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A proportion of superficial capillaries in joint synovium are known to be fenestrated. The specialized functions of these fenestrated capillaries are unknown. We report the finding of fenestrae in tenosynovial capillaries from rabbit peroneal tendon sheaths. Fenestrations occupied 0.66% of the endothelial surface. Fenestrated capillaries appear to be a general feature of synovium, rather than a specific feature of joint tissue.
OBJECTIVE AND IMPORTANCE: The preservation of oculomotor nerves is one of the most significant issues regarding the resection of meningiomas around the cavernous sinus. CLINICAL PRESENTATION: We report the case of a patient whose oculomotor nerve was fenestrated, caused by a large meningioma around the cavernous sinus. The nerve function remained intact until surgery. INTERVENTION: During surgery, one trunk of the fenestrated nerve behind the tumor was sacrificed. The fenestrated shape of the nerve led us to the misjudgment that the preserved other trunk located along the upper margin of the tumor was the whole nerve. CONCLUSION: Although fenestrated oculomotor nerves may be rare, their possibility should be kept in mind during surgery around the cavernous sinus.
OBJECTIVE AND IMPORTANCE: A rare case of an aneurysm arising at the fenestration of the P2 segment of the posterior cerebral artery is reported. CLINICAL PRESENTATION: A 37-year-old man presented with severe headache and disturbance of consciousness. Computed tomographic scanning showed diffuse subarachnoid hemorrhage. Cerebral angiography revealed an aneurysm at the fenestration of the P2 segment of the right posterior cerebral artery. The aneurysm was located at the middle portion of the lower trunk of the fenestration. An unruptured arteriovenous malformation was incidentally found in the right thalamus. INTERVENTION: A right frontotemporal craniotomy with orbitozygomatic osteotomy was made, and the aneurysm was successfully clipped. One year after the operation, gamma knife surgery was performed for the right thalamic arteriovenous malformation. CONCLUSION: This is the first reported case of an aneurysm originating from the middle portion of a fenestrated posterior cerebral artery.
To determine the effect of peripherally fenestrated contact lenses on central corneal edema, 6 subjects (12 eyes) wore steeply fitted lenses of identical dimensions but with various numbers of 0.1-mm diameter peripheral fenestrations for 3-hr periods. At the end of the wearing periods, thickening, steepening, and central clouding of the cornea were generally reduced as the number of fenestrations was increased. However, 20 fenestrations were required before the edema was reduced to a clinically acceptable level.
Nine subjects wore fenestrated and unfenestrated soft contact lenses for 6-hr periods. The lenses worn in the experimental eye were fenestrated with four, 0.80-mm holes, located in the midperipheral region of the lens. THe corneal swelling was monitored with a biomicroscope and pachometer and the fenestrations significantly reduced the corneal swelling compared with the same lens worn prior to fenestration.
STUDY DESIGN: Retrospective comparative study of the postoperative subsidence of two interbody devices following posterior or transforaminal lumbar interbody fusion (PLIF/TLIF) for degenerative spondylolisthesis of the lumbar spine. OBJECTIVE: To assess certain radiograph characteristics of PLIF/TLIF using two interbody fusion devices at L4-L5. SUMMARY OF BACKGROUND DATA: PLIF can achieve spinal stabilization with vertebral body support and direct neural decompression. Although various interbody devices have been used in PLIF procedures, no radiographic studies have compared the load-bearing capabilities of open box and fenestrated tube interbody cages. METHODS: Seventy-five patients who underwent one-level PLIF in the L4-L5 [corrected] segment for degenerative spondylolisthesis were retrospectively reviewed with a minimum 2-year follow-up. Fenestrated tube (Group FT: n = 30 [corrected]) or open box (Group OB: n = 45 [corrected]) cages were used for the PLIF procedure. The following radiographic parameters were evaluated to compare the load-bearing capabilities: disc space height (DH); percent increase and decrease of disc height (% IDH and % DDH, respectively); and percent coverage of the cage on the endplate (% CC). RESULTS: There were no significant differences in the baseline data, including age, segmental instability and osteoporotic status, between the two groups. Anterior %IDH and % CC were significantly higher in Group OB than in Group FT (% IDH: 69.4% vs. 57.3%; % OC: 24.5% vs. 12.9%), and anterior and posterior % DDH were significantly higher in Group FT than in Group OB (anterior: -2.9% vs. -.1%; posterior: -6.6% vs. -.3%). Although the restored DH gradually reduced over time in both groups, significant reduction to the preoperative level only occurred in Group FT. CONCLUSIONS: The load-bearing capabilities of the open box cage are superior to those of the fenestrated tube cage. Since there were no significant differences between the baseline status of the two groups, the larger cross-sectional area and stable framework design of the open box cage appears to bring about a greater load-bearing capability. Therefore, the open box cage seems to be biomechanically more advantageous as an interbody device for PLIF than the fenestrated tube cage.
