Pseudoaneurysm formation in a subset of patients with small intestinal submucosa biologic patches after carotid endarterectomy

Robert A. McCready, Jason Hodde, Randy J. Irwin, Arthur C. Coffey, Janet L. Divelbiss, M. Ann Bryant, Richard W. Chitwood, Douglas S. Paget, Bart A. Chess

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: The carotid artery is frequently patched after carotid endarterectomy (CEA) to minimize the risks of early postoperative thrombosis and late recurrent stenosis. The small intestinal submucosa (SIS) patch is a biologic vascular patch derived from porcine small intestine. It is composed primarily of cell-free collagen and other extracellular matrix constituents that act as a scaffold for host cell deposition. Methods: In May 2001, we began an investigational trial of SIS patches in 76 patients undergoing patch angioplasty of the carotid artery after CEA. Results: No adverse events related to the patches were observed in the first 69 patients implanted with an SIS patch. However, in late 2002, seven patients were found to have asymptomatic pseudoaneurysms (PSA) by duplex imaging ≤10 weeks after their CEAs. The trial was immediately suspended. The PSAs were treated by surgical resection with vein grafting in two patients and placement of covered endoluminal stents in four patients. One patient is being followed as the PSA is small and has remained stable. Histopathologic examination of the SIS patch explanted from one of the surgically treated patients demonstrated the presence of actin-positive myofibroblasts or smooth muscle cells. Extensive mechanical testing of the SIS material from the two material lots associated with PSAs demonstrated thinner and more variable physical characteristics compared with control device lots. Conclusions: Biologic patches that undergo active remodeling in the carotid artery require greater thickness than was anticipated to decrease wall stress and suture hole elongation. Patches exceeding this minimum thickness will be required to ensure the safety of new SIS patch designs for vascular operations.

Original languageEnglish (US)
Pages (from-to)782-788
Number of pages7
JournalJournal of Vascular Surgery
Volume41
Issue number5
DOIs
StatePublished - May 2005
Externally publishedYes

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Carotid Endarterectomy
False Aneurysm
Carotid Arteries
Blood Vessels
Myofibroblasts
Angioplasty
Sutures
Small Intestine
Smooth Muscle Myocytes
Stents
Extracellular Matrix
Actins
Veins
Pathologic Constriction
Thrombosis
Swine
Collagen
Safety
Equipment and Supplies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

McCready, R. A., Hodde, J., Irwin, R. J., Coffey, A. C., Divelbiss, J. L., Bryant, M. A., ... Chess, B. A. (2005). Pseudoaneurysm formation in a subset of patients with small intestinal submucosa biologic patches after carotid endarterectomy. Journal of Vascular Surgery, 41(5), 782-788. https://doi.org/10.1016/j.jvs.2005.02.035

Pseudoaneurysm formation in a subset of patients with small intestinal submucosa biologic patches after carotid endarterectomy. / McCready, Robert A.; Hodde, Jason; Irwin, Randy J.; Coffey, Arthur C.; Divelbiss, Janet L.; Bryant, M. Ann; Chitwood, Richard W.; Paget, Douglas S.; Chess, Bart A.

In: Journal of Vascular Surgery, Vol. 41, No. 5, 05.2005, p. 782-788.

Research output: Contribution to journalArticle

McCready, RA, Hodde, J, Irwin, RJ, Coffey, AC, Divelbiss, JL, Bryant, MA, Chitwood, RW, Paget, DS & Chess, BA 2005, 'Pseudoaneurysm formation in a subset of patients with small intestinal submucosa biologic patches after carotid endarterectomy', Journal of Vascular Surgery, vol. 41, no. 5, pp. 782-788. https://doi.org/10.1016/j.jvs.2005.02.035
McCready, Robert A. ; Hodde, Jason ; Irwin, Randy J. ; Coffey, Arthur C. ; Divelbiss, Janet L. ; Bryant, M. Ann ; Chitwood, Richard W. ; Paget, Douglas S. ; Chess, Bart A. / Pseudoaneurysm formation in a subset of patients with small intestinal submucosa biologic patches after carotid endarterectomy. In: Journal of Vascular Surgery. 2005 ; Vol. 41, No. 5. pp. 782-788.
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AU - Hodde, Jason

AU - Irwin, Randy J.

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AU - Divelbiss, Janet L.

AU - Bryant, M. Ann

AU - Chitwood, Richard W.

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