INCREASED BLOOD-FLOW INHIBITS NEOINTIMAL HYPERPLASIA IN ENDOTHELIALIZED VASCULAR GRAFTS
INCREASED BLOOD-FLOW INHIBITS NEOINTIMAL HYPERPLASIA IN ENDOTHELIALIZED VASCULAR GRAFTS
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DOI：
10.1161/01.res.69.6.1557
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发表时间：
1991-12-01
影响因子：
20.1
通讯作者：
CLOWES, AW
中科院分区：
文献类型：
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作者：
KOHLER, TR;KIRKMAN, TR;CLOWES, AW
动脉内膜增生是血管重建失败的主要原因，可能受到血流的影响。我们研究了血流增加对多孔聚四氟乙烯移植物内膜增生的影响。这些移植物在2周后形成内皮细胞衬里，1个月后由于底层平滑肌细胞的增殖而形成新的内膜增厚。远端动静脉瘘的建立增加了血流量(从230+/-35增加到785+/-101毫升/分，P<0.001)和平均切变率(从26+/-4增加到78+/-10达因/厘米~2，P<0.001)，而不会引起移植物的压力下降。瘘管并没有改变内皮覆盖的模式，但确实导致新生内膜横截面积显著减少(从3个月时的2.60±0.52降至0.42±0.07 mm2，p<；0.01)。详细的形态计量学分析显示，平滑肌细胞和基质含量减少了相当的百分比，这表明增加血流的主要作用是减少平滑肌细胞的数量，而不影响单个细胞产生的基质的数量。术后2个月，新生内膜厚度迅速增加(从术后2个月的0.60±0.03 mm~2增加到术后1个月的3.88±0.55 mm~2，p<；0.01)。这些结果支持这样一种假设，即血流的变化不仅影响正常血管的结构，也影响病变血管的结构。
Intimal hyperplasia is a primary cause of failure after vascular reconstruction and may be affected by blood flow. We have studied the effects of increased blood flow on intimal hyperplasia in porous polytetrafluoroethylene grafts implanted in baboons. These grafts develop an endothelial lining by 2 weeks and neointimal thickening due to proliferation of underlying smooth muscle cells by 1 month. Creation of a distal arteriovenous fistula increased flow (from 230 +/- 35 to 785 +/- 101 ml/min, p < 0.001) and mean shear (from 26 +/- 4 to 78 +/- 10 dynes/cm2, p < 0.001) without causing a drop in pressure across the grafts. Fistula How did not alter the pattern of endothelial coverage but did cause a marked reduction in the cross-sectional area of the neointima (from 2.60 +/- 0.52 to 0.42 +/- 0.07 mm2 at 3 months, p < 0.01). Detailed morphometric analysis revealed an equivalent percentage decrease in smooth muscle cells and matrix content, suggesting that the primary effect of increased flow was to reduce smooth muscle cell number without affecting the amount of matrix produced by individual cells. The neointima remained sensitive to changes in flow at late times; ligation of the fistula after 2 months resulted in a rapid increase in neointimal thickness (from 0.60 +/- 0.03 mm2 after 2 months of fistula How to 3.88 +/- 0.55 mm2 1 month after ligation of fistula, p < 0.01). These results support the hypothesis that changes in blood flow affect the structure of diseased as well as normal vessels.