Pichakron Kullada O, Bui Phiet T, Pickard Brian J, Perlstein Jon, Mathis Derek, Muir-Padilla Jeannie, Ihnat Daniel M
Department of Surgery, David Grant Medical Center, Travis Air Force Base, CA, USA.
Vasc Endovascular Surg. 2006 May-Jun;40(3):213-22. doi: 10.1177/153857440604000306.
Adequate autogenous vein is often the limiting factor in achieving a successful infrainguinal bypass. Attempts have been made to find alternative conduits; however, these alternatives have demonstrated inferior patency rates. We attempt to show that a split-thickness skin graft conduit provides a feasible autogenous arterial conduit. Neoconduits were prepared with an autogenous split-thickness skin graft (STSG) tubularized for a length of 5-6 centimeters with an appropriate caliber match to native artery. The deep dermal side of the graft was randomized to form either the external surface or the luminal surface. The neoconduit was placed as an interposition graft in the left common carotid artery. Grafts were studied in vivo with duplex ultrasonography and ex vivo by histopathology and immunohistochemistry. Feasibility study involved 4 animals with grafts harvested for study at 24 hours (n = 2) and 7 days (n = 2). Two subsequent groups were studied to evaluate 3-month (n = 8) and 6-month (n = 5) patency. All grafts (n = 4) in the feasibility phase of the study were patent at the time of harvest without evidence of aneurysmal degeneration. In the subsequent 8 goats, grafts with the deep dermal side forming the extraluminal surface (n = 4) had a propensity to ulcerate and rupture or to become aneurysmal (75%). The patency rate of these grafts at 6 weeks was 25%. In contrast, grafts with the deep dermal side forming the intraluminal surface (n = 4) demonstrated 75% patency at 6 weeks. Because of these results the remaining goats underwent placement of neoconduits with the deep dermal side forming the luminal surface. These grafts maintained a patency rate of 80% at 6 months. Neoconduits implanted with a diameter greater than 1.5 times the native arterial diameter became aneurysmal. Histopathology demonstrated neointimal formation in all grafts patent for longer than 7 days. Immunohistochemical staining for Factor VIII/von Willebrand's factor (vWF) was reactive in the endoluminal cells of these grafts. Immunohistochemical staining for a-smooth muscle actin demonstrated reactivity in conduits patent for greater than 1 month. Split-thickness skin may provide a feasible source for autogenous conduit in arterial reconstructions and warrants further study. Technical factors affecting patency include orientation of the deep dermal surface of the STSG and the diameter of the neoconduit at the time of implantation.
充足的自体静脉往往是成功进行股动脉以下旁路移植术的限制因素。人们已尝试寻找替代管道；然而，这些替代品的通畅率较低。我们试图证明，分层皮片移植管道可提供一种可行的自体动脉管道。用自体分层皮片（STSG）制备新管道，将其管状化至5 - 6厘米长，并使其管径与天然动脉适当匹配。将移植物的深层真皮面随机形成外表面或管腔表面。将新管道作为间置移植物置于左颈总动脉。通过双功超声对移植物进行体内研究，并通过组织病理学和免疫组织化学进行体外研究。可行性研究涉及4只动物，在24小时（n = 2）和7天（n = 2）时采集移植物进行研究。随后的两组用于评估3个月（n = 8）和6个月（n = 5）的通畅情况。在研究的可行性阶段，所有移植物（n = 4）在采集时均通畅，无动脉瘤样变性的证据。在随后的8只山羊中，深层真皮面形成管腔外表面的移植物（n = 4）有溃疡、破裂或形成动脉瘤的倾向（75%）。这些移植物在6周时的通畅率为25%。相比之下，深层真皮面形成管腔内表面的移植物（n = 4）在6周时的通畅率为75%。由于这些结果，其余山羊接受了深层真皮面形成管腔表面的新管道植入。这些移植物在6个月时的通畅率维持在80%。植入直径大于天然动脉直径1.5倍的新管道会形成动脉瘤。组织病理学显示，所有通畅时间超过7天的移植物均有新生内膜形成。因子VIII/血管性血友病因子（vWF）免疫组化染色在这些移植物的腔内细胞中有反应。α-平滑肌肌动蛋白免疫组化染色在通畅时间超过1个月的管道中有反应。分层皮片可为动脉重建中的自体管道提供可行来源，值得进一步研究。影响通畅的技术因素包括STSG深层真皮面的方向以及植入时新管道的直径。
