Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.190025
Jornal Vascular Brasileiro
Original Article

Lesão aguda da parede arterial provocada pelo método de interrupção temporária de fluxo em diferentes vias de cirurgia aórtica: estudo morfológico e biomecânico da aorta de porcos

Acute aortic wall injury caused by aortic cross-clamping: morphological and biomechanical study of the aorta in a swine model of three aortic surgery approaches

Marcela Polachini Prata; Rodrigo Gibin Jaldin; Pedro Luiz Toledo de Arruda Lourenção; Marcone Lima Sobreira; Ricardo de Alvarenga Yoshida; Simone Antunes Terra; Rosa Marlene Viero; Winston Bonetti Yoshida

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Resumo

Resumo: Contexto: O clampeamento aórtico e a oclusão da aorta com balão poderiam levar a lesões na parede aórtica.

Objetivo: O objetivo deste estudo foi verificar as alterações da parede aórtica relacionadas ao método de interrupção de fluxo (cample ou balão) em diferentes técnicas disponíveis para cirurgia de aorta.

Métodos: Os experimentos foram realizados em 40 porcos fêmeas pesando de 25-30 kg, alocados para quatro grupos: S (n = 10), nenhuma intervenção (sham); C (n = 10), laparotomia mediana transperitoneal para acesso à aorta abdominal infrarrenal com tempo de clampeamento de 60 minutos; L (n = 10), cirurgia laparoscópica da aorta abdominal infrarrenal com tempo de clampeamento de 60 minutos; EV (n = 10), controle aórtico proximal com inserção de cateter-balão para oclusão aórtica por acesso femoral, inflado a fim de promover oclusão aórtica contínua por 60 minutos. Após a eutanásia, as aortas foram removidas e seccionadas para obtenção de espécimes histológicos destinados a análises morfométricas e por microscopia de luz. Os fragmentos longitudinais restantes foram estirados até a ruptura, e determinaram-se padrões mecânicos.

Resultados: Observou-se redução do limite de proporcionalidade da aorta abdominal, diminuição da rigidez e da carga de ruptura nos grupos submetidos a campleamento aórtico (C e L) em comparação ao grupo EV.

Conclusões: O campleamento aórtico durante cirurgia aberta ou laparoscópica pode afetar as propriedades mecânicas da aorta, ocasionando redução de resistência da parede aórtica sem desencadear alterações na estrutura histológica da parede aórtica.

Palavras-chave

aorta abdominal, resistência à tração, estresse mecânico, dispositivos de oclusão vascular

Abstract

Background: Aortic cross-clamping and balloon occlusion of the aorta could lead to damage to the aorta wall. Objective: The aim of this study was to investigate changes to the aorta wall related to the method used to interrupt flow (clamping or balloon) in the different techniques available for aortic surgery. Methods: Experiments were performed on 40 female pigs, weighing 25-30kg, which were randomly allocated to 4 study groups: S (n=10), no intervention (sham group); C (n=10), midline transperitoneal laparotomy for infrarenal abdominal aortic access with 60 min of cross-clamping; L (n=10), laparoscopic infrarenal abdominal aortic surgery with 60 min of cross-clamping; EV (n=10), remote proximal aortic control with transfemoral arterial insertion of aortic occlusion balloon catheter, inflated to provide continued aortic occlusion for 60min. After euthanasia, the aortas were removed and cross-sectioned to obtain histological specimens for light microscopic and morphometric analyses. The remaining longitudinal segments were stretched to rupture and mechanical parameters were determined. Results: We observed a reduction in the yield point of the abdominal aorta, decrease in stiffness and in failure load in the aortic cross-clamping groups (C and L) compared with the EV group. Conclusions: Aortic cross-clamping during open or laparoscopic surgery can affect the mechanical properties of the aorta leading to decrease in resistance of the aorta wall, without structural changes in aorta wall histology

Keywords

abdominal aorta; tensile strength; mechanical stress; vascular closure devices.

References

1 Coscas R, Maumias T, Capdevila C, Javerliat I, Goëau-Brissonnière O, Coggia M. Mini-invasive treatment of abdominal aneurysms: current roles of endovascular, laparoscopic and open techniques. Ann Vasc Surg. 2014;28(1):123-31. http://dx.doi.org/10.1016/j.avsg.2013.05.007. PMid:24200131.

2 Pascarella L, Aboul Hosn M. Minimally invasive management of severe aortoiliac occlusive disease. J Laparoendosc Adv Surg Tech A. 2018;28(5):562-8. http://dx.doi.org/10.1089/lap.2017.0675. PMid:29346011.

3 Ahmed N, Gollop ND, Ellis J, Khan OA. How does elective laparoscopic aortic aneurysm repair compare to endovascular aneurysm repair? Interact Cardiovasc Thorac Surg. 2014;18(6):814-20. http://dx.doi.org/10.1093/icvts/ivu031. PMid:24578481.

4 Robertson L, Nandhra S. Laparoscopic surgey for elective abdominal aortic aneurysm repair. Cochrane Database Syst Rev. 2017;5:CD012302.

