HUMAN TRANSLUMINALLY PLACED ENDOVASCULAR STENTED GRAFTS - PRELIMINARY HISTOPATHOLOGIC ANALYSIS OF HEALING GRAFTS IN AORTOILIAC AND FEMORAL-ARTERY OCCLUSIVE DISEASE
HUMAN TRANSLUMINALLY PLACED ENDOVASCULAR STENTED GRAFTS - PRELIMINARY HISTOPATHOLOGIC ANALYSIS OF HEALING GRAFTS IN AORTOILIAC AND FEMORAL-ARTERY OCCLUSIVE DISEASE
复制标题
DOI：
10.1016/s0741-5214(95)70191-5
复制
发表时间：
1995-04-01
影响因子：
4.3
通讯作者：
PARODI, JC
中科院分区：
文献类型：
--
作者：
MARIN, ML;VEITH, FJ;PARODI, JC
目的：本研究的目的是对闭塞性疾病患者移植的人血管内支架移植物进行初步组织病理学分析。方法：在 16 个月的时间里，21 名因主动脉髂或股动脉闭塞性疾病引起肢体威胁性缺血的患者体内植入了 26 个血管内支架移植物。所有移植物均通过远离原发疾病区域的开放性动脉切开术插入。随访期间，两名患者在移植后2周和7个月因先前存在的心脏病死亡，其血管内移植物连同周围动脉的一部分被移出。在 3 周和 6 周后的移植物狭窄以及 3、5 和 6 个月后的流出动脉狭窄的手术翻修过程中，获得了其他 5 个血管内移植物的样本。所有标本均经过福尔马林培育，并用苏木精、伊红和三色染色进行研究，并对因子 VIII 相关抗原、α 肌动蛋白平滑肌、巨噬细胞抗原 (MAC-387) 和 PC-10（一种小鼠单克隆抗体，特异性识别石蜡切片中的增殖细胞核抗原）进行免疫组织化学研究。结果：放置支架移植物三周后，在扩张的移植物的两个表面上都存在机化血栓。聚四氟乙烯（PTFE）接枝物。 6 周时，在吻合口周围区域可见到覆盖有内皮的新生内膜，移植后 3 个月，在距吻合口 1 至 3 厘米处可见到新生内膜。 5 个月时移植的标本显示距吻合口 8 厘米处存在因子 VIII 阳性细胞。外囊的组织病理学状况似乎有所不同，具体取决于 PTFE 移植物上是否存在外包裹以及移植物插入动脉壁的哪一层。在包裹的移植物附近或放置在外膜内平面的移植物周围观察到以多核巨细胞为特征的异物反应。插入培养基内的移植物被有序、排列的平滑肌细胞和少量单核细胞包围。在外周移位和人工血管内移植物外部的自体动脉粥样硬化斑块内未观察到广泛的平滑肌细胞增殖（PC-10活性）。结论：这些对人类PTFE血管内支架移植物愈合的初步观察表明，斑块增生有限，并且远离移植物动脉吻合处的管腔表面存在内皮细胞。目前还不清楚这是否是一种独特的治愈表现。插入动脉壁内的假体移植物。
Purpose: The purpose of this study was to perform a preliminary histopathologic analysis of explanted human endovascular stented grafts from patients treated for occlusive disease.Methods: Over a 16-month period, 26 endovascular stented grafts were placed in 21 patients with limb-threatening ischemia caused by aortoiliac or femoral artery occlusive disease. All grafts were inserted through open arteriotomies remote from the region of primary disease. During the follow-up period, two patients died of preexisting heart disease 2 weeks and 7 months after grafting, and a portion of their endovascular grafts with the surrounding artery was explanted. Specimens from five other endovascular grafts were obtained during surgical revision for graft stenosis after 3 and 6 weeks and for outflow artery stenosis after 3, 5, and 6 months. All specimens were formalin bred and studied with hematoxylin and eosin and trichrome staining and immunohistochemically for factor VIII-related antigen, alpha actin smooth muscle, macrophage antigen (MAC-387) and PC-10 (a mouse monoclonal antibody which specifically recognizes proliferating cell nuclear antigen in paraffin sections).Results: Three weeks after placement of the stented grafts, organizing thrombus was present on both surfaces of the expanded polytetrafluoroethylene (PTFE) grafts. At 6 weeks, evidence of a neointima with overlying endothelium was seen in the perianastomotic region, and 3 months after grafting it was seen 1 to 3 cm from the anastomosis. The specimen explanted at 5 months demonstrated factor VIII-positive cells 8 cm from the anastomosis. The histopathologic condition of the external capsule appeared to vary, depending on the presence or absence of an external wrap on the PTFE graft and on which layer in the arterial wall the graft was inserted. A foreign body reaction characterized by multinucleated giant cells was seen adjacent to wrapped grafts or around those placed in an intraadventitial plane. Grafts inserted within the media were surrounded by orderly, arranged, smooth muscle cells and few mononuclear cells. Extensive smooth muscle cell proliferation (PC-10 activity) was not seen within native artery atherosclerotic plaques peripherally displaced and external to prosthetic endovascular grafts.Conclusions: These preliminary observations on the healing of PTFE endovascular stented grafts in human beings demonstrate limited plaque hyperplasia and the presence of endothelial cells on the luminal surface remote from the graft-artery anastomosis. It is unclear whether this is a unique manifestation of healing; in prosthetic grafts inserted within the walls of arteries.