The purpose of this clinical study was to evaluate the usefulness of laparoscopic fenestration of symptomatic liver cysts. Between September 1996 and September 2001, 6 patients underwent laparoscopic fenestration for symptomatic hepatic cysts. All 6 patients were women. The mean age was 59.5 (range 40-74). Two patients had single and 4 had multiple cysts. The mean diameter of the lesions, measured by preoperative computed tomography (CT), was 16.8 cm (range 10-20). The indications for surgical treatment included abdominal fullness associated with pain or dyspepsia. The surgical procedure involved puncture and aspiration of the cyst and subsequent circular electroresection of the cystic wall. Laparoscopic fenestration was successfully done in all 6 patients. The operating time was 148 minutes (range 110-215). Mean blood loss was 93 mL (range 5-300). Histologic examination of the cyst wall showed 5 simple cysts and 1 papillary serous cystadenoma. There were no intraoperative or postoperative complications. The mean hospital stay after surgery was 4.3 days (range 3-5). Complete relief of symptoms was achieved in 5 patients during the postoperative follow-up (range 2-6 years, mean 4). Follow-up CT (1 month to 4 years) has shown regression of the cysts in all patients (mean 3.8 cm, range 2-8). Laparoscopic fenestration of symptomatic liver cysts is a simple and effective method to relieve symptoms with minimal surgical trauma.
Vascular endothelial growth factor (VEGF) is an important regulator of vasculogenesis and vascular permeability. Hepatic sinusoidal endothelial cells (SECs) possess sieve-like pores that form an anastomosing labyrinth structure by the deeply invaginated plasma membrane. Caveolin is the principal structural protein in caveolae. In this study, we examined the role of VEGF on the fenestration and permeability of SECs and the relation with caveolin-1. SECs isolated from rat livers by collagenase infusion method were cultured for 24 h with (10 or 100 ng/ml) or without VEGF. The cells were then examined by transmission and scanning electron microscopy (EM). The expression of caveolin was investigated by confocal immunofluorescence, immunogold EM, and Western blot. Endocytosis and intracellular traffic was studied using horseradish peroxidase (HRP) reaction as a marker of fluid phase transport in SECs. Both transmission and scanning EM showed an increased number of sinusoidal endothelial fenestrae (SEF) in SECs cultured with VEGF. By confocal immunofluorescence, SECs cultured with VEGF displayed prominent caveolin-l-positive aggregates in the cytoplasm, especially surrounding the nucleus region. Immunogold EM depicted increased caveolin-1 reactivity on vesicles and vacuoles of VEGF-treated SECs compared with VEGF-nontreated cells. However, there was no change in the level of caveolin-1 protein expression on Western blot. After HRP injection, an increase of electron-dense tracer filled the SEF in cells treated with VEGF. Our results suggested that VEGF induced fenestration in SECs, accompanied by an increased number of caveolae-like vesicles. Increased caveolin-1 might be associated with vesicle formation but not with fenestration. Increased fenestration may augment hepatic sinusoidal permeability and transendothelial transport.
The incidence and distribution of alveolar fenestrations and dehiscences and their association with root prominence and occlusal faceting were investigated in 87 dry Bedouin jaws derived from the region of the southern Negev. Fenestrations were most frequently found in maxillary molars and canines and mandibular canines and lateral incisors. Dehiscences were most consistently observed in mandibular canines and first premolars. Maxillary fenestrations were consistently found in the apical half of the root length as were 60% of mandibular fenestrations.
