Sottiurai V S, Yao J S, Flinn W R, Batson R C
Surgery. 1983 Jun;93(6):809-17.
The distal anastomoses of thrombosed saphenous vein (11), bovine (4), Dacron (7), and polytetrafluoroethylene (PTFE) (27) grafts removed en bloc during reoperation or amputation were studied with light microscopy, scanning electron microscopy, and transmission electron microscopy. Analysis of the ultrastructures of the distal anastomostic regions was done to characterize morphogenesis of intimal hyperplasia and neointimal proliferation. Complete reendothelialization occurred in all vein grafts. In bovine heterografts, there were isolated areas of endothelia. Thrombosed PTFE grafts were lined with gelatinous, proteinaceous material with no consistent organized cellular pattern. In contrast, laminated fibrous tissue produced by fibroblasts lined the Dacron grafts. Intimal hyperplasia was found in 6 of 11 vein grafts and in all prosthetic grafts examined. Regardless of the type of graft used, intimal hyperplasia was found predominantly at the heel of the graft and on the floor of the artery. Beneath the endothelia, collagenous ground substance and myofibroblasts mixed with smooth muscle cells were seen, characterized by pyknotic nuclei, reduced cytoplasm/nuclei ratio, and loss of cytoplasmic organelles. Endothelialization occurred exclusively in vein grafts. Prosthetic grafts lacked endothelia, with the neointima consisting of fibroblasts and fibrous matrix. In intimal hyperplasia, two forms of smooth muscle cell pathomorphogenesis were recognized. Formation of myofibroblasts induced medial fibroplasia, whereas degeneration of muscle cells progressed to medial necrosis. Smooth muscle cells seem to play a role not previously recognized in the pathogenesis of graft failure.
对在再次手术或截肢时整块切除的隐静脉（11例）、牛血管（4例）、涤纶（7例）和聚四氟乙烯（PTFE）（27例）移植血管的远端吻合口进行了光镜、扫描电镜和透射电镜研究。对远端吻合口区的超微结构进行分析，以表征内膜增生和新生内膜增殖的形态发生。所有静脉移植血管均发生了完全再内皮化。在牛异种移植血管中，存在孤立的内皮区域。血栓形成的PTFE移植血管内衬有凝胶状蛋白质物质，没有一致的有组织细胞模式。相比之下，成纤维细胞产生的层状纤维组织衬于涤纶移植血管。在11例静脉移植血管中的6例以及所有检查的人工血管移植中均发现内膜增生。无论使用何种类型的移植血管，内膜增生主要见于移植血管的足跟部和动脉底部。在内皮下方，可见胶原性基质以及与平滑肌细胞混合的肌成纤维细胞，其特征为核固缩、细胞质/细胞核比率降低以及细胞质细胞器丧失。内皮化仅发生在静脉移植血管中。人工血管移植缺乏内皮，新生内膜由成纤维细胞和纤维基质组成。在内膜增生中，识别出两种平滑肌细胞病理形态发生形式。肌成纤维细胞的形成诱导了中膜纤维增生，而肌细胞的退变进展为中膜坏死。平滑肌细胞似乎在移植失败的发病机制中发挥了以前未被认识到的作用。
