Kusaba A
Department of Surgery II, Faculty of Medecine, University of Ryukyus, Okinawa, Japan.
Nihon Geka Gakkai Zasshi. 1997 Aug;98(8):697-9.
In cases of peripheral arterial reconstructive surgery, it is important to prevent postoperative early and late occlusion of the reconstructed artery. The postoperative early outcome of the reconstructed artery were related to electromagnetically determined flow waveform of the reconstructed artery. Flow waveform was classified in 5 types, i. e. types O, I, II, III, and IV. The prognosis of the reconstructed arteries with types O and I was excellent. Type II showed no postoperative early occlusion but late occlusion did occur in 31%. Type III and IV were all failed within 48 hours postoperatively. Correlation between prognosis of the reconstructed artery and flow waveform was established by the intraluminal velocity profile of blood flow, using a specially designed flow wave simulation pump system. Postoperative late occlusion in arterial reconstruction often occurs in cases with poor distal runoff and caused by intimal hyperplasia of implanted autovein graft and its distal end-to-side anastomosis. The features of intimal hyperplasia of the implanted autovein graft differed from those at the distal end-to-side anastomosis; the former being related to active proliferation of smooth muscle cells while the latter displayed an excessive proliferation of fibroblasts and collagen fibers.
在周围动脉重建手术中，预防重建动脉术后早期和晚期闭塞至关重要。重建动脉的术后早期结果与通过电磁法测定的重建动脉血流波形有关。血流波形分为5种类型，即O型、I型、II型、III型和IV型。O型和I型重建动脉的预后良好。II型术后未发生早期闭塞，但31%发生了晚期闭塞。III型和IV型在术后48小时内均失败。使用专门设计的血流波模拟泵系统，通过血流的腔内速度剖面确定了重建动脉预后与血流波形之间的相关性。动脉重建术后的晚期闭塞常发生在远端血流不佳的病例中，是由植入的自体静脉移植物及其远端端侧吻合口的内膜增生引起的。植入的自体静脉移植物内膜增生的特征与远端端侧吻合口处的不同；前者与平滑肌细胞的活跃增殖有关，而后者表现为成纤维细胞和胶原纤维的过度增殖。
