Silk fibroin vascular graft: a promising tissue-engineered scaffold material for abdominal venous system replacement

AbstractNo alternative tissue-engineered vascular grafts for the abdominal venous system are reported. The present study focused on the development of new tissue-engineered vascular graft using a silk-based scaffold material for abdominal venous system replacement. A rat vein, the inferior vena cava, was replaced by a silk fibroin (SF, a biocompatible natural insoluble protein present in silk thread), tissue-engineered vascular graft (10 mm long, 3 mm diameter, n = 19, SF group). The 1 and 4 -week patency rates and histologic reactions were compared with those of expanded polytetrafluoroethylene vascular grafts (n = 10, ePTFE group). The patency rate at 1 and 4 weeks after replacement in the SF group was 100.0% and 94.7%, and that in the ePTFE group was 100.0% and 80.0%, respectively. There was no significant difference between groups (p = 0.36). Unlike the ePTFE graft, CD31-positive endothelial cells covered the whole luminal surface of the SF vascular graft at 4 weeks, indicating better endothelialization. SF vascular grafts may be a promising tissue-engineered scaffold material for abdominal venous system replacement.

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Liver resection combined with inferior vena cava resection and reconstruction using artificial vascular graft: A literature review

Annals of Gastroenterological Surgery ◽

10.1002/ags3.12068 ◽

2018 ◽

Vol 2 (3) ◽

pp. 182-186 ◽

Cited By ~ 2

Author(s):

Yoshito Tomimaru ◽

Hidetoshi Eguchi ◽

Hiroshi Wada ◽

Yuichiro Doki ◽

Masaki Mori ◽

...

Keyword(s):

Liver Resection ◽

Literature Review ◽

Inferior Vena Cava ◽

Vascular Graft ◽

Inferior Vena ◽

Vena Cava ◽

Inferior Vena Cava Resection

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Surgical Outcomes of Liver Resection Combined with Inferior Vena Cava Resection and Reconstruction with Artificial Vascular Graft

Digestive Surgery ◽

10.1159/000493434 ◽

2018 ◽

Vol 36 (6) ◽

pp. 502-508 ◽

Cited By ~ 2

Author(s):

Yoshito Tomimaru ◽

Hidetoshi Eguchi ◽

Hiroshi Wada ◽

Yuichiro Doki ◽

Masaki Mori ◽

...

Keyword(s):

Liver Resection ◽

Inferior Vena Cava ◽

Surgical Outcomes ◽

Vascular Graft ◽

Inferior Vena ◽

Liver Tumors ◽

Vena Cava ◽

Bile Leakage ◽

Inferior Vena Cava Resection ◽

Ivc Resection

Background/Aim: Inferior vena cava (IVC) resection and reconstruction with concomitant liver resection sometimes represent the only chance for patients with liver tumors involving the IVC to get cured. However, surgical outcomes of liver resection with IVC resection and reconstruction using an artificial vascular graft have not been well investigated. Methods: Out of a total of 1,179 cases, only 12 involving liver resection between 1998 and 2016 at our institution included IVC resection and reconstruction using an artificial vascular graft. An expanded polytetrafluoroethylene graft was used for the IVC reconstruction in all 12 cases. We investigated the surgical outcomes of these combined surgeries. Results: The median operative time was 650 min and the median blood loss was 2,600 mL. Postoperative complications (≥ grade III in the Clavien-Dindo classification) developed in 2 patients – 1 case of bleeding and one of bile leakage. There were no cases of operative mortality. No complications associated with the vascular graft were observed throughout the postoperative follow-up period, and the grafts remained patent in all cases. Conclusions: These results indicate favorable surgical outcomes of liver resection combined with IVC resection and reconstruction.

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VENOUS DRAINAGE OF KIDNEY;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.02.3113 ◽

2019 ◽

Vol 26 (02) ◽

Author(s):

Robina Shaheen ◽

Muhammad Nasir Jamil ◽

Aminullah

Keyword(s):

