Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Surgery. 2013 Jan;153(1):63-9. doi: 10.1016/j.surg.2012.06.005. Epub 2012 Jul 31.
Vein grafts fail as the result of wall maladaptations to surgical injury and hemodynamic perturbations. Interleukin-1 signaling has emerged as an important mediator of the vascular response to trauma and hemodynamically induced vascular lesions. We therefore hypothesized that interleukin-1 signaling drives early vein graft wall adaptations.
Using interleukin-1 type I receptor knockout (IL-1RI(-/-)) and wild-type (B6129SF2/J) mice, we investigated morphologic changes 28 days after interposition isograft from donor inferior vena cava to recipient carotid artery, without (n = 19) or with (n = 13) outflow restriction. The impact of mouse strain on the response to vein arterialization also was evaluated between B6129SF2/J (n = 18) and C57BL/6J (n = 19) mice.
No differences were observed in the traditional end points of intimal thickness and calculated luminal area, yet media+adventitia thickness of the vein graft wall of IL-1RI(-/-) mice was 44% to 52% less than wild-type mice, at the both proximal (P < .01, P < .01) and distal (P = .054, P < .01) portions of vein grafts, for both normal flow and low flow, respectively. Compared with the C57BL/6J strain, B6129SF2/J mice exhibited no difference in vein graft intimal thickness but 2-fold greater media+adventitia thickness (P < .01).
When lacking IL-1 signaling, the vein graft wall adapts differently compared with the injured artery, showing typical intima hyperplasia although attenuated media+adventitia thickening. B6129SF2/J mice exhibit more media+adventitia response than C57BL/6J mice. The inflammatory networks that underlie the vein response to arterialization hold many roles in the adaptation of the total wall; thus, the utility of anti-inflammatory approaches to extend the durability of vein grafts comes into question.
静脉移植物的失败是由于其壁对手术损伤和血流动力学干扰的适应性不良所致。白细胞介素-1 信号已成为创伤和血流动力学诱导的血管病变中血管反应的重要介质。因此,我们假设白细胞介素-1 信号驱动早期静脉移植物壁适应性改变。
使用白细胞介素-1 Ⅰ型受体敲除(IL-1RI(-/-))和野生型(B6129SF2/J)小鼠,我们在无(n = 19)或有(n = 13)流出限制的情况下,研究了从供体下腔静脉到受体颈动脉的静脉同种异体间置 28 天后的形态学变化。我们还在 B6129SF2/J(n = 18)和 C57BL/6J(n = 19)小鼠之间评估了小鼠品系对静脉动脉化反应的影响。
在传统的内膜厚度和计算的管腔面积终点方面没有观察到差异,但 IL-1RI(-/-) 小鼠的静脉移植物壁的中膜+外膜厚度比野生型小鼠分别低 44%至 52%,在静脉移植物的近端(P <.01,P <.01)和远端(P =.054,P <.01)部位,无论是正常血流还是低血流。与 C57BL/6J 品系相比,B6129SF2/J 小鼠的静脉移植物内膜厚度没有差异,但中膜+外膜厚度增加了 2 倍(P <.01)。
在缺乏白细胞介素-1 信号的情况下,与损伤的动脉相比,静脉移植物壁会发生不同的适应性改变,尽管中膜+外膜厚度的增加较弱,但仍表现出典型的内膜增生。B6129SF2/J 小鼠比 C57BL/6J 小鼠表现出更强的中膜+外膜反应。炎症网络在静脉对动脉化的反应中起重要作用,它在整个壁的适应性中起着许多作用;因此,抗炎方法延长静脉移植物耐久性的效用受到质疑。