Abstract
Although the histologic effects of balloon catheter thromboembolectomy in arteries are well described, little is known about its effects on arterialized vein grafts. A chronic canine model was used to compare the intimai hyperplasia that develops following balloon catheter thrombectomy versus thrombolytic therapy when each treatment was used to open experimentally occluded reversed autogenous vein grafts. Eleven of 12 dogs survived to the time of graft thrombosis and treatment. Ten grafts in one group of animals were treated with shear force-controlled balloon catheter thrombectomy, and eleven grafts in another group of animals were treated with infusion of urokinase (average 355, 833 lU/graft). Explantation and histologic evaluation was performed 5 weeks after treatment. Data were evaluated at comparable anatomic locations. These studies demonstrated the development of intimal hyperplasia in both groups with no statistically significant differences in the intimal thickening between the two treatment groups. It is hypothesized that vessel wall damage occurs at the time of thrombosis with the adherence of thrombus to the wall, and that this may be as important in producing intimai hyperplasia as the effects of carefully performed balloon thrombectomy or lytic therapy. (Ann Vasc Surg 1997;11:559-564.)
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Whittemore AD, Clowes AW, Couch NP, et al. Secondary femoropopliteal reconstruction. Ann Surg 1981;193:35–42.
Cohen JR, Mannick JA, Couch NP, et al. Recognition and management of impending vein graft failure. Arch Surg 1986;121:758–9.
Sullivan KL, Gardinier GA, Kandarpa K, et al. Efficacy of thrombolysis in infrainguinal bypass grafts. Circulation 1991;83(suppl I):I-99–I-I05.
Towne JB, Bandyk DF. Application of thrombolytic therapy in vascular occlusive disease. Am J Surg 1987; 154:548–59.
Koltun WA, Gardinier GA, Harrington DP, et al. Thrombolysis in the treatment of peripheral arterial vascular occlusions. Arch Surg 122 1987; 901–5.
Belkin M, Belkin BA, Bucknam CA, et al. Efficacy of streptokinase vs urokinase. Arch Surg 1986;121:769–73.
Schwarcz TH, Dobrin PB, Mrkvicka R, et al. Early myointimal hyperplasia after balloon catheter embolectomy: Effect of shear forces and multiple withdrawals. J Vasc Surg 1988; 7:495–9.
Greenwood LH, Gallert JW, Yrizarry JM, et al. Diffuse arterial narrowing after thromboembolectomy with the Fogarty balloon catheter. Am J Radiol 1984;142:141–2.
Bowles CR, Olcott CW, Pakter RL, et al. Diffuse arterial narrowing as a result of intimal proliferation: A delayed complication of embolectomy with the Fogarty catheter. J Vasc Surg 1988;7:487–94.
Dobrin PB, Gray J, Schwarcz TH. In vivo models used to study myointimal hyperplasia. In: Dobrin PB, ed. Intimal Hyperplasia, Austin TX: R.G. Landes Co., 1994, pp 75–83.
Chidi C, DePalma RG. Atherogenic potential of the embolectomy catheter. Surgery 1978;83:549–57.
Belkin M, Donaldson MC, Whittemore AD, Mannick JA, et al. Observations on the use of thrombolytic agents for thrombotic occlusion of infrainguinal vein grafts. J Vasc Surg 1990;11:289–96.
Jorgensen RA, Dobrin PB. Balloon embolectomy in small arteries IV: Correlation of shear forces with histologic injury. Surgery 1983;93:798–810.
Rubanyi GM, ed. Cardiovascular significance of endothelium-deprived vasoactive factors, 1st ed. Mount Kisco, NY: Futura Publishing Company, Inc., 1992.
Ryan US, Rubanyi GM, eds. Endothelial Regulation of Vascular Tone. 1st ed. New York: Marcel Dekker Inc., 1992.
Goldberg EM, Goldberg MC, Chowdhury LN, et al. Effects of embolectomy-thrombectomy catheters on vascular architecture. J Cardiovasc Surg 1983;24:74–80.
Dotter CT, Rosch J. Seaman AJ. Selective clot lysis with low dose streptokinase. Radiology 1974;111:31–7.
Marx M, Armstrong WP, Wack JP, et al. Short duration, high dose urokinase infusion for re-canalization of occluded aorto-coronary bypass grafts. Am J Roentgenology 1989; 153:167–71.
Browse DJ, Torrie EPH, Galland RB. Low-dose intra-arterial thrombolysis in the treatment of occluded vascular grafts. Br J Surg 1992;79:86–8.
Gardinier GA, Harrington DP, Koltun W, et al. Salvage of occluded arterial bypass grafts by means of thrombolysis. J Vasc Surg 189;9:426–31.
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Morasch, M.D., Zenni, G.C., Dobrin, P.B. et al. Intimai hyperplasia following thrombectomy versus thrombolysis in occluded vein grafts. Annals of Vascular Surgery 11, 559–564 (1997). https://doi.org/10.1007/s100169900091
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DOI: https://doi.org/10.1007/s100169900091