5 Slayback JB, Bowen WW, Hinshaw DB. Intimal injury from arterial clamps. Am J Surg. 1976;132(2):183-7. http://dx.doi.org/10.1016/0002-9610(76)90045-3. PMid:952348.

6 Margovsky AI, Lord RSA, Meek AC, Bobryshev YV. Artery wall damage and platelet uptake from so-called atraumatic arterial clamps: an experimental study. Cardiovasc Surg. 1997;5(1):42-7. http://dx.doi.org/10.1016/S0967-2109(96)00064-6. PMid:9158122.

7 Borges LF, Gutierrez PS, Marana HR, Taboga SR. Picrosirius polarization staining method as an efficient histopathological tool for collagenolysis detection in vesical prolapse lesions. Micron. 2007;38(6):580-3. http://dx.doi.org/10.1016/j.micron.2006.10.005. PMid:17126553.

8 Jaldin RG, Castardelli É, Perobelli JE, et al. Morphologic and biomechanical changes of thoracic and abdominal aorta in a rat model of cigarette smoke exposure. Ann Vasc Surg. 2013;27(6):791-800. http://dx.doi.org/10.1016/j.avsg.2013.03.002. PMid:23880458.

9 Loh CS, Al-Jafari MS, Croton R. Acute rupture of the abdominal aorta from cross-clamp injury. Eur J Vasc Surg. 1990;4(6):647-8. http://dx.doi.org/10.1016/S0950-821X(05)80824-2. PMid:2279578.

10 Chen HY, Navia JA, Shafique S, Kassab GS. Fluid-structure interaction in aortic cross-clampig:implications for vessel injury. J Biomech. 2010;43(2):221-7. http://dx.doi.org/10.1016/j.jbiomech.2009.08.042. PMid:19883917.

11 Dobrin PB, McGurrin JF, McNulty JA. Chronic histologic changes after vascular clamping are not associated with altered vascular mechanics. Ann Vasc Surg. 1992;6(2):153-9. http://dx.doi.org/10.1007/BF02042737. PMid:1599834.

12 Thompson MM, Nasim A, Sayers RD, et al. Oxygen free radical and cytokine generation during endovascular and conventional aneurysm repair. Eur J Vasc Endovasc Surg. 1996;12(1):70-5. http://dx.doi.org/10.1016/S1078-5884(96)80278-4. PMid:8696901.

13 Malina M, Veith F, Ivancev K, Sonesson B. Balloon occlusion of the aorta during endovascular repair of ruptured abdominal aortic aneurysm. J Endovasc Ther. 2005;12(5):556-9. http://dx.doi.org/10.1583/05-1587.1. PMid:16212455.

14 Sincos IR, Aun R, Silva ES, et al. Impact of stent-graft oversizing on the thoracic aorta: experimental study in a porcine model. J Endovasc Ther. 2011;18(4):576-84. http://dx.doi.org/10.1583/11-3470.1. PMid:21861750.

15 Matsuda H, Tanaka Y, Hino Y, et al. Transbrachial arterial insertion of aortic occlusion balloon catheter in patients with shock from ruptured abdominal aortic aneurysm. J Vasc Surg. 2003;38(6):1293-6. http://dx.doi.org/10.1016/S0741-5214(03)00774-2. PMid:14681630.

16 Batchelor WB, Robinson R, Strauss BH. The extracellular matrix in balloon arterial injury: a novel target for restenosis prevention. Prog Cardiovasc Dis. 1998;41(1):35-49. http://dx.doi.org/10.1016/S0033-0620(98)80021-2. PMid:9717858.

17 Keris V, Ozolanta I, Enina G, Kasyanovs V, Aide H, Bricis R. Biomechanical and structure assessment of transluminal angioplasty. Med Eng Phys. 1998;20(5):339-46. http://dx.doi.org/10.1016/S1350-4533(98)00032-0. PMid:9773687.

18 Bertanha M, Moroz A, Jaldin RG, et al. Morphofunctional characterization of decellularized vena cava as tissue engineering scaffolds. Exp Cell Res. 2014;326(1):103-11. http://dx.doi.org/10.1016/j.yexcr.2014.05.023. PMid:24929113.

19 Cerqueira NF, Yoshida WB, Müller SS, Sequeira JL, Rodrigues AC, Padovani CR. Morphological and biomechanical study of abdominal aorta of rats submitted to experimental chronic alcoholism. Acta Cir Bras. 2005;20(3):213-8. http://dx.doi.org/10.1590/S0102-86502005000300004. PMid:16033179.

20 Yoshida WB, Müller SS, Carvalho I, Fabris VE, Naresse LE, Maffei FHA. Tensile strengthand histological changes of abdominal aorta of malnourished rats. Cardiovasc Surg. 1995;3(4):437-9. http://dx.doi.org/10.1016/0967-2109(95)94165-S. PMid:7583001.

