saline with heparin and antibiotic, (3) phosphate-buffered saline, (4) 2.5% glutaraldehyde + phosphate-buffered saline, and (5) Custodiol (histidine-tryptophan-ketoglutarate). Changes in the vein wall were histologically investigated up to day 35. Possible retention of the capacity of endothelial function was evaluated by immunohistochemical detection of endothelial nitric oxide synthase. RESULTS:: Formalin as the control medium well preserved the vein wall morphology, but endothelial nitric oxide synthase immunostaining was very weak. Phosphate-buffered saline and isotonic saline with heparin and antibiotic poorly preserved vein wall morphology. Phosphate-buffered saline endothelial nitric oxide synthase staining decreased dramatically throughout the study period. Compared to phosphate-buffered saline, stronger isotonic saline with heparin and antibiotic endothelial nitric oxide synthase staining was noted at day 35 (p < 0.001). Custodiol and glutaraldehyde better preserved vein morphology compared to ISHA and PBS at day 5 and later (p < 0.001), but compared to stronger isotonic saline with heparin and antibiotic their endothelial nitric oxide synthase staining was weaker. CONCLUSION:: In terms of preserving the morphology of saphenous veins, phosphate-buffered saline and isotonic saline with heparin and antibiotic were the poorest, while Custodiol and glutaraldehyde were the best. Demonstrating good retention of endothelial nitric oxide synthase staining throughout the study period, isotonic saline with heparin and antibiotic seems to have the best potential to retain vein wall functionality, despite relatively poor morphological preservation.

Mortality After Elective and Ruptured Abdominal Aortic Aneurysm Surgical Repair: 12-Year Single-Center Experience of Estonia.

BACKGROUND AND AIMS: Abdominal aortic aneurysm is a degenerative vascular pathology with high mortality due to its rupture, which is why timely treatment is crucial. The current single-center retrospective study was undertaken to analyze short- and long-term all-cause mortality after operative treatment of abdominal aortic aneurysm and to examine the factors that influence outcome. MATERIAL AND METHODS: The data of all abdominal aortic aneurysm patients treated with open repair or endovascular aneurysm repair in 2004-2015 were retrospectively retrieved from the clinical database of Tartu University Hospital. The primary endpoint was 30-day, 90-day, and 5-year all-cause mortality. The secondary endpoint was determination of the risk factors for mortality. RESULTS AND CONCLUSION: Elective abdominal aortic aneurysm repair was performed on 228 patients (mean age 71.8 years), of whom 178 (78%) were treated with open repair and 50 (22%) with endovascular aneurysm repair. A total of 48 patients with ruptured abdominal aortic aneurysm were treated with open repair (mean age 73.8 years) at the Department of Vascular Surgery, Tartu University Hospital, Estonia. Mean follow-up period was 4.2 ± 3.3 years. In patients with elective abdominal aortic aneurysm, 30-day, 90-day, and 5-year all-cause mortality rates were 0.9%, 2.6%, and 32%, respectively. In multivariate analysis, the main predictors for 5-year mortality were preoperative creatinine value and age (p < 0.05). In patients with ruptured abdominal aortic aneurysm, 30-day, 90-day, and 5-year all-cause mortality rates were 22.9%, 33.3%, and 55.1%, respectively. In multivariate analysis, the risk factors for 30-day mortality in ruptured abdominal aortic aneurysm were perioperative hemoglobin and lactate levels (p < 0.05). According to this study, the all-cause mortality rates of elective abdominal aortic aneurysm and ruptured abdominal aortic aneurysm at our hospital were comparable to those at other centers worldwide. Even though some variables were identified as potential predictors of survival, the mortality rates after ruptured abdominal aortic aneurysm remain high. Early diagnosis, timely treatment, and detection of the risk factors for abdominal aortic aneurysm progression would improve survival in patients with abdominal aortic aneurysm.

Inverse relations of serum phosphatidylcholines and lysophosphatidylcholines with vascular damage and heart rate in patients with atherosclerosis.

