Jensen N, Lindblad B, Bergqvist D
Department of Surgery, Lund University, Malmö General Hospital, Sweden.
J Cardiovasc Surg (Torino). 1994 Oct;35(5):425-9.
The prospect of seeding endothelial cells to a prosthetic graft has been successful in the experimental setting, but less convincing in clinical studies in humans. This study was performed with the objective of evaluating endothelial cell seeding of aorto-bi-iliofemoral reconstructions with cells harvested at the same procedure.
Randomized study with one graft limb seeded and with at least 5 year follow-up.
University Hospital.
15 patients undergoing aorto-bi-ilio-femoral reconstruction.
One graft limb (randomly determined) was seeded with autologous endothelial cells (median 5.2 x 10(5)) enzymatically (Dispase II) harvested from the saphenous vein (length 8-15 cm, diameter 4-8 mm). The other graft limb served as a control.
Two months after surgery platelets were labelled with 111In and platelet activity registered over the graft. Long-term outcome were followed (median 5 years and 10 months).
No difference in platelet activity was noted between the seeded and non-seeded graft limb. Different techniques of calculating graft wall activity showed large interindividual variations in the results. Long-term outcome showed that three patients died, two from myocardial infarction on postoperative day three and 60, and one patient died four years after surgery from a lung cancer. Grafts functioned well. In one non-seeded graft limb the patient had severe microembolisation postoperatively that required amputation 10 days after surgery. Of seeded graft limbs one occluded 42 months after surgery, intimal hyperplasia at the distal anastomosis was seen and in one patient progress of arteriosclerosis required additional surgery 12 months after initial operation with profundaplasty (partly due to intimal hyperplasia) and later two additional femoro-distal reconstructions were needed.
In summary with our single-staged technique for seeding of endothelial cells to a graft limb in a high flow situation no effect on platelet activity at two months was found and long-term outcome was not obviously influenced.
在实验环境中，将内皮细胞接种到人工血管移植物上已取得成功，但在人体临床研究中却缺乏说服力。本研究旨在评估在同一手术过程中采集细胞进行主-双髂股重建时内皮细胞接种的情况。
随机研究，一个移植肢体接种细胞，并进行至少5年的随访。
大学医院。
15例行主-双髂股重建术的患者。
一个移植肢体（随机确定）接种从大隐静脉（长度8 - 15厘米，直径4 - 8毫米）酶解（Dispase II）收获的自体内皮细胞（中位数5.2×10⁵）。另一个移植肢体作为对照。
术后两个月用¹¹¹铟标记血小板，并记录移植血管上的血小板活性。随访长期结果（中位数为5年10个月）。
接种和未接种的移植肢体之间血小板活性无差异。不同的计算移植血管壁活性的技术显示结果存在较大个体差异。长期结果显示，3例患者死亡，2例分别于术后第3天和第60天死于心肌梗死，1例患者术后4年死于肺癌。移植物功能良好。在一个未接种的移植肢体中，患者术后出现严重微栓塞，术后10天需要截肢。在接种的移植肢体中，1例在术后42个月闭塞，可见远端吻合口内膜增生，1例患者动脉硬化进展，在初次手术后12个月需要进行额外手术（包括股深动脉成形术，部分原因是内膜增生），后来还需要进行两次额外的股-远端重建。
总之，采用我们的单阶段技术在高流量情况下将内皮细胞接种到移植肢体上，术后两个月未发现对血小板活性有影响，长期结果也未受到明显影响。
