title: Procedure for human saphenous veins ex vivo perfusion and external reinforcement.
abstract: The mainstay of contemporary therapies for extensive occlusive arterial disease is venous bypass graft. However, its durability is threatened by intimal hyperplasia (IH) that eventually leads to vessel occlusion and graft failure. Mechanical forces, particularly low shear stress and high wall tension, are thought to initiate and to sustain these cellular and molecular changes, but their exact contribution remains to be unraveled. To selectively evaluate the role of pressure and shear stress on the biology of IH, an ex vivo perfusion system (EVPS) was created to perfuse segments of human saphenous veins under arterial regimen (high shear stress and high pressure). Further technical innovations allowed the simultaneous perfusion of two segments from the same vein, one reinforced with an external mesh. Veins were harvested using a no-touch technique and immediately transferred to the laboratory for assembly in the EVPS. One segment of the freshly isolated vein was not perfused (control, day 0). The two others segments were perfused for up to 7 days, one being completely sheltered with a 4 mm (diameter) external mesh. The pressure, flow velocity, and pulse rate were continuously monitored and adjusted to mimic the hemodynamic conditions prevailing in the femoral artery. Upon completion of the perfusion, veins were dismounted and used for histological and molecular analysis. Under ex vivo conditions, high pressure perfusion (arterial, mean = 100 mm Hg) is sufficient to generate IH and remodeling of human veins. These alterations are reduced in the presence of an external polyester mesh.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital/Harvard Medical School; alban.longchamp@gmail.com.
authors.forename: Alban
authors.initials: A
authors.lastname: Longchamp
authors.affiliation: Laboratory of Experimental Medicine, Department of Medicine, CHUV University Hospital.
authors.forename: Florent
authors.initials: F
authors.lastname: Allagnat
authors.affiliation: Department of Vascular Surgery, Pellegrin Hospital, University of Bordeaux.
authors.forename: Xavier
authors.initials: X
authors.lastname: Berard
authors.affiliation: Laboratory of Experimental Medicine, Department of Medicine, CHUV University Hospital.
authors.forename: Florian
authors.initials: F
authors.lastname: Alonso
authors.affiliation: Laboratory of Experimental Medicine, Department of Medicine, CHUV University Hospital.
authors.forename: Jacques-Antoine
authors.initials: JA
authors.lastname: Haefliger
authors.affiliation: Department of Thoracic and Vascular Surgery, CHUV University Hospital.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Deglise
authors.affiliation: Department of Thoracic and Vascular Surgery, CHUV University Hospital.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Corpataux
mesh_terms: D006801:Humans; D006965:Hyperplasia; D010477:Perfusion / Q000295:instrumentation* / Q000379:methods*; D011091:Polyesters / Q000737:chemistry; D012501:Saphenous Vein / Q000502:physiology* / Q000601:surgery*; D013526:Surgical Mesh; D017539:Tunica Intima / Q000473:pathology
chemical_list: D011091:Polyesters