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犬静脉移植动脉化的可逆性。

The reversibility of canine vein-graft arterialization.

作者信息

Fann J I, Sokoloff M H, Sarris G E, Yun K L, Kosek J C, Miller D C

机构信息

Department of Cardiovascular Surgery, Stanford University School of Medicine, Calif.

出版信息

Circulation. 1990 Nov;82(5 Suppl):IV9-18.

PMID:2225440
Abstract

We assessed the reversibility of functional and morphological changes of arterialized vein segments by returning them to the venous circulation. Thirteen dogs underwent right carotid and femoral veno-arterial grafting. After 12 weeks, veno-arterial grafts were removed for contractility (norepinephrine [NE] and 5-hydroxytryptamine [5-HT]), luminal prostacyclin (PGI2), and morphometric analyses; the remaining segments were used as left jugular and femoral veno-venous grafts. After another 12 weeks, the veno-venous grafts were harvested. To NE, veno-arterial grafts (ED50, 5.4 +/- 0.1 [-log M]) were less sensitive than control veins (ED50, 6.0 +/- 0.2) or veno-venous grafts (ED50, 6.4 +/- 0.2) but were more sensitive than control arteries (ED50, 4.0 +/- 0.1); the maximum tension of veno-arterial grafts (6.2 +/- 0.6 g) was greater than that of veins, less than that of arteries (9.8 +/- 1.0 g), and comparable with that of veno-venous grafts (5.1 +/- 1.1 g). To 5-HT, veno-arterial (ED50, 7.5 +/- 0.1) and veno-venous (ED50, 7.3 +/- 0.2) grafts were more sensitive than arteries (ED50, 6.0 +/- 0.3), while the vein was unresponsive; the maximum tension of veno-arterial grafts (5.0 +/- 0.7 g) was less than that of arteries (6.9 +/- 0.9 g) and greater than that of veno-venous grafts (1.4 +/- 0.3 g). PGI2 production in veins (3.6 +/- 0.8 ng/ml), veno-arterial grafts (3.9 +/- 0.8 ng/ml), and veno-venous grafts (3.3 +/- 0.9 ng/ml) was comparable and less than that of arteries (6.4 +/- 0.9 ng/ml). Veno-arterial graft intimal thickness (127 +/- 8 microns) and intimal area (15.6 +/- 1.8 x 10(3) microns 2) tended to be greater than that in the veno-venous graft (113 +/- 9 microns and 12.4 +/- 1.8 x 10(3) microns 2); also, the veno-arterial graft medial area (103.0 +/- 7.3 x 10(3) microns 2) was greater than that of the veno-venous graft (80.3 +/- 6.9 x 10(3) microns 2), thereby resulting in a similar relative intimal area (13 +/- 1%). Therefore, some changes associated with arterialization, for example, adrenergic sensitivity, maximum tension to 5-HT, medial thickening, and perhaps intimal hyperplasia, reverted toward venous values when replaced in the venous environment, possibly due to variations in pressure, flow, shear stress, and/or graft preparation techniques. Luminal PGI2 was unchanged in the grafts, implying that graft contractility was not modulated by luminal PGI2.

摘要

我们通过将动脉化静脉段恢复至静脉循环来评估其功能和形态学改变的可逆性。13只犬接受了右颈动脉和股静脉 - 动脉移植。12周后,取出静脉 - 动脉移植物进行收缩性(去甲肾上腺素[NE]和5 - 羟色胺[5 - HT])、管腔前列环素(PGI2)及形态计量学分析;其余节段用作左颈静脉和股静脉 - 静脉移植物。再过12周后,收获静脉 - 静脉移植物。对于NE,静脉 - 动脉移植物(半数有效剂量[ED50],5.4±0.1[-log M])比对照静脉(ED50,6.0±0.2)或静脉 - 静脉移植物(ED50,6.4±0.2)敏感性低,但比对照动脉(ED50,4.0±0.1)敏感性高;静脉 - 动脉移植物的最大张力(6.2±0.6 g)大于静脉,小于动脉(9.8±1.0 g),与静脉 - 静脉移植物(5.1±1.1 g)相当。对于5 - HT,静脉 - 动脉(ED50,7.5±0.1)和静脉 - 静脉(ED50,7.3±0.2)移植物比动脉(ED50,6.0±0.3)更敏感,而静脉无反应;静脉 - 动脉移植物的最大张力(5.0±0.7 g)小于动脉(6.9±0.9 g)且大于静脉 - 静脉移植物(1.4±0.3 g)。静脉、静脉 - 动脉移植物和静脉 - 静脉移植物中PGI2的产生量(3.6±0.8 ng/ml、3.9±0.8 ng/ml和3.3±0.9 ng/ml)相当且低于动脉(6.4±0.9 ng/ml)。静脉 - 动脉移植物内膜厚度(127±8微米)和内膜面积(15.6±1.8×10³微米²)倾向于大于静脉 - 静脉移植物(113±9微米和12.4±1.8×10³微米²);同样,静脉 - 动脉移植物中膜面积(103.0±7.3×10³微米²)大于静脉 - 静脉移植物(80.3±6.9××10³微米²),从而导致相对内膜面积相似(13±1%)。因此,一些与动脉化相关的改变,例如肾上腺素能敏感性、对5 - HT的最大张力、中膜增厚以及可能的内膜增生,当放回静脉环境中时会恢复至静脉值,这可能是由于压力、流量、剪切应力和/或移植物制备技术的差异所致。移植物中管腔PGI2未发生变化,这意味着移植物收缩性不受管腔PGI2调节。

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