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

Problems of displacement, poor healing, degradation of the polymers and corrosion of the metallic frame in endovascular devices still require in-depth investigations. As the tissues and the foreign materials are in close contact, it is of paramount importance to efficiently investigate the interfaces between them. Inclusion in polymethymethacrylate (PMMA) permits us to obtain thin slides and preserve the capacity to perform the appropriate stainings. An AneuRx prosthesis was harvested in bloc with the surrounding tissues at the autopsy of a patient 25 months post deployment in a 5.7 cm diameter AAA and sectioned in the direction of the blood flow in two halves. A cross-section of the encapsulated distal segment together with the surrounding aneuryshmal sac was embedded in polymethylmethacrylate (PMMA). Further to complete polymerization, slices of the specimen were cut on a precision banding saw under coolant. They were affixed onto methacrylate slides with a UV cured adhesive. Binding and polishing were done on a numeric grinder and slices 25 to 30 microm in thickness were stained with toluidine blue prior to observation in light microscopy. Additional slices were prepared for scanning electron microscopy and X-ray energy dispersive spectrometry for determination of the elemental composition of the Nitinol stent. The aortic wall did not demonstrate complete integrity along with its circumference. Some areas of rupture were noted. The content of the sac was heavily shrunk and was mostly acellular. The walls of the device were very well encapsulated. The PMMA embedding permitted the polyester wall, the Nitinol wire and the collagen to keep in close contact. Scanning electron microscopy involved backscattered electrons and confirmed the corrosion the Nitinol wire at the boundary with living tissues. Based upon the results obtained, we believe that PMMA embedding is the most appropriate method to process endovascular devices for histological and material investigation. Needless to say, that paraffin embedding would have not been feasible for such a big size specimen involving different materials.

Characterization of abnormalities responsible for immediate rejection of porcine aortic valves for the manufacture of bioprostheses

Gross observation at the slaughterhouse determines the primary selection of porcine aortic valves for the manufacture of bioprostheses. This step is critical because only valves with significant abnormalities are rejected. The present study validated this selection process by investigating the pathological characteristics of one series of accepted valves and one series of rejected valves. Macroscopy, x-ray examination, light microscopy, and scanning electron microscopy (SEM) were performed on 5 initially rejected valves, 3 leaflets from 3 other initially rejected valves, and 6 valves that successfully passed this first step in the selection process. Abnormalities were macroscopically visible only on the rejected valves and were described as thick white areas, heavy white striations, thin spots, white plaques, and nodules. Individual variability in the structure of each leaflet was more significant in the rejected valves than in the valves that had passed the first inspection. The leaflets of the rejected valves were also irregularly thick with a lack of consistency in the position and prominence of the different layers. The formation of nodules and the presence of white plaques in the inner fibrosa layer were among the pathological features. The initially accepted valves considered defect free under gross observation continued to display some weaknesses, and not all of the valves selected during the first step of the process were suitable to become bioprostheses. Because the manufacturer carries out further quality control inspections at every step of preparation resulting in additional rejections, it is therefore anticipated that all valves with defects will be rejected. None of the rejected valves were defect free, and rejection was fully justified.

Can the infusion of elastase in the abdominal aorta of the Yucatán miniature swine consistently produce experimental aneurysms?

The intraluminal elastase perfusion model has been proved to be potentially effective in producing abdominal aortic aneurysm in rodents, but it produced unpredictable results in larger animals. The purpose of this study was to explore the potential ability of such a model to produce experimental aneurysm consistently in the Yucatán miniature swine. Six Yucatán miniature swine received infusion with porcine elastase into an isolated segment of the infrarenal aorta. The excised arterial segments were examined macroscopically to assess the luminal surface characteristics and histologically to describe the different pathologic injuries induced by the elastase treatment on the intima, media, and adventitia of the arterial wall. Histologic examination revealed that the elastic network of the media was destroyed. In the first week after perfusion, altered smooth muscle cells were located in the intima and innermost layer of the media in juxtaposition with the occlusive thrombus. Infiltration of inflammatory cells was observed in these regions of elastic network and smooth muscle cell alterations. In the arterial segments of swine sustained for 3 weeks, a reduction of smooth muscle cells was noted in some areas. An important number of necrotic lesions was observed, and they were associated with the development of calcium deposits. Significant intimal hyperplasic reaction was identified at day 19 and again at day 21. However, no aneurysmal development was observed. This study constituted the first experiment with infusion of porcine elastase in the Yucatán miniature swine infrarenal aorta. The present experimental protocol induced important elastic network and smooth muscle cell alterations leading to severe necrotic lesions associated with calcium deposition, but it produced no aneurysmal dilatation. This model requires further testing to obtain a more complete degradation of the elastic network in both the media and adventitia and more significant collagenolysis without early thrombotic events.

[Ultrastructural characteristics of the venous endothelium in primary varices of the legs]

The author establishes by using TEM a considerable variability of endothelial cell ultrastructure in primary varicose veins. Endothelial cells of varicose veins differ from these in normal ones by deformation of configuration of the cells and of their nucleus accompanied by alterations in other cellular organelles. These changes express the stimulation of the endothelial cell aiming their adaptation to hemodynamic changes ABD combine with destructive intracellular changes as well. Probably, adaptation capacities of endothelial cells are restricted to definite limits in which they can change themselves. Beyond these limits endothelial cells can not compensate and undergo degenerative alterations. The author discusses the possible functional changes of the venous endothelium related to substance transport in the venous wall, to lipid accumulation in the endothelium and to thrombus formation.

[Morphologic changes in the walls of the internal saphenous vein used as an arterial bypass]

Long saphenous vein (LSV) is considered an optimal plastic material for arterial reconstructions in revascularization of the myocardium and in the femoral-popliteal segment. The authors analyze the results from the investigation of the operation material from 12 patients with obliterating atherosclerosis of the lower limbs in which reversed LSV has been previously used for arterial bypass grafts. Material is taken during the second operation performed between two days and 18 months after the first reconstruction. In the early period after LSV implantation into the arterial blood flow there is a prevalence of destructive alterations which are mainly manifested in the intima and internal layers of the media. In later periods a massive layer is formed growing into the venous vascular lumen designated as "néo-intima". Investigations of its structure and of mechanisms of its formation could enable the regulation of this process by clinicists.