21 Suk P, Cundrle I Jr, Hruda J, et al. Porcine model of ruptured abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2012;43(6):698-704. http://dx.doi.org/10.1016/j.ejvs.2012.02.020. PMid:22421373.

22 Martín-Cancho MF, Sánchez-Margallo FM, Soria F, et al. Physiological responses to different ischemic periods during laparoscopic infrarenal aortic cross-clamping: evaluation in an experimental animal model. Ann Vasc Surg. 2009;23(4):506-18. http://dx.doi.org/10.1016/j.avsg.2008.12.002. PMid:19375889.

23 Martin-Cancho MF, Crisostomo V, Soria F, et al. Physiologic responses to infrarenal aortic cross-clamping during laparoscopic or conventional vascular surgery in experimental animal model: comparative study. Anesthesiol Res Pract. 2008;581948:1-8. http://dx.doi.org/10.1155/2008/581948. PMid:21197458.

24 Alric P, Ryckwaert F, Branchereau P, Marty-Ane C, Mary H, Colson P. A porcine model of systemic and renal haemodynamic responses to infrarenal aortic cross-clamping. Eur J Vasc Endovasc Surg. 2003;25(1):72-8. http://dx.doi.org/10.1053/ejvs.2002.1789. PMid:12525815.

25 Gutierrez PS, Reis MM, Higuchi ML, Aiello VD, Stolf NAG, Lopes EA. Distribution of hyaluronan and dermatan/chondroitin sulfate proteoglycans in human aortic dissection. Connect Tissue Res. 1998;37(3-4):151-61. http://dx.doi.org/10.3109/03008209809002435. PMid:9862217.

26 Taghizadeh N, Vonk JM, Boezen HM. Lifetime smoking history and cause-specific mortality in a cohort study with 43 years of follow-up. PLoS One. 2016;11(4):e0153310. http://dx.doi.org/10.1371/journal.pone.0153310. PMid:27055053.

27 Steele PM, Chesebro JH, Stanson AW, et al. Balloon angioplasty. Natural history of the pathophysiological response to injury in a pig model. Circ Res. 1985;57(1):105-12. http://dx.doi.org/10.1161/01.RES.57.1.105. PMid:3159504.

28 Consigny PM, Tulenko TN, Nicosia RF. Immediate and long-term effects of angioplasty-balloon dilation on normal rabbit iliac artery. Arteriosclerosis. 1986;6(3):265-76. http://dx.doi.org/10.1161/01.ATV.6.3.265. PMid:2939818.

29 Savlovskis J, Krievins D, de Vries J-PPM, et al. Artic neck enlargement after endovascular aneurysm repair using balloon-expandable versus self-expanding endografts. J Vasc Surg. 2015;62(3):541-9. http://dx.doi.org/10.1016/j.jvs.2015.04.393. PMid:26213274.

30 Ribeiro MAF Jr, Feng CYD, Nguyen ATM, et al. The complications associated with Ressuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). World J Emerg Surg. 2018;13(1):20-5. http://dx.doi.org/10.1186/s13017-018-0181-6. PMid:29774048.

31 Polindara C, Waffenschmidt T, Menzel A. Simulation of balloon angioplasty in residually stressed blood vessels-Application of a gradient-enhanced fibre damage model. J Biomech. 2016;49(12):2341-8. http://dx.doi.org/10.1016/j.jbiomech.2016.01.037. PMid:26924658.

32 Zubilewicz T, Wronski J, Bourriez A, et al. Injury in vascular surgery--the intimal hyperplastic response. Med Sci Monit. 2001;7(2):316-24. PMid:11257743.

33 Barone GW, Cornely JM, Flagagan TL, Kron IL. Assessing clamp related vascular injuries by measurement of associated vascular dysfunction. Surgery. 1989;105(4):465-71. PMid:2648627.

34 Sassani SG, Kakisis J, Tsangaris S, Sokolis DP. Layer-dependent wall properties of abdominal aortic aneurysms: Experimental study and material characterization. J Mech Behav Biomed Mater. 2015;49:141-61. http://dx.doi.org/10.1016/j.jmbbm.2015.04.027. PMid:26011656.

35 Taghizadeh H, Tafazzoli-Shadpour M. Characterization of mechanical properties of lamellar structure of the aortic wall: effect of aging. J Mech Behav Biomed Mater. 2017;65:20-8. http://dx.doi.org/10.1016/j.jmbbm.2016.08.011. PMid:27544616.

36 Babin-Ebell J, Gimpel-Henning K, Sievers H-H, Scharfschwerdt M. Influence of clamp duration and pressure on endothelial damage in aortic cross-clamping. Interact Cardiovasc Thorac Surg. 2010;10(2):168-71. http://dx.doi.org/10.1510/icvts.2009.220996. PMid:19934161.

37 Dobrin PB, McGurrin JF, McNulty JA. Chronic histologic changes after vascular clamping are not associated with altered vascular mechanics. Ann Vasc Surg. 1992;6(2):153-9. http://dx.doi.org/10.1007/BF02042737. PMid:1599834.
 

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