Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.
Department of Pathology, Stanford University, Stanford, CA, USA.
J Vasc Access. 2024 Jul;25(4):1180-1186. doi: 10.1177/11297298231153716. Epub 2023 Feb 10.
Central venous catheters (CVCs) are often trimmed during heart transplantation and pediatric cardiac surgery. However, the risk of endothelial injury caused by the cut tip of the CVC has not been evaluated. We hypothesized that there is no difference in the degree of endothelial injury associated with trimmed CVCs versus standard untrimmed CVCs.
In four adult male sheep, the left external jugular vein was exposed in three segments, one designated for an untouched control group, one for the trimmed CVC group, and one for the untrimmed CVC group. Trimmed and untrimmed CVC tips were rotated circumferentially within their respective segments to abrade the lumen of the vein. The vein samples were explanted, and two representative sections from each sample were analyzed using hematoxylin and eosin (H&E) staining, as well as with immunohistochemistry against CD31, von Willebrand factor (vWF), endothelial nitric oxide synthase (eNOS), and caveolin. Higher immunohistochemical stain distributions and intensities are associated with normal health and function of the venous endothelium. Data are presented as counts with percentages or as means with standard error.
H&E staining revealed no evidence of endothelial injury in 6/8 (75%) samples from the untouched control group, and no injury in 4/8 (50%) samples from both the trimmed and untrimmed CVC groups ( = 0.504). In all remaining samples from each group, only mild endothelial injury was observed. Immunohistochemical analysis comparing trimmed CVCs versus untrimmed CVCs revealed no difference in the percentage of endothelial cells staining positive for CD31 (57.5% ± 7.2% vs 55.0% ± 9.2%, = 0.982), vWF (73.8% ± 8.0% vs 62.5% ± 9.6%, = 0.579), eNOS (66.3% ± 4.2% vs 63.8% ± 7.5%, = 0.962), and caveolin (53.8% ± 5.0% vs 51.3% ± 4.4%, = 0.922). There were no significant differences between the groups in the distributions of stain intensity for CD31, vWF, eNOS, and caveolin.
Trimmed CVCs do not increase endothelial injury compared to standard untrimmed CVCs.
中心静脉导管（CVC）在心脏移植和儿科心脏手术中经常被修剪。然而，CVC 尖端切割引起的内皮损伤风险尚未得到评估。我们假设修剪后的 CVC 与标准未修剪的 CVC 相比，内皮损伤程度没有差异。
在四只成年雄性绵羊中，暴露左侧颈外静脉的三个节段，一个指定为未受影响的对照组，一个为修剪的 CVC 组，一个为未修剪的 CVC 组。修剪和未修剪的 CVC 尖端在各自的节段内旋转以磨损静脉管腔。取出静脉样本，对每个样本的两个代表性切片进行苏木精和伊红（H&E）染色以及免疫组织化学分析，针对 CD31、血管性血友病因子（vWF）、内皮型一氧化氮合酶（eNOS）和 caveolin。较高的免疫组织化学染色分布和强度与静脉内皮的正常健康和功能相关。数据以计数和百分比或平均值和标准误差表示。
H&E 染色显示，未受影响的对照组的 6/8（75%）样本中没有内皮损伤的证据，修剪和未修剪的 CVC 组的 4/8（50%）样本中也没有损伤（=0.504）。在每组的所有其余样本中，仅观察到轻微的内皮损伤。比较修剪的 CVC 与未修剪的 CVC 的免疫组织化学分析显示，CD31（57.5%±7.2% vs 55.0%±9.2%，=0.982）、vWF（73.8%±8.0% vs 62.5%±9.6%，=0.579）、eNOS（66.3%±4.2% vs 63.8%±7.5%，=0.962）和 caveolin（53.8%±5.0% vs 51.3%±4.4%，=0.922）阳性的内皮细胞百分比没有差异。CD31、vWF、eNOS 和 caveolin 的染色强度分布在组间没有显著差异。
与标准未修剪的 CVC 相比，修剪的 CVC 不会增加内皮损伤。