Interstitial flow through the subendothelial intima and media of an artery wall was simulated numerically to investigate the water flow distribution through fenestral pores which affects the wall shear stress on smooth muscle cells right beneath the internal elastic lamina (IEL). A two-dimensional analysis using the Brinkman model of porous media flow was performed. It was observed that the hydraulic permeability of the intimal layer should be much greater than that of the media in order to predict a reasonable magnitude for the pressure drop across the subendothelial intima and IEL (about 23 mostly at a 70 mm Hg luminal pressure). When Ki was set equal to the value in the media, this pressure drop was unrealistically high. Furthermore, the higher value of Ki produced a nearly uniform distribution of water flow through a simple array of fenestral pores all having the same diameters (1.2 microm), whereas when Ki was set at the value in the media, the flow distribution through fenestral pores was highly nonuniform and nonphysiologic. A deformable intima model predicted a nonuniform flow distribution at high pressure (180 mm Hg). Damage to the IEL was simulated by introducing a large fenestral pore (up to 17.8 microm) into the array. A dramatic increase in flow through the large pore was observed implying an altered fluid mechanical environment on the smooth muscle cells near the large pore which has implications for intimal hyperplasia and atherosclerosis. The model also predicted that the fluid shear stress on the bottom surface of an endothelial cell is on the order of 10 dyne/cm2, a level which can affect cell function.
Previous studies showed the existence of submesothelial fenestrated capillaries in the human parietal and rabbit diaphragmatic peritoneum, as well as in the mouse mesentery. The present study demonstrates the presence of electronegative fixed charges at the luminal aspect of endothelial cells, as well as long the subendothelial basement membrane of the fenestrated capillaries of the mouse mesentery. This situation will eventually preclude the transfenestral passage of anionic plasma proteins. On the other hand, fenestrated capillaries are much more permeable to water and small-molecular-size solutes than those of the continuous type. Therefore, the high hydraulic conductivity of fenestrae may well imply that a substantial part of water and small solutes leave the blood compartment through the fenestral channels.
BACKGROUND: Aortic dissection with branch obstruction is associated with high morbidity and mortality. Fenestration of the dissection flap to relieve distal vessel ischemia is at present largely performed surgically. The surgical mortality and morbidity are high, because most patients are poor candidates for anesthesia or surgery. METHODS AND RESULTS: Nine percutaneous fenestrations (one with additional stenting of the infrarenal true aortic lumen) were performed under local anesthesia in seven patients with aortic dissection. The presenting symptoms were abdominal angina or claudication. By the transfemoral approach, the intimal flap was initially punctured with a needle-catheter combination through which a guidewire was placed across the dissection flap. The fenestration was carried out with a balloon catheter introduced over the guidewire. The procedure was performed under on-line guidance with intravascular ultrasound imaging. The procedure was performed successfully and without complications in all patients. After intervention, symptoms resolved in all seven patients. CONCLUSIONS: Intravascular ultrasound-guided percutaneous fenestration of the intimal flap in symptomatic aortic dissections with distal vessel involvement is a technically feasible and safe procedure that can effectively relieve the patient's symptoms.
Several endothelial growth factors induce both blood and lymphatic angiogenesis. However, a systematic comparative study of the impact of these factors on vascular morphology and function has been lacking. In this study, we report a quantitative analysis of the structure and macromolecular permeability of FGF-2-, VEGF-A-, and VEGF-C-induced blood and lymphatic vessels. Our results show that VEGF-A stimulated formation of disorganized, nascent vasculatures as a result of fusion of blood capillaries into premature plexuses with only a few lymphatic vessels. Ultrastructural analysis revealed that VEGF-A-induced blood vessels contained high numbers of endothelial fenestrations that mediated high permeability to ferritin, whereas the FGF-2-induced blood vessels lacked vascular fenestrations and showed only little leakage of ferritin. VEGF-C induced approximately equal amounts of blood and lymphatic capillaries with endothelial fenestrations present only on blood capillaries, mediating a medium level of ferritin leakage into the perivascular space. No endothelial fenestrations were found in FGF-2-, VEGF-A-, or VEGF-C-induced lymphatic vessels. These findings highlight the structural and functional differences between blood and lymphatic vessels induced by FGF-2, VEGF-A, and VEGF-C. Such information is important to consider in development of novel therapeutic strategies using these angiogenic factors.
