An endovascular model of ischemic myopathy from peripheral arterial disease.
Peripheral arterial disease (PAD) is a significant age-related medical condition with limited pharmacologic options. Severe PAD, termed critical limb ischemia, can lead to amputation. Skeletal muscle is the end organ most affected by PAD, leading to ischemic myopathy and debility of the patient. Currently, there are not any therapeutics to treat ischemic myopathy, and proposed biologic agents have not been optimized owing to a lack of preclinical models of PAD. Because a large animal model of ischemic myopathy may be useful in defining the optimal dosing and delivery regimens, the objective was to create and to characterize a swine model of ischemic myopathy that mimics patients with severe PAD.



Yorkshire swine (N = 8) underwent acute right hindlimb ischemia by endovascular occlusion of the external iliac artery. The effect of ischemia on limb function, perfusion, and degree of ischemic myopathy was quantified by weekly gait analysis, arteriography, hindlimb blood pressures, femoral artery duplex ultrasound scans, and histologic examination. Animals were terminated at 5 (n = 5) and 6 (n = 3) weeks postoperatively. Ossabaw swine (N = 8) fed a high-fat diet were used as a model of metabolic syndrome for comparison of arteriogenic recovery and validation of ischemic myopathy.



There was persistent ischemia in the right hindlimb, and occlusion pressures were significantly depressed compared with the untreated left hindlimb out to 6 weeks (systolic blood pressure, 31 ± 21 vs 83 ± 15 mm Hg, respectively; P = .0007). The blood pressure reduction resulted in a significant increase of ischemic myopathy in the gastrocnemius muscle in the treated limb. Gait analysis revealed a functional deficit of the right hindlimb immediately after occlusion that improved rapidly during the first 2 weeks. Peak systolic velocity values in the right common femoral artery were severely diminished throughout the entire study (P < .001), and the hemodynamic environment after occlusion was characterized by low and oscillatory wall shear stress. Finally, the internal iliac artery on the side of the ischemic limb underwent significant arteriogenic remodeling (1.8× baseline) in the Yorkshire but not in the Ossabaw swine model.



This model uses endovascular technology to produce the first durable large animal model of ischemic myopathy. Acutely (first 2 weeks), this model is associated with impaired gait but no tissue loss. Chronically (2-6 weeks), this model delivers persistent ischemia, resulting in ischemic myopathy similar to that seen in PAD patients. This model may be of use for testing novel therapeutics including biologic therapies for promoting neovascularization and arteriogenesis.
Department of Surgery, Emory University School of Medicine, Atlanta, Ga.
Chandler A
CA
Long
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga.
Lucas H
LH
Timmins
University of Nebraska Medical Center, Omaha, Neb.
Panagiotis
P
Koutakis
Cardiovascular Center of Excellence, Louisiana State University School of Medicine, New Orleans, La.
Traci T
TT
Goodchild
Cardiovascular Center of Excellence, Louisiana State University School of Medicine, New Orleans, La.
David J
DJ
Lefer
University of Nebraska Medical Center, Omaha, Neb.
Iraklis I
II
Pipinos
University of Nebraska Medical Center, Omaha, Neb.
George P
GP
Casale
Department of Surgery, Emory University School of Medicine, Atlanta, Ga; Surgical and Research Services, Atlanta VA Medical Center, Atlanta, Ga. Electronic address: lbrewst@emory.edu.
Luke P
LP
Brewster
D000792:Angiography; D000818:Animals; D001783:Blood Flow Velocity; D003251:Constriction, Pathologic; D004195:Disease Models, Animal; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D005684:Gait; D006439:Hemodynamics; D006614:Hindlimb; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000473:pathology / Q000503:physiopathology; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D015607:Stents; D034421:Sus scrofa; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex; D066253:Vascular Remodeling
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