Nerve Growth Factor Promotes Angiogenesis and Skeletal Muscle Fiber Remodeling in a Murine Model of Hindlimb Ischemia

Background： Therapeutic angiogenesis has been shown to promote blood vessel growth and improve tissue perfusion.Nerve growth factor （NGF） has been reported to play an important role in both physiological and pathological angiogenesis.This study aimed to investigate the effects of NGF on angiogenesis and skeletal muscle fiber remodeling in a murine model of hindlimb ischemia and study the relationship between NGF and vascular endothelial growth factor （VEGF） in angiogenesis.Methods： Twenty-four mice were randomly allocated to normal control group （n =6）, blank control group （n =6）, VEGF gene transfection group （n =6）, and NGF gene transfection group （n =6）.The model of left hindlimb ischemia model was established by ligating the femoral artery.VEGF165 plasmid （125 μg） and NGF plasmid （125 μg） was injected into the ischemic gastrocnemius of mice from VEGF group and NGF group, respectively.Left hindlimb function and ischemic damage were assessed with terminal points at 21th day postischemia induction.The gastrocnemius of four groups was tested by hematoxylin-eosin staining, proliferating cell nuclear antigen and CD34 immunohistochemistry staining, and myosin ATPase staining.NGF and VEGF protein expression was detected by enzyme-linked immunosorbent assay.Results： On the 21th day after surgery, the functional assessment score and skeletal muscle atrophy degree of VEGF group and NGF group were significantly lower than those of normal control group and blank control group.The endothelial cell proliferation index and the capillary density of VEGF group and NGF group were significantly increased compared with normal control group and blank control group （P 〈 0.05）.The NGF and VEGF protein expression of NGF group showed a significant rise when compared with blank control group （P 〈 0.05）.Similarly, the VEGF protein expression of VEGF group was significantly higher than that of blank control group （P 〈 0.05）, but there was no significant difference of the NGF protein expression between VEGF group and blank control group （P 〉 0.05）.The type Ⅰ skeletal muscle fiber proportion in gastrocnemius of NGF group and VEGF group was significantly higher than that of blank control group （P 〈 0.05）.Conclusions： NGF transfection can promote NGF and VEGF protein expression which not only can induce angiogenesis but also induce type Ⅰ muscle fiber expression in ischemic limbs.

Outcomes of Chimney and/or Periscope Techniques in the Endovascular Management of Complex Aortic Pathologies

Background：The chimney/periscope technique has been used to address complex aortic pathologies.This study aimed to report the outcomes and experiences of chimney and/or periscope grafts （CPGs） used in the endovascular management of complex aortic pathologies.Methods：Twenty-two patients with complex aortic pathologies were retrospectively studied from January 2013 to August 2016 in two vascular centers of teaching hospitals.All patients were diagnosed using computed tomography angiography （CTA）.The patients were followed up at postoperative 1,3,6,and 12 months and yearly thereafter with X-ray,ultrasound,and/or CTA.Results：Twenty-two cases （17 males;mean age 60.7 ＆#177; 16.3 years） with complex aortic pathologies were analyzed.Nineteen patients underwent CPGs only,and the other three cases underwent the simultaneous implantation of chimney/periscope and fenestrated/scallop grafts.Twenty-six arteries were managed with forty CPGs during the procedures.Complete angiographies revealed two Type Ⅰ endoleaks,one Type Ⅲ endoleak,and one Type Ⅳ endoleak.Other intraoperative complications included brachial thrombosis,external iliac artery rupture,and left renal stenosis.The 30-day mortality was 0.The mean follow-up was 26.1 ＆#177; 10.1 months with a range of 2-39 months.During the follow-up,two Type Ⅰ endoleaks and one Type Ⅳ endoleak were observed.One right renal stent occlusion occurred in the 5th month and turned patent after reintervention.Three patients died during the follow-up,one due to an aneurysm rupture as a Type Ⅰ endoleak,and two due to myocardial infarction.The instant technical success was 96%.The primary and secondary patencies were 92%and 96%,respectively.The overall survival rates were 95%,84%,and 84% at 12,24,and 36 months,respectively.Stent migration was not observed in any patient.Conclusions：Chimney/periscope techniques could be used to tackle complex aortic pathologies,but the indications must be strictly controlled,and additional experiences are required.