Bayramiçli M, Yilmaz B, San T, Numanoglu A
Department of Plastic and Reconstructive Surgery, Marmara University Medical School, Istanbul, Turkey.
J Reconstr Microsurg. 1998 Nov;14(8):575-86. doi: 10.1055/s-2008-1040778.
The early effects of hematoma on the healing pattern of interpositional vein grafts were studied in 60 rats. In all animals, vein grafts approximately 10-mm in length were used to bridge defects created in the femoral artery and vein on the same side, with a 1:1 graft-to-host diameter match. Grafted vessels were completely covered with hematoma and separated from the surrounding tissue in 30 animals, while the other 30 rats served as controls. Both groups were divided into six subgroups of five animals each, according to the age of the grafts: 1, 3, 5, 7, 14, and 21 days. Graft patency and healing were assessed both clinically and histologically 20/30 (66.6 percent) of the interarterial and 27/30 (90 percent) of the intervenous vein grafts in Group 1 (hematoma group), and 28/30 (93.3 percent) of the interarterial and 29/30 196.6 percent) of the intervenous vein grafts in Group 2 (controls) were found patent. The patency rate of the interarterial vein grafts in the hematoma group was statistically significantly lower than in the control group and than in the intervenous vein grafts of the same group (p<0.005). The majority of interarterial vein-graft failures occurred after postoperative day 7 in Group 1. Patent specimens were examined under scanning electron and light microscopy. The authors concluded that perivascular hematoma caused spasm and flow disturbance, prolonged vessel-wall ischemia, and severe vessel-wall injury in the arterial circulation of the microvenous grafts. It also delayed the healing process and subjected the grafts to the development of occlusive mural thrombus. In contrast, the healing pattern of the intervenous vein grafts was not markedly influenced by perivascular hematoma, and equilibrium between thrombogenic and antithrombogenic factors on the graft surface was restored over a short period of time.
在60只大鼠中研究了血肿对间置静脉移植物愈合模式的早期影响。在所有动物中，使用长度约为10毫米的静脉移植物来桥接同一侧股动脉和静脉中形成的缺损，移植物与宿主直径匹配为1:1。30只动物的移植血管完全被血肿覆盖并与周围组织分离，另外30只大鼠作为对照。根据移植物的存活时间，两组均分为六个亚组，每组五只动物：1天、3天、5天、7天、14天和21天。在术后20/30（66.6%）的动脉间和27/30（90%）的静脉间移植物中，第1组（血肿组）的移植物通畅情况和愈合情况通过临床和组织学评估，第2组（对照组）中28/30（93.3%）的动脉间和29/30（96.6%）的静脉间移植物被发现通畅。血肿组动脉间静脉移植物的通畅率在统计学上显著低于对照组以及同组的静脉间移植物（p<0.005）。第1组中大多数动脉间静脉移植物失败发生在术后第7天之后。对通畅的标本进行扫描电子显微镜和光学显微镜检查。作者得出结论，血管周围血肿导致微静脉移植物动脉循环中的痉挛和血流紊乱，延长血管壁缺血时间，并造成严重的血管壁损伤。它还延迟了愈合过程，并使移植物易于形成闭塞性壁血栓。相比之下，静脉间移植物的愈合模式未受到血管周围血肿的明显影响，并且移植物表面促血栓形成和抗血栓形成因子之间的平衡在短时间内得以恢复。
