Galego S J, Miranda F, Pinto Ortiz J, De Lima Bessa K, Vilhena de Carvalho Fürst R, Yumi Fujii E, Ramacciotti O
Federal University of Sao Paulo, EPM (Escola Paulista de Medicina), Sao Paulo, Brazil.
J Vasc Access. 2006 Jan-Mar;7(1):15-23. doi: 10.1177/112972980600700104.
The objective of this study was to assess the blood flow in arteriovenous (AV) communications comparing autologous and homologous veins, in the femoral vessels of dogs.
Ten mongrel dogs were used for the blood flow analysis, and two AV grafts (AVG) were placed in each of them. The grafts were made with an autologous vein in one side, and a omologous vein, kept in a 0.25% glutaraldehyde solution, in the other side. The volumetric flow was measured before and after AVG placement. Fifteen minutes after surgery, the volumetric flow was measured in the cranial artery, in the caudal artery, in the graft and in the vein, and the same procedure was repeated 15 days after surgery. Measurements were done using an eletromagnetic flowmeter calibrated previously. For data analysis, the Wilcoxon test was used (to compare the difference in the results between the times and the techniques used) alfa </=0.05).
An increase of about 5.3 times was observed in the femoral artery cranial portion flow of these accesses during the first operation and an increase of 6.8 times in the re-operation for both techniques. In the femoral artery caudal portion of the AVGs there was a blood flow inversion of about 1.6 times for both techniques during the first operation and about 4.1 and 3.7 times for the autologous and homologous veins, respectively. There was a significant increase in the autologous grafts. In the cranial portion of the femoral vein, there was an increase in the flow in relation to the femoral artery flow before graft placement. There was an increase of 5.3 and 7.4 times for the autologous and homologous grafts, respectively, in the first operation and from 8-9.6 times in the re-operation. There was also a significant increase in the autologous graft in relation to the two procedures. A significant difference among the grafts placed during the first surgery was observed, which was not observed after 15 days. In the graft blood flow analysis, a flow increase of 5.1 times for the autologous vein and 6.6 times for the homologous vein and from 7.5-8.2 times in the re-operation was found in relation to the femoral artery flow. There was a significant increase in autologous vein flow between the first operation and the re-operation.
The mean blood flow of the homologous AVG was greater during the first operation and similar to the autologous grafts during the re-operation. Therefore, the homologous AVG could be considered a possible alternative to vascular access for hemodialysis.
本研究的目的是评估犬股血管中自体静脉和同种异体静脉动静脉(AV)交通支的血流情况。
选用10只杂种犬进行血流分析,每只犬植入两个动静脉移植物(AVG)。一侧的移植物采用自体静脉制作,另一侧的移植物采用保存在0.25%戊二醛溶液中的同种异体静脉制作。在植入AVG前后测量体积流量。术后15分钟,测量颅侧动脉、尾侧动脉、移植物和静脉中的体积流量,术后15天重复相同操作。测量使用预先校准的电磁流量计进行。数据分析采用Wilcoxon检验(比较不同时间和所用技术结果的差异),α≤0.05)。
在首次手术期间,这些通路的股动脉颅侧部分血流增加约5.3倍,两种技术再次手术时增加6.8倍。在AVG的股动脉尾侧部分,两种技术在首次手术期间血流反转约1.6倍,自体静脉和同种异体静脉分别约为4.1倍和3.7倍。自体移植物有显著增加。在股静脉颅侧部分,与植入移植物前的股动脉血流相比,血流增加。首次手术时,自体移植物和同种异体移植物的血流分别增加5.3倍和7.4倍,再次手术时增加8 - 9.6倍。自体移植物在两种手术中也有显著增加。观察到首次手术时植入的移植物之间存在显著差异,15天后未观察到。在移植物血流分析中,与股动脉血流相比,自体静脉血流增加5.1倍,同种异体静脉血流增加6.6倍,再次手术时增加7.5 - 8.2倍。首次手术和再次手术之间自体静脉血流有显著增加。
同种异体AVG在首次手术期间平均血流较大,再次手术时与自体移植物相似。因此,同种异体AVG可被视为血液透析血管通路的一种可能替代方案。