Topical VEGF enhances healing of thoracic aortic anastomosis for coarctation in a rabbit model.
BACKGROUND
Recurrent stenosis after extended end-to-end anastomosis for aortic coarctation is the primary indication for further interventions in children. Tension because of the extended resection and local arterial wall hypoxia are possible pathogenetic mechanisms. We hypothesized that (1) tension interferes with healing and (2) that vascular endothelial growth factor (VEGF), a hypoxia sensitive angiogenic inducer, may enhance healing of the vascular anastomosis.


RESULTS
In a model of coarctation repair, rabbits underwent thoracic aortic end-to-end anastomosis after transection (no-tension; n=15), resection of an aortic ring (tension; n=14) or resection and topical VEGF treatment (0.75 microg VEGF165; tension+VEGF; n=14). Gross and histologic characteristics of the aortic wall were assessed at 1 week, 1 and 2 months. In the tension only group at 1 month, the severity of vascular remodeling was increased with fibrosis and calcification compared with controls. At 2 months, this group also revealed more luminal stenosis (29% versus 19%; P<0.001). Exogenous VEGF resulted in significantly less fibrosis, calcification and chondroid metaplasia at 1 month (P<0.05) and luminal area was only reduced 3% at 2 months (P<0.001 versus tension group).


CONCLUSIONS
In a rabbit model of coarctation repair, the addition of tension on the vascular anastomosis resulted in poor healing and luminal stenosis. Topical VEGF maintained luminal integrity by decreasing fibrosis and calcification. These findings suggest that topical VEGF may be a promising new strategy to enhance healing and improve the outcome of vascular anastomoses for coarctation of the aorta.
Seipelt
Ralf G
RG
Division of Pediatric Cardiovascular Thoracic Surgery, Children's Memorial Hospital, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60614, USA.
Backer
Carl L
CL
Mavroudis
Constantine
C
Stellmach
Veronica
V
Seipelt
Ingrid M
IM
Cornwell
Mona
M
Hernandez
Jose
J
Crawford
Susan E
SE
D000287:Administration, Topical; D000714:Anastomosis, Surgical; D000818:Animals; D001013:Aorta, Thoracic / Q000601:surgery*; D001017:Aortic Coarctation / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic / Q000517:prevention & control; D016228:Endothelial Growth Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D036341:Intercellular Signaling Peptides and Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D008222:Lymphokines / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D011817:Rabbits; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D014945:Wound Healing
D016228:Endothelial Growth Factors; D036341:Intercellular Signaling Peptides and Proteins; D008222:Lymphokines; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors