Histological and morphometric analyses of early and late aortocoronary vein grafts and distal anastomoses.
Histological and morphometric analyses of early and late aortocoronary vein grafts and distal anastomoses.
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发表时间：
1998-05
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通讯作者：
J. Butany;Tirone E. David;Matadial Ojha
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作者：
J. Butany;Tirone E. David;Matadial Ojha
背景：主动脉冠状静脉移植物在植入后第一年内发生纤维肌性内膜增生。组织重构可能促进移植物动脉粥样硬化和血栓形成。血管造影研究表明，人冠状静脉移植物原位一年或多年变得狭窄，优先在远端吻合对主体或主干的移植物或在近端吻合。既往研究未报告远端移植物/动脉闭塞周围内膜病变性质和分布的形态学数据。目的观察27例冠状静脉桥血管内膜及其远端病变的组织学和形态学变化。方法对72例尸检心脏和1例心脏移植心脏进行检查、照相和10%甲醛缓冲液固定。将3 ~ 7个3 mm长的移植物及其远端骨段切片，染色并通过光学显微镜检查。结果11例早期移植物植入6周或6周以下，主要在缝合线处出现明显的细胞增生。在16例1.5 - 15年的晚期原位移植物中，纤维肌性内膜增厚程度在帽和缝合线处最大，而在自体动脉底部和移植物体内，增厚程度分别约为帽上的三分之一和三分之二。结论冠状静脉移植物远端吻合口狭窄可能与移植物帽和缝合线处内膜增厚的优先发展有关。由于纤维肌性内膜增生已被报道在静脉移植物体内动脉粥样硬化和血栓形成的发展中起作用，因此远端吻合处的局灶性增生也可能在静脉移植物失败中起作用。
BACKGROUND Aortocoronary vein grafts develop fibromuscular intimal hyperplasia within the first year of implantation. Tissue remodeling may promote development of graft atherosclerosis and thrombosis. Angiographic studies show that human aortocoronary vein grafts in situ for one or more years become stenosed, preferentially at the distal anastomosis versus the body or trunk of the graft or at the proximal anastomosis. Previous studies have not reported morphological data on the nature and distribution of intimal lesions around the distal graft/artery anastomoses. OBJECTIVE To examine and quantify histological and morphometric changes within the intima of 27 aortocoronary vein grafts and their distal anastomoses. METHODS Seventy-two hearts obtained at autopsy and one at heart transplantation were examined, photographed and fixed in 10% buffered formaldehyde solution. Three to seven 3 mm long segments of grafts and their distal anastomoses were sectioned, stained and examined by light microscopy. RESULTS Eleven early grafts were implanted for six weeks or less, and they showed significant cellular hyperplasia mainly at the suture line. In 16 late grafts in situ 1.5 to 15 years, the degree of fibromuscular intimal thickening was greatest on the hood and at the suture line, whereas on the floor of the native artery and in the graft body the degree of thickening was approximately one-third and two-thirds, respectively, that seen on the hood. CONCLUSIONS Stenosis of aortocoronary vein grafts at their distal anastomosis is likely related to the preferential development of intimal thickening on the hood of the graft and at the suture line. Because fibromuscular intimal hyperplasia has been reported to play a role in the development of atherosclerosis and thrombosis in the body of vein grafts, this focal hyperplasia at the distal anastomosis may also play a role in vein graft failure.