Dardik H, Ibrahim I M, Sussman B, Kahn M, Sanchez M, Klausner S, Baier R E, Meyer A E, Dardik I I
Ann Surg. 1984 Jan;199(1):61-8. doi: 10.1097/00000658-198401000-00011.
In a series of 756 glutaraldehyde-stabilized umbilical vein grafts implanted over a 7 1/2-year period, aneurysms were identified in seven cases. The earliest aneurysm was seen at 31 months after implantation and the remainder between 43 and 79 months after surgery. Corrective surgery was performed in five cases and succeeded in four. Although definite mechanisms have not been identified, mechanical fatigue, reversal of aldehyde crosslinks, and immunologic factors may be operative. The pathologic changes include: (1) actual dilation of both graft and mesh with or without intraluminal thrombus and, (2) maintenance of graft diameter with erosion of the umbilical vein and polyester mesh rupture leading to perigraft hematoma and false aneurysm formation. Microscopic examination and infrared spectral analysis confirmed the presence of host-contributed lipid in some specimens. Although this is a low incidence of aneurysm formation, umbilical vein grafts should be selected primarily for patients with limited life expectancy or for whom alternative materials with comparable or superior patency rates are not available or acceptable. Periodic angiography, particularly after 3 or 4 years, is recommended as a routine part of follow-up examinations. Improved graft materials and control of host environmental factors are potential means to reduce the noted degradation.
在7年半的时间里植入了一系列756个戊二醛固定的脐静脉移植物，其中7例发现有动脉瘤形成。最早的动脉瘤在植入后31个月出现，其余的在手术后43至79个月出现。5例患者接受了矫正手术，4例成功。虽然尚未确定确切机制，但机械疲劳、醛交联的逆转和免疫因素可能起作用。病理变化包括：（1）移植物和网片实际扩张，伴有或不伴有腔内血栓形成；（2）移植物直径保持不变，但脐静脉受侵蚀且聚酯网片破裂，导致移植物周围血肿和假性动脉瘤形成。显微镜检查和红外光谱分析证实部分标本中存在宿主来源的脂质。虽然动脉瘤形成的发生率较低，但脐静脉移植物应主要用于预期寿命有限的患者，或无法获得或无法接受具有相当或更高通畅率的替代材料的患者。建议定期进行血管造影，特别是在3或4年后，作为随访检查的常规部分。改进移植物材料和控制宿主环境因素是减少所述降解的潜在方法。
