Herring M B, Compton R S, LeGrand D R, Gardner A L, Madison D L, Glover J L
J Vasc Surg. 1987 Aug;6(2):114-8. doi: 10.1067/mva.1987.avs0060114.
At St. Vincent Hospital, Indianapolis, 17 patients have undergone femoropopliteal bypass operations with polytetrafluoroethylene (PTFE) grafts that were seeded with enzymatically harvested, autogenous endothelium. Three patients received seeded grafts because satisfactory veins were not available. Twenty-eight patients alternately received seeded or unseeded, externally supported e-PTFE grafts. Graft patency was evaluated by clinical criteria and changes in the Doppler ankle-brachial systolic pressure ratios at 2 and 30 days postoperatively and at 3-month intervals thereafter. Occlusions were defined arteriographically if the clinical situation or the Doppler findings deteriorated. Smoking histories were taken, and carboxyhemoglobin (COHgb) levels were sampled 1 month postoperatively. Cumulative patency after 3 months was 93.3% +/- 6.5% for seeded and 84.0% +/- 10.4% for unseeded grafts. After 1 year it was 81.6% +/- 12.3% for seeded grafts and 30.8% +/- 18.7% for unseeded grafts (p = 0.02). Thus far all but one of the occlusions have occurred in patients with a history of smoking or with a COHgb level greater than 1.5%, whereas all of the seeded grafts in nonsmokers with COHgb levels less than or equal to 1.5% are patent. We conclude that endothelial seeding of PTFE femoropopliteal grafts is feasible. During this preliminary study period, a small number of patients had favorable patency rates with seeded as compared with unseeded grafts, especially among smokers. A multiple-institution study will be needed to establish the role of endothelial cell seeding in the treatment of vascular occlusions of the femoral and popliteal arteries.
在印第安纳波利斯的圣文森特医院，17例患者接受了用聚四氟乙烯（PTFE）移植物进行的股腘动脉搭桥手术，这些移植物接种了经酶法采集的自体内皮细胞。3例患者接受接种移植物是因为无法获得满意的静脉。另外28例患者交替接受接种或未接种的外部支撑型e-PTFE移植物。通过临床标准以及术后2天和30天以及此后每隔3个月的多普勒踝肱收缩压比值变化来评估移植物通畅情况。如果临床情况或多普勒检查结果恶化，则通过血管造影确定闭塞情况。记录吸烟史，并在术后1个月采集碳氧血红蛋白（COHgb）水平样本。接种移植物3个月后的累积通畅率为93.3%±6.5%，未接种移植物为84.0%±10.4%。1年后，接种移植物为81.6%±12.3%，未接种移植物为30.8%±18.7%（p = 0.02）。到目前为止，除1例闭塞外，所有闭塞均发生在有吸烟史或COHgb水平大于1.5%的患者中，而COHgb水平小于或等于1.5%的非吸烟患者的所有接种移植物均保持通畅。我们得出结论，PTFE股腘动脉移植物的内皮接种是可行的。在这个初步研究阶段，与未接种移植物相比，少数接种移植物的患者有较好的通畅率，尤其是在吸烟者中。需要进行多机构研究以确定内皮细胞接种在治疗股动脉和腘动脉血管闭塞中的作用。
