Herring M, Gardner A, Peigh P, Madison D, Baughman S, Brown J, Glover J
J Vasc Surg. 1984 Nov;1(6):877-87. doi: 10.1067/mva.1984.avs0010877.
We studied 117 inferior vena cava (IVC) replacements in dogs to determine the effects of graft material, graft size, endothelial seeding, and cultured endothelial linings on graft patency. As a control, the IVC was removed and reimplanted in 11 dogs. Dacron (n = 7) and expanded polytetrafluoroethylene (e-PTFE) grafts (n = 12) were seeded immediately with the use of enzymatically derived autogenous jugular vein endothelium. Cultured linings were prepared for e-PTFE grafts (n = 9) by inoculating the graft with jugular endothelium and nurturing the lining in tissue culture for 14 to 30 days before implantation. Unseeded grafts (n = 27) were prepared according to the manufacturer's recommendations. These six methods of preparation were tested in grafts measuring 6 mm I.D. and 60 mm in length. Other sizes were tested with a Latin square study design. After 30 to 60 days the grafts were perfusion fixed and studied with light and transmission electron microscopy. Patency was determined by contrast cavography after 7 and 30 days. Patency in the IVC reimplantation was 100% compared with 28.0% of the e-PTFE (p = 0.001) and none of the Dacron grafts that measured 6 mm I.D. and 60 mm long. e-PTFE and Dacron graft patency also differed significantly (p = 0.035). Seeded and culture-lined e-PTFE grafts in that same size were patent in 31.6% compared with 16.7% of unseeded e-PTFE. With grafts measuring 80 mm long, three of the five e-PTFE grafts were patent between 3 and 7 days. All progressed to occlusion by 30 days and compared poorly with all other graft sizes tested (2.6% progression to occlusion [p = 3 X 10(-8)]). Recanalization was not seen in 10 occluded grafts that were followed for 60 days. The histologic features of seeded grafts differed remarkably from grafts previously studied in the arterial circulation and from culture-lined and unseeded venous prostheses in that 60% had prominent large, random, endothelium-lined channels within the inner capsule. Larger graft diameters (p = 0.009) and the omission of an endothelial surface treatment (p = 0.004) were associated with anastomotic subendothelial fibrous hyperplasia. We conclude that graft material is the major determinant of patency in IVC replacements, that an extensive endothelial surface promotes patency, but that simply seeding e-PTFE or Dacron grafts with 10(5) endothelial cells does not provide sufficient endothelium to alter early patency.(ABSTRACT TRUNCATED AT 400 WORDS)
我们对犬类的117例下腔静脉（IVC）置换进行了研究，以确定移植材料、移植尺寸、内皮接种和培养的内皮衬里对移植通畅性的影响。作为对照，在11只犬中切除并重新植入下腔静脉。使用酶促获取的自体颈静脉内皮立即对涤纶（n = 7）和膨体聚四氟乙烯（e-PTFE）移植物（n = 12）进行接种。通过将颈静脉内皮接种到e-PTFE移植物（n = 9）上，并在植入前在组织培养中培养内皮衬里14至30天，来制备培养衬里。未接种的移植物（n = 27）根据制造商的建议制备。这六种制备方法在内径6 mm、长度60 mm的移植物中进行测试。其他尺寸则采用拉丁方研究设计进行测试。30至60天后，对移植物进行灌注固定，并通过光镜和透射电镜进行研究。在7天和30天后通过造影腔静脉造影确定通畅性。下腔静脉再植入的通畅率为100%，相比之下，内径6 mm、长60 mm的e-PTFE移植物通畅率为28.0%（p = 0.001），涤纶移植物无一通畅。e-PTFE和涤纶移植物的通畅性也有显著差异（p = 0.035）。相同尺寸的接种和培养衬里的e-PTFE移植物通畅率为31.6%，未接种的e-PTFE移植物为16.7%。对于长度为80 mm的移植物，5个e-PTFE移植物中有3个在3至7天内保持通畅。到30天时全部进展为闭塞，与测试的所有其他移植物尺寸相比情况较差（闭塞进展率为2.6% [p = 3×10⁻⁸]）。在随访60天的10个闭塞移植物中未观察到再通。接种移植物的组织学特征与先前在动脉循环中研究的移植物以及培养衬里和未接种的静脉假体有显著不同，因为60%的移植物在内膜囊内有突出的大的、随机的、内皮衬里的通道。较大的移植物直径（p = 0.009）和省略内皮表面处理（p = 0.004）与吻合口内膜下纤维增生有关。我们得出结论，移植材料是下腔静脉置换通畅性的主要决定因素，广泛的内皮表面可促进通畅性，但仅用10⁵个内皮细胞接种e-PTFE或涤纶移植物并不能提供足够的内皮来改变早期通畅性。（摘要截断于400字）
