人类血管移植物胶原蛋白涂层的吸收与愈合过程

Vascular grafts collagen coating resorption and healing process in humans.

作者信息

Helfer Elise, Kuntz Salomé, Dion Delphine, Heim Frédéric, Georg Yannick, Thaveau Fabien, Lejay Anne, Chakfé Nabil

机构信息

Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire, Strasbourg, France.

Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, Strasbourg, France.

出版信息

JVS Vasc Sci. 2022 Mar 25;3:193-204. doi: 10.1016/j.jvssci.2022.02.001. eCollection 2022.

DOI:10.1016/j.jvssci.2022.02.001

PMID:35495568

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9046442/

Abstract

BACKGROUND

The objective of the present study was to evaluate the bioresorption rate of collagen coating (CC) sealed on textile vascular grafts (VGs) and their healing in humans using histologic analysis of explanted VGs.

METHODS

A total of 27 polyester textile VGs had been removed during surgery from 2012 to 2020. The segments underwent histologic assessment. The CC bioresorption rate was assessed using morphometric analysis to determine the internal and external capsule thickness, inflammatory reaction degree, presence of neovessels, and endothelial cell layer.

RESULTS

A total of 27 VGs were explanted from 25 patients because of infection (n = 5; 18.5%), thrombosis (n = 7; 25.9%), stenosis (n = 2; 7.4%), rupture (n = 4; 14.8%), aneurysmal degeneration (n = 3; 11.1%), revascularization (n = 4; 14.8%), or another cause (n = 2; 7.4%), with a median implantation duration of 291 days (interquartile range [IQR], 48-911 days). VGs with remaining CC (n = 7; 26%) had been explanted earlier than had those without (n = 20; 74%; 1 day [IQR, 1-45 days] vs 516 days [IQR, 79-2018 days]; = .001). After 1 year, no remaining CC was detected on the analyzed VG sections. VGs implanted for <90 days had had a greater CC maximal thickness (63.90 μm [IQR, 0-83.25 μm] vs 0 μm [IQR, 0-0 μm]; = .006) and a greater CC surface coverage (180° [IQR, 0°-360°] vs 0° [IQR, 0°-0°]; = .002) than those implanted for >90 days. VGs implanted for >90 days had a greater external capsule thickness (889.2 μm [IQR, 39.6-1317 μm] vs 0 μm [IQR, 0-0 μm]; = .002), a higher number of inflammatory mononuclear cells and giant cells (168 cells [IQR, 110-310 cells] vs 0 cells [IQR, 0-94 cells]; < .0001) and a higher number of neovessels (4 [IQR, 0-5] vs 0 [IQR, 0-0]; = .001) than those implanted for <90 days.

CONCLUSIONS

CC had a slow bioresorption rate in humans. Complete healing was never achieved, with no endothelial coverage observed. This finding implies that CC might not help graft healing.

摘要

背景

本研究的目的是通过对取出的血管移植物（VG）进行组织学分析，评估密封在纺织血管移植物上的胶原蛋白涂层（CC）的生物吸收速率及其在人体中的愈合情况。

方法

2012年至2020年期间，共有27个聚酯纺织血管移植物在手术中被取出。对这些节段进行了组织学评估。使用形态计量分析评估CC的生物吸收速率，以确定内、外膜厚度、炎症反应程度、新生血管的存在以及内皮细胞层。

结果

共有27个血管移植物从25名患者体内取出，原因包括感染（n = 5；18.5%）、血栓形成（n = 7；25.9%）、狭窄（n = 2；7.4%）、破裂（n = 4；14.8%）、动脉瘤样变性（n = 3；11.1%）、血管再通（n = 4；14.8%）或其他原因（n = 2；7.4%），中位植入时间为291天（四分位间距[IQR]，48 - 911天）。仍有CC残留的血管移植物（n = 7；26%）比没有CC残留的血管移植物（n = 20；74%）更早被取出（1天[IQR，1 - 45天]对516天[IQR，79 - 2018天]；P = .001）。1年后，在分析的血管移植物切片上未检测到残留的CC。植入时间<90天的血管移植物的CC最大厚度更大（63.90μm[IQR，0 - 83.25μm]对0μm[IQR，0 - 0μm]；P = .006），CC表面覆盖率更高（180°[IQR，0° - 360°]对0°[IQR，0° - 0°]；P = .002），比植入时间>90天的血管移植物更大。植入时间>90天的血管移植物的外膜厚度更大（889.2μm[IQR，39.6 - 1317μm]对0μm[IQR，0 - 0μm]；P = .002），炎症单核细胞和巨细胞数量更多（168个细胞[IQR，110 - 310个细胞]对0个细胞[IQR，0 - 94个细胞]；P < .0001），新生血管数量更多（4个[IQR，0 - 5个]对0个[IQR，0 - 0个]；P = .001），比植入时间<90天的血管移植物更多。