Inferior Vena Cava ◽

Renal Vein ◽

Inferior Vena ◽

Vena Cava ◽

Renal Veins ◽

Drainage Pattern ◽

Significant Difference ◽

Group A ◽

Group D

Background: In the era of changing trends in favour of laparoscopic andminimally invasive surgery, a better understanding of renal veins is of paramount importance. Although various classifications of renal veins have been proposed,none is without shortcomings. We investigated the drainage pattern of renal veins in cadavers and aim to address the shortcomings in previous classifications by proposing a new classification of renal veins. Study Design: Observational cross-sectional study. Setting: Embalmed cadavers or autopsy cases in anatomy and forensic departments of various medical colleges of Lahore (Fatima Jinnah, King Edwards, Allama Iqbal). Period: One year from Feb2008 to Jan2009. Methods: The kidneys and inferior vena cava were well exposed incases with well-preserved renal vessels and kidneys. A mixture of gelatin and Indian ink were injected into inferior vena cava which in turn filled renal veins. Renal vein patterns were studied. We report frequencies in the proposed renal vein groups and subgroups. Results: A total of 50 pairs of kidneys were studied (50 right, 50 left). The renal veins were classified into five groups (A-E) depending on number and arrangement of primary tributaries that formed renal vein.All groups were further divided into three sub groups (1, 2 and 3) depending on whether or not an additional renal vein or any other variant pattern existed, except group E. Subgroup1 represented normal renal vein across all groups. Groups A, B, C consisted of renal veins formed by union of 2, 3, 4 primary tributaries respectively, all from anterior aspect. Group D consisted of renal veins where a posterior primary tributary existed. While group E included renal veins formed by any other number or pattern of primary tributaries. Group A was the most frequent type overall (40%), more common on the right side (56% vs 24%). Group B was the most frequentgroup on the left side (38%). The least frequent group was group E with equal frequency on both sides (6%), closely preceded by group D, which was more frequent on the left side (12% vs 2%). The only statistically significant difference in relation to major groups between right and left kidneys was in group A (56% vs 24% respectively; P=0.001). Conclusion: We proposed a comprehensive classification of renal veins taking into account their variant and anomalous patterns and tributaries not previously considered by other classifications.Future studies in diverse populations with bigger sample are warranted to investigate some of the patterns not observed in this study.

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Diameter and collapse index of inferior vena cava as a clinical indicator of resuscitation for critically ill hypotensive patients

10.21203/rs.3.rs-49017/v1 ◽

2020 ◽

Author(s):

Seongpyo Mun

Keyword(s):

Inferior Vena Cava ◽

Critically Ill ◽

Inferior Vena ◽

Vena Cava ◽

Adverse Outcomes ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Clinical Indicator ◽

Significant Difference ◽

Collapse Index

Abstract Purpose The role of diameter and collapse index of inferior vena cava (DCIIVC) in reflecting intravascular volume status and fluid responsiveness remains unclear. We aimed to evaluate the effectiveness of DCIIVC as a clinical indicator for fluid resuscitation (FR) in critically ill hypotensive patients.Methods This retrospective study enrolled hypotensive patients admitted to the surgical intensive care unit (SICU) between May 2018 and April 2019. Between May and October 2018, fluid therapy was conducted by a physician’s decision (non-DCIIVC group, 32 patients). Between November 2018 and April 2019, DCIIVC was used as a guide (DCIIVC group, 30 patients). Clinical outcomes of the two periods were compared.Results Total amount of fluid intake (TAFI) of non-DCIIVC and DCIIVC group in 24 h was 4,130 and 3,560, respectively (p < 0.05). TAFI in 48 h was 8,420 and 6,910, respectively (p < 0.01). Lactate levels at admission, 24 and 48 h after admission were 4.1 vs 3.8, 3.2 vs 3.1, and 1.9 vs 2.1 mmol/L, respectively. Mean duration of mechanical ventilation, ICU stay, and hospital stay were 4.1 vs 4.5, 7.2 vs 6.3, and 18.1 vs 17.2, respectively. Overall mortality was 16.7% vs 13.3%. There was no significant difference in any other characteristic except TAFI.Conclusion DCIIVC can be used as a tool for indicating FR in critically ill hypotensive patients. This can help physicians infuse fluid restrictively, without adverse outcomes.

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Surgical Treatment Strategy with Combined Cardiopulmonary Bypass for Renal Cell Carcinoma with Tumor Embolism Developed in Inferior Vena Cava

The Heart Surgery Forum ◽

10.1532/hsf.2741 ◽

2020 ◽

Vol 23 (1) ◽

pp. E025-E029

Author(s):

Tomohiro Imazuru ◽

Masateru Uchiyama ◽

Tomoki Shimokawa

Keyword(s):

Renal Cell Carcinoma ◽

Cardiopulmonary Bypass ◽

Inferior Vena Cava ◽

Cell Carcinoma ◽

Surgical Management ◽

Renal Cell ◽

Tumor Thrombus ◽

Inferior Vena ◽

Vena Cava ◽

Significant Difference

Objective: Renal cell carcinoma (RCC) with tumor thrombus in the inferior vena cava (IVC) presents surgeons with a technical intraoperative challenge because of the need for aggressive surgical management. In this study, we describe our method for surgical management with cardiopulmonary bypass (CPB) and investigate the long-term outcomes of RCC patients with and without CPB. Methods: Fifteen patients with RCC underwent nephrectomy and IVC thrombectomy from May 2011 to December 2017. We retrospectively reviewed and analyzed the clinical course of all patients. Novick classification was used to assess the level of tumor thrombus extension into the IVC. Patient characteristics, surgical procedures, and postoperative outcome data in both groups were collected. Results: Twelve patients were male and 3 were female, with an average age of 62.9 ± 10.9 years (range 46 to 82). The average operative times were 824 ± 335 minutes in the patients with CPB and 646 ± 162 minutes in those without CPB (P = .17). The average amount of intraoperative bleeding was 2125 ± 1315 ml in the patients with CPB and 3333 ± 1431 ml in those without CPB (P = .14). The same tendency was observed in patients of Novick levels 3 and 4. The mean observation period was 1061.4 days. No 30-day mortality was noted. There was no significant difference in all-cause survival between the patients with CPB and those without. Conclusions: We conclude that surgical management with CPB and circulatory arrest may be a viable and safe method of treatment for RCC patients.