BACKGROUND AND AIMS: The rapidly growing discipline of lipidomics allows the study of a wide spectrum of lipid species in body fluids and provides new insights into the pathogenesis of cardiovascular disease. We investigated serum phosphatidylcholine (PC) and lysophosphatidylcholine (lysoPC) species in relation to arterial stiffness, hemodynamics, and endothelial dysfunction in symptomatic patients with atherosclerosis and in healthy controls. METHODS AND RESULTS: Thirty-two patients with peripheral arterial disease (age 61.7 ± 9.0 years), 52 patients with coronary artery disease (age 63.2 ± 9.2 years), and 40 apparently healthy controls (age 60.3 ± 7.1 years) were studied. Serum levels of 90 glycerophospholipids were determined with the AbsoluteIDQ™ p180 kit (BIOCRATES Life Sciences AG, Innsbruck, Austria). The technique of applanation tonometry was used for non-invasive pulse wave analysis and carotid-femoral pulse wave velocity (cf-PWV) assessment. Decreased serum levels of several individual PC and lysoPC species (e.g., PC aa C28:1, PC aa C30:0, PC aa C32:2, PC ae C30:0 and PC ae C34:2, lysoPC a C18:2) were observed for the patient groups in comparison to the healthy subjects. In addition, a considerable number of PCs and lysoPCs were inversely related to either cf-PWV, heart rate, asymmetric dimethylarginine (ADMA) or ADMA/arginine for patients with symptomatic atherosclerosis but not for the controls. CONCLUSION: We found altered relationships between PC and lysoPC profiles, inflammation, and arterial function in atherosclerotic patients, compared to healthy subjects.

Prognostic impact of arterial stiffness in patients with symptomatic peripheral arterial disease.

OBJECTIVES: Arterial stiffness (AS) is increasingly recognized as an independent risk factor in different high-risk populations. Whether changes in AS can predict prognosis in patients with symptomatic peripheral arterial disease (PAD) has never been investigated. The aim of the present study was to test the hypothesis that AS is an independent predictor of all-cause and cardiovascular disease (CVD) mortality in patients with symptomatic PAD. METHODS: A cohort of 117 symptomatic PAD patients (aged 62.3 ± 7.7 years) were prospectively recruited from the Department of Vascular Surgery, Tartu University Hospital, between 2002 and 2010. The AS was measured using pulse wave analysis and assessment of pulse wave velocity (PWV). RESULTS: During the follow-up period (mean 4.1 ± 2.2 years) there were 32 fatal events. Kaplan-Meier analysis showed that the probability of all-cause and CVD mortality decreased with increasing small artery elasticity (SAE), as estimated by the log-rank test (p = .004; p = .005, respectively). By contrast, large artery elasticity, augmentation index, and aortic and brachial PWV were not significantly related to mortality. In a Cox proportional hazard model, SAE above the median was associated with decreased all-cause and CVD mortality after adjustment for confounding factors: relative risk (RR), 0.37; 95% confidence interval (CI), 0.17-0.81; p = .01; RR, 0.11; 95% CI, 0.01-0.86; p = .04, respectively). CONCLUSIONS: This study provides the first evidence, obtained from an observational study, that decreased small artery elasticity is an independent predictor of all-cause and CVD mortality in patients with symptomatic PAD.

Aortic stiffness and vitamin D are independent markers of aortic calcification in patients with peripheral arterial disease and in healthy subjects.

OBJECTIVE: Arterial stiffness is a significant determinant of cardiovascular risk and is related to vascular calcification. Vitamin D may regulate arterial calcification and has been associated with cardiovascular survival benefits. However, data about the relationship between arterial stiffness, aortic calcification and vitamin D levels in patients with peripheral arterial disease (PAD) and in healthy subjects are limited. We examined the potential association between aortic calcification, arterial stiffness and vitamin D levels in patients with symptomatic PAD and in healthy individuals. METHODS: We studied 78 men with PAD (aged 63 ± 7 years) and 74 healthy men (aged 61 ± 10 years). Aortic pulse wave velocity (aPWV) was determined by applanation tonometry using the Sphygmocor device. Aortic calcification score (ACS) was quantified by computed tomography. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured using a radioimmune assay. RESULTS: ACS (4.9(2.3-8.9) vs. 0.2(0.03-1.6) (cm³); p < 0.01), aPWV (9.8 ± 2.4 vs. 8.2 ± 1.6 (m s⁻¹; p < 0.01) and 25(OH)D (15.1 ± 5.4 vs. 19.0 ± 5.9 (ng ml⁻¹); p < 0.01) were different in the patients compared with the controls. In multivariate analysis, ACS was independently determined by 25(OH)D, aPWV, calcium and age in patients with PAD (R² = 0.49; p < 0.001) and by 25(OH)D, aPWV, cholesterol/high-density lipoprotein (HDL) and age in the control group (R² = 0.55; p < 0.001). Increased aPWV and lower levels of 25(OH)D were associated with decreased ankle-brachial pressure index (p = 0.03). CONCLUSION: These results indicate that calcification of the aorta is independently associated with aortic stiffness and serum 25(OH)D level in patients with PAD and in healthy subjects. Aortic stiffness and abnormal vitamin D level may contribute to vascular calcification and are related to higher severity grade of atherosclerotic disease.

