Polymethylmethacrylate (PMMA) as an embedding medium preserving tissues and foreign materials encroaching in endovascular devices

Chronic implantation of intravascular cardioverter defibrillator in a canine model: device stability, vascular patency, and anchor histology

INTRODUCTION

A percutaneously placed implantable intravascular defibrillator (PICD) has been developed with a right ventricular (RV) single-coil lead and titanium electrodes in the superior vena cava (SVC) and the inferior vena cava (IVC). This study evaluated implant techniques, device stability, and anchor histology of the PICD over 9 months in a canine model.

METHODS

Twenty-four hounds (wt = 30-55 kg) were anesthetized and a custom sheath introduced into the right femoral vein. The PICD was advanced over a wire and positioned with the titanium electrodes (cathodes) in the SVC and the IVC. A nitinol anchor secured the device in the jugular. The RV lead was positioned in the RV apex and screwed into place. The catheters, wires, and sheath were removed with an average implant time of 14 minutes. In one group of animals (n = 13), serial venograms were performed at 7 days, 14 days, and 28 days. In a second group (n = 6) and third group (n = 5), venograms were also performed at 90 days and 270 days, respectively. Six canines were sacrificed and anchor histologic examination done at 90 days.

RESULTS

All implants were successful with no surgical complications observed. Devices (N = 24) remained appropriately positioned with no anchor migration. Histology at 90 days showed 98% endothelialization of the anchor. Venograms revealed patent IVC and jugular veins in all animals at every time point examined.

CONCLUSIONS

The PICD can be rapidly and chronically implanted in animals. Long-term intravascular defibrillator placement is feasible in a canine model.

Analysis of explanted Latecba modular stent-grafts deployed transrenally to repair AAAs with short necks in 29 dogs

Twenty-nine modular stent-grafts deployed transrenally to repair AAAs with short necks in dogs were harvested at autopsy of the animals after scheduled durations of implantations of 10 days, one month, three months, and six months. Analyses of the explanted devices included non-destructive techniques such as gross observations, X-rays CT scan, IVUS and angioscopy. Further to appropriate dissection, histological investigations were carried out by means of scanning electron microscopy (SEM) and light microscopy. All the 29 specimens were extensively encapsulated with fibrous tissues but the fibrous capsule was thin in six of them; four capsules were ulcerated. The X-rays confirmed the stability of the devices that were still straight (12), slightly bent (12) or bent (4). The modules were misaligned in only one case. IVUS and angioscopy confirmed the patency of all the stent-grafts with thin internal capsules both proximally and distally with variable capsulation in the mid-section of the grafts. The left renal artery orifices were found to be patent at dissection with no obstruction to flow. The luminal flow surface of the stent-grafts was smooth and glistening proximally and distally containing endothelial like cells and vasa-vasorum. Poor healing was noted in the aneurysm area. Transrenal deployment of this modular stent-graft is feasible and gave excellent results with regard to biofunctionality and biocompatibility. The device proved to be safe and efficient.