Matsuura John H, Black Kirby S, Levitt Adam B, Rosenthal David, Wellons Eric D, Fallon Michael T, Davenport Cynthia K, Goodman Christy L, Pagelsen Natalie D, Ollerenshaw Jeremy D
Department of Surgery, Atlanta Medical Center, Atlanta, GA, USA.
J Am Coll Surg. 2004 May;198(5):778-83. doi: 10.1016/j.jamcollsurg.2004.01.020.
One of the greatest challenges in hemodialysis access surgery is improving the durability of prosthetic grafts caused by structural deterioration. The depopulated bovine ureter SynerGraft (SG) (CryoLife, Inc) is a tissue-engineered vascular graft processed to remove the xenograft cells while maintaining an unfixed connective tissue matrix capable of autologous cell repopulation by the recipient.
Nineteen 6-mm diameter bovine ureter SG conduits were implanted in 12 dogs as arteriovenous grafts between the carotid artery and jugular vein (n = 11) or between the femoral artery and vein (n = 8). Performance of these biologic conduits was compared with that of 15 IMPRA (Bard) ePTFE grafts implanted in 9 dogs, including 9 arteriovenous grafts between the carotid artery and jugular vein and 6 femoral artery to femoral vein grafts. After 14 days, the grafts were accessed once weekly. Histologic and immunohistochemical analyses were performed on grafts explanted between 10 to 60 weeks.
The 6- and 12-month primary patency rates of the bovine SG were 72.6% and 58.6%, respectively, compared with 6- and 12-month primary patency for ePTFE conduits of 57.4% and 57.4%, respectively. None of the bovine SG grafts became infected, but synthetic conduits became infected within 54 days of implantation. At 10 weeks, bovine ureter SG conduit showed fibroblast cell migration and proliferation with incorporation into the surrounding subcutaneous tissue, and elongated cells expressing the contractile protein smooth muscle actin were also observed. After 24 weeks, procollagen synthesis was demonstrated in the fully colonized graft matrix. The ePTFE grafts had no evidence of cellular ingrowth and an absence of endothelium.
The bovine SG was appropriately remodeled to its host environment through an organized process of recellularization and neovascularization. The absence of infection, similar patency rates, and cell repopulation of the matrix warrant further investigation.
血液透析通路手术面临的最大挑战之一是提高因结构恶化导致的人工血管移植物的耐用性。去细胞牛输尿管SynerGraft（SG）（CryoLife公司）是一种组织工程血管移植物，经过处理去除了异种移植细胞，同时保留了未固定的结缔组织基质，能够由受体进行自体细胞再填充。
将19根直径6毫米的牛输尿管SG导管作为动静脉移植物植入12只犬体内，连接颈动脉和颈静脉（n = 11）或股动脉和股静脉（n = 8）。将这些生物导管的性能与植入9只犬体内的15根IMPRA（巴德）ePTFE移植物进行比较，其中包括9根颈动脉和颈静脉之间的动静脉移植物以及6根股动脉至股静脉移植物。14天后，每周对移植物进行一次穿刺。对在10至60周之间取出的移植物进行组织学和免疫组织化学分析。
牛SG的6个月和12个月初级通畅率分别为72.6%和58.6%，而ePTFE导管的6个月和12个月初级通畅率分别为57.4%和57.4%分别。牛SG移植物均未发生感染，但合成导管在植入后54天内发生感染。在10周时，牛输尿管SG导管显示有成纤维细胞迁移和增殖，并融入周围皮下组织，还观察到表达收缩蛋白平滑肌肌动蛋白的伸长细胞。24周后，在完全定植的移植物基质中证实有前胶原合成。ePTFE移植物没有细胞向内生长的迹象，也没有内皮。
牛SG通过有组织的再细胞化和新血管形成过程被适当地重塑以适应其宿主环境。无感染、相似的通畅率以及基质的细胞再填充值得进一步研究。
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