PURPOSE: To report an unusual case of endovascular abdominal aortic aneurysm (AAA) exclusion in which a fenestrated stent-graft was used to seal a proximal Type I endoleak. METHODS AND RESULTS: An 84-year-old man with a 6.0-cm AAA underwent an aortomonoiliac aneurysm exclusion procedure that was complicated by a proximal endoleak. Because the patient had no right kidney, an additional stent-graft was designed to cover the right renal artery stump while preserving left renal perfusion through a fenestration in the graft material. This approach was successful in obliterating the endoleak around the proximal attachment site, but flow through the lumbar arteries remained. CONCLUSIONS: The use of a fenestrated stent-graft is feasible, but the type of fenestration in this case has limited applicability owing to the rarity of patients with suitable anatomy.
The development of endovascular devices to treat aneurysms that abut or involve the visceral vessels has occurred in an effort to reduce the significant procedural morbidity and mortality associated with conventional repair. To accomplish this, three systems have been trialed. The first technique was developed to treat juxtarenal aneurysms and involves the placement of customized fenestrations strategically placed within the fabric of the graft. These are aligned with the ostia of the visceral vessels incorporated by the repair and supplemented by the placement of a balloon expandable stent. In a similar fashion, aneurysms that involve the visceral vessels can be treated with a fenestrated graft where the fenestration is reinforced with a nitinol ring. This is then mated with a balloon-expandable stentgraft, allowing the devices to seal at the level of the nitinol ring. An alternative means of incorporating the visceral vessels is to use directional branches where one or more additional limbs (typically 8 mm) are anastomosed to the aortic graft, through which access into the visceral vessel is attained. Mating stentgrafts for the later design can be of a self-expanding or balloon expandable nature. The experience with fenestrated devices is mature and associated with a low perioperative mortality (<2%) without many long-term complications. The treatment of thoracoabdominal aneurysms with branches has provided us with optimism regarding the technique, but results are only short term in nature. Further device development is ongoing and dissemination of this technology is now occurring in Europe, Australia and Canada.
Three weeks after an automobile accident, a 35-year-old man experienced left throat and neck pain, numbness of the left face and tongue, dysphagia, left arm pain and weakness, and left miosis. At age 27, he had suffered an aneurysmal subarachnoid hemorrhage. Angiography at that time had also demonstrated a fenestration of the left intracranial vertebral artery. At the time of the second presentation, angiography showed that one of the limbs of the fenestration had become occluded. Although the vast majority of intracranial arterial fenestrations are asymptomatic, occlusion of one of the limbs of a fenestration may be the cause of stroke.
Two cases of aneurysm occurring on a fenestrated basilar artery are reported. One patient had a saccular aneurysm in the typical location at the vertebrobasilar junction at the proximal end of the fenestrated basilar segment. The aneurysm sac projected dorsally into the brain stem. The other patient had a blister-like aneurysm distal to a fenestration of the terminal basilar artery. The development of a distal aneurysm on a fenestrated basilar artery is predictable based on the reported morphology of the vessel wall in this vascular anomaly.
The vascular endothelial growth factor (VEGF) was originally described as vascular permeability factor due to its ability to increase microvascular permeability to plasma proteins. However, the vessel types (arteriolar, venular, and capillary) affected by VEGF and the modification of endothelial morphology in response to increased permeability induced by VEGF in vivo have not been precisely documented. By topical application or intradermal injection of recombinant human VEGF-165 we find that VEGF increases the permeability of postcapillary venules as well as muscular venules and capillaries. Surprisingly, we also find that endothelia of small venules and capillaries become fenestrated within 10 minutes of VEGF application. Fenestrations appeared in vascular beds which do not normally have fenestrated endothelium, namely the cremaster muscle and skin. Histamine, saline, and heat-inactivated VEGF do not cause fenestrations. Increased permeability is completely inhibited when VEGF is cleared by immunoprecipitation with anti-VEGF monoclonal antibodies. The VEGF effect on permeability is unlike that of any other mediator described to date since both muscular venules and capillaries are affected.