Tamaki M, Tamashiro M, Kamada Y, Koja K, Kusaba A
Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
Surg Today. 1999;29(7):614-25. doi: 10.1007/BF02482987.
We examined the microscopic features and distribution of collagens in the hyperplastic intima of arterially implanted autovein bypass grafts under conditions of a reduced blood flow with a poor distal outflow. Vascular anastomosis was made using 7-0 nonabsorbable polypropylene sutures (PP group), or absorbable polydioxanone sutures (PDS group). On the contralateral limb, an autovein bypass graft was performed under normal flow conditions (NF group). The thickness of the intima in the NF group was approximately 50 microm throughout the duration of the study, while in the PP and PDS groups, intimal hyperplasia progressed to 290+/-112 microm and 267+/-123 microm, respectively, at 13 months after grafting. Collagen accumulated significantly in both the PP and PDS groups; types IV and V collagen in particular increased considerably in the deep layer. Regardless of the suture materials, the progression of intimal hyperplasia was considered to be closely related to the poor distal outflow to be and caused by the proliferation of myofibroblasts and active production of collagen. The increase in types IV and V collagen, particularly in the deep layer of the hyperplastic intima, was due to development of numerous vasa vasora in this region.
我们研究了在远端血流减少且流出不畅的情况下，动脉植入自体静脉搭桥移植物增生内膜中胶原蛋白的微观特征和分布。血管吻合采用7-0不可吸收聚丙烯缝线（PP组）或可吸收聚二氧杂环己酮缝线（PDS组）。在对侧肢体上，在正常血流条件下进行自体静脉搭桥移植（NF组）。在整个研究期间，NF组内膜厚度约为50微米，而在PP组和PDS组中，移植后13个月时内膜增生分别进展至290±112微米和267±123微米。PP组和PDS组中胶原蛋白均显著积聚；尤其是IV型和V型胶原蛋白在深层大量增加。无论缝合材料如何，内膜增生的进展被认为与远端流出不畅密切相关，是由肌成纤维细胞增殖和胶原蛋白的活跃产生所致。IV型和V型胶原蛋白的增加，尤其是在增生内膜深层的增加，是由于该区域大量血管滋养管的形成。
