Owens Christopher D, Rybicki Frank J, Wake Nicole, Schanzer Andres, Mitsouras Dimitrios, Gerhard-Herman Marie D, Conte Michael S
Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
J Vasc Surg. 2008 Jun;47(6):1235-42. doi: 10.1016/j.jvs.2008.01.009. Epub 2008 Apr 28.
The remodeling of vein bypass grafts after arterialization is incompletely understood. We have previously shown that significant outward lumen remodeling occurs during the first month of implantation, but the magnitude of this response is highly variable. We sought to examine the hypothesis that systemic inflammation influences this early remodeling response.
A prospective observational study was done of 75 patients undergoing lower extremity bypass using autogenous vein. Graft remodeling was assessed using a combination of ultrasound imaging and two-dimensional high-resolution magnetic resonance imaging.
The vein graft lumen diameter change from 0 to 1 month (22.7% median increase) was positively correlated with initial shear stress (P = .016), but this shear-dependent response was disrupted in subjects with an elevated baseline high-sensitivity C-reactive protein (hsCRP) level of >5 mg/L. Despite similar vein diameter and shear stress at implantation, grafts in the elevated hsCRP group demonstrated less positive remodeling from 0 to 1 month (13.5% vs 40.9%, P = .0072). By regression analysis, the natural logarithm of hsCRP was inversely correlated with 0- to 1-month lumen diameter change (P = .018). Statin therapy (beta = 23.1, P = .037), hsCRP (beta = -29.7, P = .006), and initial shear stress (beta = .85, P = .003) were independently correlated with early vein graft remodeling. In contrast, wall thickness at 1 month was not different between hsCRP risk groups. Grafts in the high hsCRP group tended to be stiffer at 1 month, as reflected by a higher calculated elastic modulus (E = 50.4 vs 25.1 Mdynes/cm2, P = .07).
Early positive remodeling of vein grafts is a shear-dependent response that is modulated by systemic inflammation. These data suggest that baseline inflammation influences vein graft healing, and therefore, inflammation may be a relevant therapeutic target to improve early vein graft adaptation.
动脉化后静脉搭桥移植物的重塑过程尚未完全明确。我们之前已经表明，在植入后的第一个月会发生显著的外向性管腔重塑，但这种反应的程度差异很大。我们试图检验全身炎症影响这种早期重塑反应的假说。
对75例接受自体静脉下肢搭桥手术的患者进行了一项前瞻性观察研究。使用超声成像和二维高分辨率磁共振成像相结合的方法评估移植物重塑情况。
静脉移植物管腔直径从0至1个月的变化（中位数增加22.7%）与初始剪切应力呈正相关（P = 0.016），但在基线高敏C反应蛋白（hsCRP）水平>5 mg/L的受试者中，这种剪切依赖性反应受到干扰。尽管植入时静脉直径和剪切应力相似，但hsCRP升高组的移植物在0至1个月时的正向重塑较少（13.5%对40.9%，P = 0.0072）。通过回归分析，hsCRP的自然对数与0至1个月的管腔直径变化呈负相关（P = 0.018）。他汀类药物治疗（β = 23.1，P = 0.037）、hsCRP（β = -29.7，P = 0.006）和初始剪切应力（β = 0.85，P = 0.003）与早期静脉移植物重塑独立相关。相比之下，hsCRP风险组之间1个月时的管壁厚度没有差异。高hsCRP组的移植物在1个月时往往更硬，这通过较高的计算弹性模量得到反映（E = 50.4对25.1 Mdynes/cm2，P = 0.07）。
静脉移植物的早期正向重塑是一种受全身炎症调节的剪切依赖性反应。这些数据表明基线炎症影响静脉移植物愈合，因此，炎症可能是改善早期静脉移植物适应性的一个相关治疗靶点。