Age-related changes in apoptosis and expressions of intercellular adhesion molecule-1 and vascular endothelial growth factor receptor type 2 in the wall of varicose veins.

AIM: Dysregulated apoptosis in the venous wall is believed to play important role in the onset and progression of human primary varicose veins. The aim of our study was to in situ investigate the apoptosis of endothelial cells (EC) and smooth muscle cells (SMC) together with the expression of intercellular adhesion molecule-1 (ICAM-1) and vascular endothelial growth factor receptor type 2 (VEGF R2) in the varicose veins of women of different age groups. METHODS: Women (n=34) undergoing surgery for varicosities were divided into three groups: Group I (younger than 35 year); Group II (36-50 years); Group III (older than 50 years). Apoptotic EC and SMC were determined by the TUNEL method. ICAM-1 and VEGF R2 were detected immunohistochemically in the endothelium, the subendothelial layer, the media and the adventitia. RESULTS: The number of apoptotic EC and SMC rose in the group of older patients (Group III vs Group I; P<0.01 and P<0.05, respectively). In the same group ICAM-1 immunostaining was increased in the endothelium, but decreased in the media and the adventitia, while VEGF R2 staining was increased in the endothelium, the subendothelial layer and the media, but decreased in the adventitia. CONCLUSION: In conclusion, our study demonstrated that apoptosis of EC and SMC increase in varicose veins with advancing age and age-related differences exist also in the expression of ICAM-1 and VEGF R2 in the wall of varicose veins of women.

Ten years experience of treating aorto-femoral bypass graft infection with venous allografts.

OBJECTIVE: The aim of the present study was to analyze our results of treating synthetic vascular graft infection in the aorto-femoral segment with venous allografts. PATIENTS AND METHODS: During 1997-2006 we treated 11 male patients with venous allografts for aorto-femoral segment prosthetic graft infection. Patients were followed postoperatively with patency assessment based on Doppler ultrasonography. RESULTS: The mean interval between the implantation of the synthetic vascular graft and the appearance of infection was 43+/-29 months (range 5 months-10 years). Overall primary patency of the venous allograft was 100%, 88% and 66% at 1, 6 and 36 months, respectively. Secondary patency rates of the venous allograft were 94% and 73% after 5 and 8 years, respectively. Overall survival rate was 100%, 64%, 46% and 27% after one month, 3, 5 and 8 years, respectively. Limb salvage rate was 100%, 94% and 73% after 1 month, 5 and 8 years, respectively. CONCLUSIONS: The use of in situ venous allograft for the treatment of synthetic graft infection in the aorto-femoral segment has led to favourable short- and long-term results.

Venous allografts for infrainguinal vascular bypass.

Between 1978 and 1993, 107 patients received venous allografts for infrainguinal revascularization because autogenous material was unavailable. These operations comprised 7.4% of 1442 reversed vein bypass procedures performed during the same period. Alloveins were harvested during varicose vein stripping and stored up to 10 days in saline solution containing heparin and antibiotics. Veins with or without minimal degenerative changes were used and when necessary segments were sutured end-to-end to obtain a convenient length. The patients comprised 95 men and 12 women of age range 44-87 years. All operations were performed for limb salvage (rest pain and gangrene); 40 femoropopliteal and 67 femorocrural bypasses were performed; 66 were primary reconstructions and 41 secondary reconstructions. The operative mortality rate was 3.7%. Early thrombosis occurred in 18 patients (16.8%), nine of whom were successfully reoperated upon. The cumulative patency rates for all bypass operations was 82.9%, 38.7% and 21.3% at 30 days, 3 and 5 years, respectively, the limb salvage rates being 84.8%, 48.0% and 29.2%, respectively. Allografts may have a place in lower-limb bypass surgery in the absence of veins, polytetrafluoroethylene or human umbilical vein.