Local hemodynamic disturbance accelerates early thrombosis of small-caliber expanded polytetrafluoroethylene grafts
Local hemodynamic disturbance accelerates early thrombosis of small-caliber expanded polytetrafluoroethylene grafts
复制标题
局部血流动力学紊乱加速小口径膨胀聚四氟乙烯移植物的早期血栓形成
DOI：
10.1177/0267659113489330
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
C. Wang
中科院分区：
文献类型：
--
作者：
S. Lu;X. Sun;P. Zhang;L. Yang;F. Gong;C. Wang
目的：小口径膨化聚四氟乙烯（ePTFE）移植物由于早期血栓形成和闭塞，在临床中不能广泛应用。这个尚未解决和认识不足的问题值得进一步调查。方法：将未包被ePTFE （n = 6）和抗cd34包被ePTFE （n = 6）单侧植入12头家猪颈动脉。超声检查吻合口近端和远端形态、直径和血流速度。用血栓形成仪检测血凝状态。7天后，处死猪，切除植入的移植物进行一般和组织学分析。利用计算流体动力学研究移植物的血流场，并计算可能指示血栓形成的参数。结果：12例ePTFE移植物中有10例（83.3%）出现血栓形成，未包被组5例，抗cd34包被组5例。在未包被和抗cd34包被的移植物中均观察到内皮细胞覆盖。吻合口及凝血状态未见明显异常。基于计算机的局部血流动力学模拟显示，人工合成ePTFE移植物柔韧性低，导致明显的血管收缩。局部壁面压力、流速和壁面剪应力明显高于对侧正常血管。结论：小口径ePTFE移植物在临床应用时，由于多种原因导致早期血栓形成，影响其通畅性。局部血流动力学紊乱是早期血栓形成最有力的预测因子。减少局部血流动力学干扰，改善吻合口质量，选择合理的抗凝策略，促进快速内皮化，可提高小口径血管移植物的长期通畅。
Objective: Small-caliber expanded polytetrafluoroethylene (ePTFE) grafts cannot be used widely in the clinical situation because of early thrombosis and occlusion. This unsolved and under-recognized problem warrants further investigation. Methods: Grafts of uncoated ePTFE (n = 6) and anti-CD34-coated ePTFE (n = 6) were implanted unilaterally into the carotid artery in 12 domestic pigs. Ultrasonography was used to test the proximal and distal anastomotic stoma morphology, diameters and blood velocities. A thrombosis instrument was used to examine the blood coagulation state. After seven days, the pigs were sacrificed and the implanted grafts were excised for general and histological analysis. Computational fluid dynamics was used to investigate the blood flow fields of the implanted grafts and to calculate parameters that might be indicative of thrombosis. Results: Thrombosis was detected in 10 of 12 (83.3%) implanted ePTFE grafts, 5 in uncoated grafts and 5 in anti-CD34-coated grafts. Endothelial cell coverage was observed in both uncoated and anti-CD34-coated grafts. No obvious abnormalities in anastomotic stoma or blood coagulation state were observed. Computer-based local hemodynamic simulation showed the low flexibility of synthetic ePTFE grafts caused obvious coarctation. Local wall pressure, velocity and wall shear stress were much higher than in the contralateral normal vessel. Conclusions: The patency of small-caliber ePTFE grafts for clinical use is impaired by early thrombosis due to mixed causes. Local hemodynamic disturbance was the most powerful predictor of early thrombosis. Decreasing local hemodynamic disturbance, improving the quality of anastomotic stoma, selecting reasonable anticoagulation strategies and promoting rapid endothelialization may increase the long-term patency of small-caliber vascular grafts.
影响因子：
2.2
作者：
Conklin, BS;Richter, ER;Chen, C
通讯作者：
Chen, C