Miyamoto S, Kikuchi H, Ikada Y, Minato M, Fujimoto K, Okada M, Sakai K, Nagata I, Yamagata S, Kaneko T
Department of Neurosurgery, Kyoto University Medical School.
No Shinkei Geka. 1990 Mar;18(3):253-8.
Saphenous vein interposition grafts have been commonly used for the reconstruction of occlusive lesions in the extracranial cerebral vessels, such as carotid or vertebral arteries. In contrast, cerebral revascularization using an artificial blood vessel has not been so common. This is due to the fact that conventional artificial blood vessels have been too firm or too rigid for use in the neurosurgery. Another reason is that the long term patency rate of small caliber artificial blood vessels has usually been inferior to that found in autologous vein grafts. The purpose of this study was to develop a soft and compliant artificial blood vessel suitable for cerebrovascular surgery. This new artificial blood vessel is made of polyurethane, porous in structure (porous polyurethane). Thus, multiple small-sized pores exist both in the inner and outer surfaces, and in the wall of the porous polyurethane graft. To test its mechanical properties, we evaluated stress-strain curves and compliance. In comparison to expanded polytetrafluoroethylene graft (Goretex), which has been one of the most commonly used artificial blood vessels in the cardiovascular surgery, the mechanical properties of the porous polyurethane graft more closely resembled those of the common carotid artery in dogs. Thus, porous polyurethane graft was shown to be a soft and compliant new artificial blood vessel. This means not only that it can be maneuvered with technical ease for anastomosis but also that there is a reduction of compliance-mismatch between the host vessel and the artificial vessel. Compliance mismatch has been documented as a major factor in the inducement of intimal hyperplasia, which causes a delayed occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)
大隐静脉移植术已普遍用于重建颅外脑血管的闭塞性病变,如颈动脉或椎动脉。相比之下,使用人工血管进行脑血运重建并不常见。这是因为传统的人工血管对于神经外科手术来说太硬或太 rigid。另一个原因是小口径人工血管的长期通畅率通常低于自体静脉移植。本研究的目的是开发一种适合脑血管手术的柔软且 compliant 的人工血管。这种新型人工血管由聚氨酯制成,结构多孔(多孔聚氨酯)。因此,在多孔聚氨酯移植物的内表面和外表面以及壁中都存在多个小尺寸的孔。为了测试其机械性能,我们评估了应力-应变曲线和 compliance。与心血管手术中最常用的人工血管之一膨体聚四氟乙烯移植物(戈尔特斯)相比,多孔聚氨酯移植物的机械性能更类似于犬类颈总动脉的性能。因此,多孔聚氨酯移植物被证明是一种柔软且 compliant 的新型人工血管。这不仅意味着它在技术上易于操作以进行吻合,而且意味着宿主血管与人工血管之间的 compliance 不匹配有所减少。已证明 compliance 不匹配是内膜增生诱导的主要因素,内膜增生会导致延迟闭塞。(摘要截短于250字)