用于颈动脉血管成形术的人工补片材料出血并发症、血栓形成性和新生内膜特征的实验评估

Rhee R Y, Gloviczki P, Cambria R A, Miller V M

Division of Vascular Surgery, Mayo Clinic, Rochester, MN 55905, USA.

Cardiovasc Surg. 1996 Dec;4(6):746-52. doi: 10.1016/s0967-2109(96)00044-0.

Experiments were designed to compare perioperative blood loss, early thrombogenicity and morphologic and functional characteristics of the neointima of three types of prosthetic materials used for carotid artery patch angioplasty. Bilateral carotid patch angioplasties were performed in 20 dogs, using 20 gelatin-impregnated fluoropassivated Dacron (GIF), 10 untreated knitted Dacron and 10 expanded polytetrafluoroethylene (PTFE) patches (5 cm2). Intraoperative blood loss, platelet deposition at 24 h and neointimal morphology at 6 weeks after the operation were assessed. Bioassay of the neointima was performed at 6 weeks in 16 patches. Mean (s.e.m.) blood loss was significantly less in GIF patches (14.7 (2.7) ml) compared with either PTFE (75.6 (24) ml) or untreated Dacron (64.3 (9.5)) (P < 0.005). Mean (s.e.m.) platelet deposition in GIF patches (1380 (328) platelets/cm2) was approximately 50% less at 24 h than in untreated Dacron (2562 (1035) platelets/cm2) or PTFE (2140 (998( platelets/cm2) patches (P < 0.05). Neointimal coverage was greater in PTFE (94 (1.3%)) compared with GIF (79 (2.7%)) or untreated Dacron (86 (2.4%)) patches (P < 0.05). The thickness of the neointimal layer of PTFE (0.5 (0.01) mm) patches was greater than other patch types; GIF (0.2 (0.01) mm) or untreated Dacron (0.3 (0.01) mm) (P < 0.50). Under bioassay conditions, acetylcholine caused release of vasoactive relaxing factor(s) from all patches. However, relaxations from baseline were less with GIF patches (-37.9 (11.7)% versus -54.5(9.6( for untreated Dacron; -50.2 (15.2)% for PTFE) (P = n.s.). Endothelin-1 release occurred from all patches and was increased with the extent of neointimal coverage. These data demonstrate that GIF patches caused the least perioperative bleeding, were the least thrombogenic at 24 h and developed the thinnest neointima at 6 weeks. All patch materials developed a functioning neointima.

本实验旨在比较用于颈动脉补片血管成形术的三种假体材料的围手术期失血量、早期血栓形成倾向以及新生内膜的形态和功能特征。对20只犬进行双侧颈动脉补片血管成形术，使用20片明胶浸渍氟钝化涤纶（GIF）、10片未处理的针织涤纶和10片膨体聚四氟乙烯（PTFE）补片（5平方厘米）。评估术中失血量、术后24小时血小板沉积情况以及术后6周新生内膜形态。对16片补片在术后6周进行新生内膜生物测定。与PTFE（75.6（24）毫升）或未处理的涤纶（64.3（9.5）毫升）相比，GIF补片的平均（标准误）失血量显著更少（14.7（2.7）毫升）（P<0.005）。术后24小时，GIF补片中的平均（标准误）血小板沉积量（1380（328）个血小板/平方厘米）比未处理的涤纶（2562（1035）个血小板/平方厘米）或PTFE（2140（998）个血小板/平方厘米）补片少约50%（P<0.05）。与GIF（79（2.7）%）或未处理的涤纶（86（2.4）%）补片相比，PTFE补片的新生内膜覆盖率更高（94（1.3）%）（P<0.05）。PTFE补片的新生内膜层厚度（0.5（0.01）毫米）大于其他补片类型；GIF（0.2（0.01）毫米）或未处理的涤纶（0.3（0.01）毫米）（P<0.50）。在生物测定条件下，乙酰胆碱可使所有补片释放血管活性舒张因子。然而，GIF补片从基线开始的舒张幅度较小（-37.9（11.7）%，未处理的涤纶为-54.5（9.6）%；PTFE为-50.2（15.2）%）（P=无显著差异）。所有补片均释放内皮素-1，且随着新生内膜覆盖率的增加而增加。这些数据表明，GIF补片导致的围手术期出血最少，术后24小时血栓形成倾向最低，术后6周新生内膜最薄。所有补片材料均形成了有功能的新生内膜。