Trubel W, Moritz A, Schima H, Raderer F, Scherer R, Ullrich R, Losert U, Polterauer P
Department of Vascular Surgery, University of Vienna, Austria.
ASAIO J. 1994 Jul-Sep;40(3):M273-8. doi: 10.1097/00002480-199407000-00007.
Dilated and varicose veins constricted with a Dacron mesh tube were successfully used as arterial bypass grafts to avoid nonautogenous vascular prostheses. Mesh constriction has also been used to adapt the venous graft lumen to the diameters of grafted arteries. The influence of the external mesh on the wall elasticity of such venous grafts and the reactions of the host artery were not investigated. Elastic properties of mesh constricted autologous veins used as arterial grafts in femoropopliteal reconstructions, as well as consecutive formation of distal anastomotic intimal hyperplasia (DAIH), were investigated in this experiment. Twenty-four autologous venous grafts were implanted in 12 sheep. Grafts were left natural (Groups 1 and 3) or were constricted with an external Dacron mesh (Groups 2 and 4); their diameters were left unchanged (Groups 1 and 2) or were matched to the diameter of the host artery (Groups 3 and 4). Wall elasticity of the graft, distal anastomosis, and distal artery were measured by locally applied crystal transducers during surgery and follow-up. Formation and localization of DAIH was evaluated histomorphologically after a median of 8.3 months. Graft wall elasticity was found to be lower (54.6 vs. 147.9, P = 0.006) and overall DAIH was found to be higher in mesh tube grafts (49.42 vs. 20.8 microns, P = 0.001, Mann-Whitney U-test). No differences in elasticity and DAIH formation were observed between grafts with adapted and large diameters. Constriction of venous grafts by a Dacron mesh tube reduces graft wall elasticity and promotes formation of DAIH. To avoid such an increased mismatch in compliance while making use of the advantages of this method, the external mesh tube must not be brought close to the distal anastomotic area itself.
用涤纶网网管收缩扩张和曲张的静脉，成功地用作动脉搭桥移植物，以避免使用非自体血管假体。网收缩也被用于使静脉移植物管腔适应移植动脉的直径。未研究外部网对这种静脉移植物壁弹性和宿主动脉反应的影响。本实验研究了在股腘动脉重建中用作动脉移植物的网收缩自体静脉的弹性特性，以及远端吻合口内膜增生（DAIH）的连续形成。将24条自体静脉移植物植入12只绵羊体内。移植物保持自然状态（第1组和第3组）或用外部涤纶网收缩（第2组和第4组）；其直径保持不变（第1组和第2组）或与宿主动脉直径匹配（第3组和第4组）。在手术和随访期间，通过局部应用晶体换能器测量移植物、远端吻合口和远端动脉的壁弹性。在中位8.3个月后，通过组织形态学评估DAIH的形成和定位。发现网网管移植物的移植物壁弹性较低（54.6对147.9，P = 0.006），总体DAIH较高（49.42对20.8微米，P = 0.001，曼-惠特尼U检验）。在直径适配和较大的移植物之间，未观察到弹性和DAIH形成的差异。用涤纶网网管收缩静脉移植物会降低移植物壁弹性并促进DAIH的形成。为了在利用该方法优点的同时避免顺应性增加的不匹配，外部网网管不得靠近远端吻合区域本身。
