Bush H L, Jakubowski J A, Curl G R, Deykin D, Nabseth D C
J Vasc Surg. 1986 Feb;3(2):204-15. doi: 10.1067/mva.1986.avs0030204.
When the saphenous vein is used in the in situ position for arterial bypass surgery, it is associated with more optimal preservation of the endothelial lining and with improved graft patency compared with reversed vein grafts. However, it is not clear whether preservation of endothelial integrity persists after arterialization. The goal of this study was to establish whether preservation of the endothelium before arterialization is a critical factor in the development of late functional and morphologic abnormalities of autogenous vein grafts. Paired reversed and in situ vein grafts were created in 75 mongrel dogs. Veins to be used in the reversed position were excised and stored in either heparinized whole blood at 37 degrees C or saline solution at 4 degrees C. Veins were studied before and after arterialization. The veins were arterialized by anastomosis to the carotid artery and excised at intervals of 1 day to 12 weeks for studies of the luminal production of prostacyclin and thromboxane A2 in addition to luminal morphology. Before arterialization, normothermic whole blood preserved biochemical function of the endothelium significantly better than hypothermic saline solution, but not as well as the in situ vein procedure. Soon after arterialization, all three vein grafts showed significant functional and morphologic abnormalities consistent with injury of the vein graft. Morphologic healing of the endothelial monolayer progressed slowly back to normal; however, the biochemical capacity of the vein graft never matched that of the prearterialized vein, nor that of normal host arteries. Regardless of surgical technique, all vein grafts exhibited a period of abnormal structure and function, which exposed them to the risk of thrombogenesis. This period of potential leukocyte or platelet interaction with the vein wall could lead to release phenomena as well as proliferative changes in the vessel wall.
当大隐静脉原位用于动脉搭桥手术时，与反转静脉移植物相比，它能更有效地保留内皮细胞层，并改善移植物通畅率。然而，尚不清楚动脉化后内皮完整性是否得以持续保留。本研究的目的是确定动脉化前内皮的保留是否是自体静脉移植物后期功能和形态异常发展的关键因素。在75只杂种犬身上制作了成对的反转和原位静脉移植物。用于反转位置的静脉被切除，并保存在37℃的肝素化全血或4℃的盐溶液中。在动脉化前后对静脉进行研究。通过与颈动脉吻合将静脉动脉化，并在1天至12周的间隔时间内切除，除了管腔形态外，还用于研究前列环素和血栓素A2的管腔生成。在动脉化之前，常温全血比低温盐溶液能更好地保留内皮的生化功能，但不如原位静脉手术。动脉化后不久，所有三种静脉移植物均出现与静脉移植物损伤一致的明显功能和形态异常。内皮单层的形态愈合缓慢恢复正常；然而，静脉移植物的生化能力从未达到动脉化前静脉的水平，也未达到正常宿主动脉的水平。无论手术技术如何，所有静脉移植物都表现出一段结构和功能异常的时期，这使它们面临血栓形成的风险。这段白细胞或血小板与静脉壁潜在相互作用的时期可能导致释放现象以及血管壁的增殖性变化。
