Hausegger Klaus A, Portugaller Horst, Macri Nicolas P, Tauss Josef, Schedlbauer Peter, Deutschmann Johannes, Stücklschweiger Georg, Stranzl Heidi
Department of Radiology, University Hospital Graz, Auenbruggerplatz 9, 8036 Graz, Austria.
Eur Radiol. 2003 Jul;13(7):1549-58. doi: 10.1007/s00330-002-1690-x. Epub 2002 Oct 31.
The aim of this study was to evaluate the healing response to a new commercially available ePTFE-covered stent graft used to create transjugular intrahepatic portosystemic shunts (TIPS) in an animal model with and without intraluminal irradiation. The study was designed for ten domestic normotensive pigs. The TIPS was created using a ePTFE-covered stent graft (Viatorr, Gore, Flagstaff, Ariz.). Five animals were scheduled for intraluminal irradiation with iridium 192 immediately after TIPS creation with a dosage of 18 Gy. Shunt venograms were performed every 2 weeks. Animals from the irradiated and non-irradiated group were killed at 2-week intervals. Maximum follow-up was planned for 8 weeks in each group, with two animals in reserve. Gross specimen evaluation and histological examination, including scanning electron microscopy, was performed. Two animals died from interventional complications. In the irradiation group, one shunt occlusion and one stenosis occurred after 2 weeks. The stenosis regressed until the end of the 8-week follow-up period and probably was caused by a resolving thrombus. In the non-irradiated group, no shunt dysfunction was observed. One animal died early due to encephalopathy. Histology revealed an increased inflammatory reaction in the irradiation group, a lesser degree of incorporation of the stent graft, and a lesser degree of endothelialization of the inner surface compared with the non-irradiated group. No significant foreign body reaction was found at any time in any of the animals. The Viatorr stent graft was well tolerated in the pig model. Intraluminal irradiation seemed to have an adverse effect on the healing response. The TIPS patency was prolonged in both the irradiated and non-irradiated group compared with data from the literature; however, seemingly better results were observed in the non-irradiated group.
本研究的目的是评估一种新的市售聚四氟乙烯（ePTFE）覆膜支架型人工血管在有或无腔内照射的动物模型中用于建立经颈静脉肝内门体分流术（TIPS）后的愈合反应。该研究设计用于十只家养血压正常的猪。使用ePTFE覆膜支架型人工血管（Viatorr，戈尔公司，弗拉格斯塔夫，亚利桑那州）建立TIPS。五只动物在TIPS建立后立即用铱192进行腔内照射，剂量为18 Gy。每2周进行一次分流静脉造影。照射组和未照射组的动物每隔2周处死。每组计划最大随访8周，保留两只动物备用。进行大体标本评估和组织学检查，包括扫描电子显微镜检查。两只动物死于介入并发症。在照射组，2周后发生1例分流闭塞和1例狭窄。狭窄在8周随访期结束时消退，可能是由溶解的血栓引起的。在未照射组，未观察到分流功能障碍。一只动物因脑病早期死亡。组织学显示，与未照射组相比，照射组炎症反应增加，支架型人工血管的整合程度较低，内表面内皮化程度较低。在任何动物的任何时间均未发现明显的异物反应。Viatorr支架型人工血管在猪模型中耐受性良好。腔内照射似乎对愈合反应有不利影响。与文献数据相比，照射组和未照射组的TIPS通畅时间均延长；然而，未照射组似乎观察到更好的结果。
