Satoh S, Nishiyama K, Shirakata S, Oga K, Oka T, Kadowaki M, Yano I
Second Department of Surgery, Kyoto Prefectural University of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1988 Jan;89(1):109-15.
Recently expanded polytetrafluoroethylene (E-PTFE) graft is often used in arterial bypass for atherosclerosis obliterans. In our series of 38 patients (48 legs) undergoing femoropopliteal bypass with E-PTFE graft of 6mm-caliber, a cumulative patency rate was 40.8% at 36 months after operation and a mean duration of patency was 26.3 months. To clarify the cause of occlusion, the diseased grafts were removed and histopathologically examined. Macroscopically, the E-PTFE graft was occluded by the intimal hyperplasia, so called pannus ingrowth from the recipient artery into the graft. The pannus formation of the graft was more remarkable in the distal than in the proximal site of anastomosis, suggesting the influence of blood flow on its formation. Microscopically, no endothelial cells were observed inside the E-PTFE graft except for the surface of pannus. Thus, less extension of endothelialization was thought to be a cause of late occlusion in E-PTFE grafts. Most desirable is the autologous saphenous vein for femoropopliteal bypass. However, when it is not available, E-PTFE graft with a larger caliber must be used in combination with postoperative anticoagulant therapy.
最近，膨体聚四氟乙烯（E-PTFE）移植物常用于动脉粥样硬化闭塞症的动脉旁路手术。在我们的系列研究中，38例患者（48条腿）接受了6毫米口径的E-PTFE移植物股腘动脉旁路手术，术后36个月的累积通畅率为40.8%，平均通畅时间为26.3个月。为了阐明闭塞的原因，将病变的移植物取出并进行组织病理学检查。宏观上，E-PTFE移植物被内膜增生所闭塞，即所谓的从受体动脉长入移植物的血管翳。移植物的血管翳形成在吻合口远端比近端更明显，提示血流对其形成有影响。微观上，除血管翳表面外，E-PTFE移植物内部未观察到内皮细胞。因此，内皮化扩展不足被认为是E-PTFE移植物晚期闭塞的一个原因。最理想的是使用自体大隐静脉进行股腘动脉旁路手术。然而，当无法获得自体大隐静脉时，必须使用更大口径的E-PTFE移植物并结合术后抗凝治疗。