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Delta Inferior Vena Cava Index Correlated with Mean Arterial Pressure (MAP) in Spinal Anesthesia

Journal of Anaesthesia and Pain ◽

10.21776/ub.jap.2021.002.02.04 ◽

2021 ◽

Vol 2 (2) ◽

pp. 65-69

Author(s):

Wiwi Jaya ◽

◽

Ulil Abshor ◽

Buyung Hartiyo Laksono ◽

Arie Zainul Fatoni ◽

...

Keyword(s):

Mean Arterial Pressure ◽

Inferior Vena Cava ◽

Arterial Pressure ◽

Spinal Anesthesia ◽

Inferior Vena ◽

Vena Cava ◽

Test Study ◽

Significant Difference ◽

Before And After ◽

Post Test

Background: Spinal anesthesia has become an alternative to general anesthesia. However, spinal anesthesia has the most common side effects including, bradycardia and hypotension. The aim of this study was to determine the relationship between changes in the inferior vena cava index (delta inferior vena cava index) to changes in mean arterial pressure in spinal anesthesia. Methods: This study was an observational pre-post test study in thirty-two patients who received spinal anesthesia. The inferior vena cava index (inferior vena cava collectibility index and caval-aorta index) was measured before and after spinal anesthesia (5 and 10 minutes after onset). Data were analyzed using the Kolmogorov Smirnov test, Shapiro-Wilk test, T-test, and correlation test with α=5% Result: There was a significant difference in mean arterial pressure (MAP), delta inferior vena cava collectibility index (D-IVC-CI), and delta caval-aorta index (D-CAo-I) before and after spinal anesthesia. D-IVC-CI and D-CAo-I are significantly correlated with MAP. The correlation between D-IVC-CI and MAP had R = -0.371 (P <0.05) at 5 minutes post-anesthesia, while D-CAo-I and MAP had R = 0.472 (P <0.05) at 10 minutes post-anesthesia. Conclusion: The delta inferior vena cava index is correlated with the mean arterial pressure (MAP) value in spinal anesthesia.

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Abstract 233: Quantification of Histological and Biomechanical Properties of Tissue-Engineered Vascular Graft in Inferior Vena Cava

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.32.suppl_1.a233 ◽

2012 ◽

Vol 32 (suppl_1) ◽

Author(s):

Yuji Naito ◽

Yong-Ung Lee ◽

Tai Yi ◽

Spencer N Church ◽

Daniel Solomon ◽

...

Keyword(s):

Gene Expression ◽

Inferior Vena Cava ◽

Vascular Graft ◽

Inferior Vena ◽

Vena Cava ◽

Biomechanical Properties ◽

Type I ◽

Ecm Remodeling ◽

Total Collagen

Background: We developed the first tissue engineered vascular graft (TEVG) for use in congenital heart surgery and confirmed its significant potential via an initial clinical trial (Shinoka et al., JTCVS 2005). The primary complication of TEVG at medium term was stenosis attributed to suboptimal neovessel remodeling, which necessitated an investigation of the mechanics and mechanobiology to predict diverse aspects of the neovessel formation. Here we present the novel tools to investigate the evolving biomechanical properties of TEVG in a mouse inferior vena cava (IVC) replacement model. Hypothesis: The biomechanical properties of a TEVG evolve nonlinearly in time from a construct-dominated stiffness to a neovessel dominated stiffness. Novel biaxial biomechanical tests are required to quantify such changes rigorously. Method: Thirty-six CB17 SCID/beige mice were implanted with TEVG (PGA + P[CL/LA]) as IVC interposition graft. Twelve tissue engineered neovessels were harvested at 2, 6, and 12 weeks after implantation. Neovessels were characterized biomechanically using a custom, computer-controlled biaxial testing device, and compared with native veins. Extracellular matrix (ECM) remodeling of the neovessel was characterized histologically, biochemically, and molecular biologically. Result: The biaxial data revealed an improved compliance of the neovessel over time. Similarly, the axial stretch response of the TEVG became more like the native vein at 12 weeks. This response was quantified as a ratio of neo-vessel to native vein and improved to reach 52% at 12 weeks from 11% at 2 weeks. Scaffold mass in vivo, estimated by remaining scaffold on histology, showed a significant decline at 6 and 12 weeks. Gene expression of both type I and III collagen peaked at 2 weeks, and total collagen mass quantified by a Sircol™ assay revealed that total collagen peaked at 2 weeks but decreased gradually to the level of native vein. Gene expression of both tropoelastin and fibrillin-1 peaked at 2 weeks, whereas elastin mass quantified by Fastin™ assay showed a delayed peak level of elastin at 6 weeks. Gene expression of MMP-2 and 9 peaked at 6 and 2 weeks, respectively, implicating robust ECM remodeling at early time points. Conclusion: Our novel histo-mechanical approach is the first to show that neovessel formation is a dynamic process characterized by progressive degradation of the scaffold and increased ECM remodeling, which yields biomechanical properties of the TEVG similar to native vessel within 12 weeks in vivo.

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