Spark J I, Yeluri S, Derham C, Wong Y T, Leitch D
Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK.
Br J Surg. 2008 May;95(5):582-5. doi: 10.1002/bjs.6052.
The aim was to assess the results of a decellularized bovine ureter graft (SynerGraft) for complex venous access.
Bovine ureter conduits were implanted in patients with a failed fistula or access graft in whom native vessels were unsuitable as conduits. Graft histories were obtained from all patients who had undergone this procedure at one institution. Failed grafts were explanted and subjected to histological examination. A sample of fresh bovine ureter was immunostained for galactose (alpha1 --> 3) galactose (alpha-Gal).
Nine patients with a median age of 46 (range 25-70) years underwent complex venous access surgery between August 2004 and November 2006 using a SynerGraft. Graft types included loop superficial femoral artery to stump of long saphenous vein (four patients), loop brachial artery to vein (two), brachial artery to axillary vein (two) and left axillary artery to innominate vein (one). Three grafts developed aneurysmal dilatation and two thrombosed. Histological assessment of the explanted bovine ureters revealed acute and chronic transmural inflammation. Immunostaining of fresh bovine ureter suggested residual cells and the xenoantigen alpha-Gal.
Graft failure with aneurysmal dilatation and thrombosis in complex arteriovenous conduits using bovine ureter may be due to residual xenoantigens.
目的是评估脱细胞牛输尿管移植物（SynerGraft）用于复杂静脉通路的效果。
将牛输尿管导管植入内瘘或血管移植物失败且自身血管不适合作为导管的患者体内。从在一家机构接受该手术的所有患者获取移植物病史。取出失败的移植物并进行组织学检查。对新鲜牛输尿管样本进行半乳糖（α1→3）半乳糖（α-Gal）免疫染色。
2004年8月至2006年11月期间，9例中位年龄为46岁（范围25 - 70岁）的患者使用SynerGraft进行了复杂静脉通路手术。移植物类型包括股浅动脉袢至大隐静脉残端（4例患者）、肱动脉袢至静脉（2例）、肱动脉至腋静脉（2例）以及左腋动脉至无名静脉（1例）。3个移植物发生动脉瘤样扩张，2个形成血栓。对取出的牛输尿管进行组织学评估显示有急性和慢性透壁性炎症。新鲜牛输尿管的免疫染色提示存在残留细胞和异种抗原α-Gal。
使用牛输尿管的复杂动静脉导管移植物出现伴有动脉瘤样扩张和血栓形成的移植物失败可能归因于残留的异种抗原。
