Herring M, Smith J, Dalsing M, Glover J, Compton R, Etchberger K, Zollinger T
Department of Surgery, St. Vincent Hospital, Indianapolis, IN.
J Vasc Surg. 1994 Oct;20(4):650-5. doi: 10.1016/0741-5214(94)90291-7.
We compared 66 seeded polytetrafluoroethylene and 53 autologous vein grafts to determine whether endothelial seeding could improve the patency of polytetrafluoroethylene femoral popliteal bypass grafts and to determine whether endothelial seeding could be performed consistently in multiple institutions.
Nine surgeons at four hospitals randomized patients to receive either a seeded polytetrafluoroethylene or a vein graft, but if no satisfactory vein (n = 26) existed, an "obligatory" seeded polytetrafluoroethylene graft was used.
Scanning electron microscopy confirmed satisfactory initial attachment of endothelium on the discarded ends of the grafts. Patency was compared with the use of log rank analysis and revealed better patency in vein grafts at 30 months (vein = 91.6% +/- 4.1%; seeded polytetrafluoroethylene = 37.8% +/- 9.4%; p = 0.006). Failed grafts revealed anastomotic hyperplasia.
(1) Vein graft patency was better than seeded polytetrafluoroethylene grafts; (2) seeding did not improve patency in below-the-knee bypasses as suggested by pilot studies; (3) the failure of seeded grafts was associated with anastomotic hyperplasia but not with the failure of initial endothelial attachment; and (4) each institution reported similar results.
我们比较了66条种植内皮细胞的聚四氟乙烯移植物和53条自体静脉移植物，以确定内皮细胞种植能否改善聚四氟乙烯股腘动脉搭桥移植物的通畅率，以及确定内皮细胞种植能否在多个机构中持续稳定地进行。
四家医院的九位外科医生将患者随机分组，使其接受种植内皮细胞的聚四氟乙烯移植物或静脉移植物，但如果没有合适的静脉（n = 26），则使用“强制性”种植内皮细胞的聚四氟乙烯移植物。
扫描电子显微镜证实内皮细胞在移植物废弃端的初始附着情况良好。使用对数秩分析比较通畅率，结果显示静脉移植物在30个月时的通畅率更高（静脉 = 91.6% +/- 4.1%；种植内皮细胞的聚四氟乙烯 = 37.8% +/- 9.4%；p = 0.006）。失败的移植物显示出吻合口增生。
（1）静脉移植物的通畅率优于种植内皮细胞的聚四氟乙烯移植物；（2）如前期研究所示，种植内皮细胞并不能改善膝下搭桥移植物的通畅率；（3）种植内皮细胞的移植物失败与吻合口增生有关，而非与内皮细胞初始附着失败有关；（4）每个机构报告的结果相似。
