Moritz A, Raderer F, Magometschnigg H, Trubel W, Ullrich R, Laufer G, Staudacher M
2nd Surgical Department, University of Vienna, Austria.
Thorac Cardiovasc Surg. 1992 Dec;40(6):356-60. doi: 10.1055/s-2007-1020180.
In general, dilated and varicose veins are not used as arterial bypass grafts despite their physiological endothelial lining. A uniform small diameter may be achieved by inserting such veins into mesh tubes. To test the degree to which dilated veins can be constricted without forming folds, in-vitro and experimental investigations were performed before such composites were used for clinical reconstructive surgery. Ovine jugular veins with a diameter of 15 mm were inserted into 6 mm tubes. After casting in paraffin wax none of the specimens showed folds on the flow surface. In 12 sheep pairs of mesh-constricted jugular veins and native femoral veins were implanted as femoropopliteal bypass grafts. Six animals were killed at 6 months and 6 at one year. All bypasses remained patent and none showed signs of obstruction caused by folds or anastomotic hyperplasia at angiographic control. Intimal hyperplasia was significantly reduced from 416 +/- 143 microns in the midportion of native vein grafts to 231 +/- 76 microns (p = 0.0001 paired t-test) in constricted veins as well as at the anastomoses (358 +/- 256 microns vs. 180 +/- 73 microns; p = 0.008). Partially or totally mesh-tube-constricted varicose veins were used for infrainguinal reconstructions in 19 patients and for coronary revascularization in 3. All grafts showed an even calibration at control angiography. As constriction does not lead to internal folds, varicose or dilated veins may be used successfully as bypass grafts after insertion into mesh tubes. The external reinforcement reduces the intimal hyperplasia within the graft and also reduces anastomotic hyperplasia.
一般来说，尽管扩张和曲张静脉具有生理性内皮衬里，但不作为动脉搭桥移植物使用。将此类静脉插入网管中可获得均匀的小直径。为了测试扩张静脉在不形成褶皱的情况下能够被收缩的程度，在将此类复合材料用于临床重建手术之前进行了体外和实验研究。将直径为15毫米的羊颈静脉插入6毫米的管中。用石蜡包埋后，所有标本在血流表面均未显示褶皱。在12对绵羊中，将网状收缩颈静脉和天然股静脉作为股腘动脉搭桥移植物植入。6只动物在6个月时处死，6只在1年时处死。所有搭桥均保持通畅，在血管造影检查中均未显示由褶皱或吻合口增生引起的梗阻迹象。内膜增生从天然静脉移植物中部的416±143微米显著降低至收缩静脉以及吻合口处的231±76微米（配对t检验，p = 0.0001）（358±256微米对180±73微米；p = 0.008）。19例患者使用部分或完全网状管收缩的曲张静脉进行腹股沟下重建，3例用于冠状动脉血运重建。所有移植物在对照血管造影中均显示管径均匀。由于收缩不会导致内部褶皱，因此曲张或扩张静脉在插入网管后可成功用作搭桥移植物。外部加固减少了移植物内的内膜增生，也减少了吻合口增生。
