Bai Hualong, Wang Zhiwei, Li Mingxing, Sun Peng, Wei Shunbo, Wang Zhiju, Xing Ying, Dardik Alan
Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China; Department of Physiology, Medical School of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
Ann Vasc Surg. 2020 Oct;68:468-475. doi: 10.1016/j.avsg.2020.04.046. Epub 2020 May 15.
The spiral saphenous vein graft is an excellent choice for venous reconstruction after periphery vein injury, but only few cases have been reported. We implanted a segment of a single saphenous vein into both the popliteal vein as a venous vein graft and into the popliteal artery as an arterial vein graft at the same time in a trauma patient; we then had an extraordinary opportunity to harvest and examine both patent venous and arterial vein grafts at 2 weeks after implantation.
A spiral saphenous vein graft was made as previously described and implanted into the popliteal vein and artery as interposition grafts; because of the patient's serious injuries, an amputation was performed at day 18 after vascular reconstruction. The grafts were harvested, fixed, and examined using histology and immunohistochemistry.
Both grafts were patent, and there was a larger neointimal area in the venous graft compared to the arterial graft. There were CD31- and vWF-positive cells on both neointimal endothelia, with subendothelial deposition of α-actin-, CD3-, CD45-, and CD68-positive cells. There were fewer cells in the venous graft neointima compared to the arterial graft neointima; however, there were more inflammatory cells in the neointima of the venous graft. Some of the neointimal cells were PCNA-positive, whereas very few cells were cleaved caspase-3 positive. The venous graft neointimal endothelial cells were Eph-B4 and COUP-TFII positive, while the arterial graft neointimal endothelial cells were dll-4 and Ephrin-B2 positive.
The spiral saphenous vein graft remains a reasonable choice for vessel reconstruction, especially in the presence of diameter mismatch. Both the venous and arterial grafts showed similar re-endothelialization and cellular deposition; the venous graft had more neointimal hyperplasia and inflammation. At an early time, endothelial cells showed venous identity in the venous graft, whereas endothelial cells showed arterial identity in the arterial graft.
Veins can be used as venous or arterial vein grafts but venous grafts have more neointimal hyperplasia and inflammation; vein grafts acquire different vessel identity depending on the environment into which they are implanted.
螺旋状大隐静脉移植物是周围静脉损伤后静脉重建的理想选择，但仅有少数病例报道。我们在一名创伤患者中，同时将一段单一大隐静脉作为静脉移植物植入腘静脉，作为动脉化静脉移植物植入腘动脉；然后，我们获得了一个特殊机会，在植入后2周收获并检查通畅的静脉和动脉化静脉移植物。
按先前描述制作螺旋状大隐静脉移植物，并作为间置移植物植入腘静脉和动脉；由于患者伤势严重，在血管重建后第18天进行了截肢。收获移植物，固定后，采用组织学和免疫组织化学方法进行检查。
两个移植物均通畅，与动脉移植物相比，静脉移植物的新生内膜面积更大。两个新生内膜内皮上均有CD31和vWF阳性细胞，α-肌动蛋白、CD3、CD45和CD68阳性细胞在内皮下沉积。与动脉移植物新生内膜相比，静脉移植物新生内膜中的细胞较少；然而，静脉移植物新生内膜中的炎性细胞较多。一些新生内膜细胞PCNA阳性，而极少细胞裂解型半胱天冬酶-3阳性。静脉移植物新生内膜内皮细胞Eph-B4和COUP-TFII阳性，而动脉移植物新生内膜内皮细胞dll-4和Ephrin-B2阳性。
螺旋状大隐静脉移植物仍是血管重建的合理选择，尤其是在存在直径不匹配的情况下。静脉和动脉移植物均显示出相似的再内皮化和细胞沉积；静脉移植物有更多的新生内膜增生和炎症。早期，静脉移植物中的内皮细胞显示静脉特征，而动脉移植物中的内皮细胞显示动脉特征。
静脉可作为静脉或动脉化静脉移植物使用，但静脉移植物有更多的新生内膜增生和炎症；静脉移植物根据其植入的环境获得不同的血管特征。
