Pressure control during preparation of saphenous veins.
Pressure control during preparation of saphenous veins.
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DOI：
10.1001/jamasurg.2013.5067
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发表时间：
2014-07
期刊：
影响因子：
16.9
通讯作者：
Cheung-Flynn, Joyce
中科院分区：
文献类型：
--
作者：
Li, Fan Dong;Eagle, Susan;Brophy, Colleen;Hocking, Kyle M.;Osgood, Michael;Komalavilas, Padmini;Cheung-Flynn, Joyce
由于静脉移植失败（VGF），用作冠状动脉旁路移植术（CABG）手术自体管道的人隐静脉（HSV）的长期通畅性仍然有限。据报道，静脉移植失败在术后12至18个月高达45%，并导致额外的手术、心肌梗死、复发性心绞痛和死亡。植入前准备HSV导致管道损伤，这可能促进VGF。研究静脉移植物准备期间的压力扩张是否导致内皮损伤和内膜增厚，以及在压力扩张期间通过使用压力释放阀（PRV）限制管腔内压力是否保留内皮功能并防止新生内膜增厚。在一所大学医院采集了13例接受CABG手术的患者的HSV节段，这些患者在采集后立即（未操作[UM]）、压力扩张后（扩张后[AD]）和典型的术中手术移植物准备后（操作后[AM]）。对来自7只健康研究动物的猪隐静脉（PSV）进行手动压力扩张，使用或不使用防止压力达到140 mm Hg或更高的在线PRV。在肌肉浴中测定了HSV和PSV的内皮功能，评估了内皮完整性，并在器官培养14天后评价了PSV的内膜增厚。内皮功能测定的力量，转换为应力，并定义为最大苯肾上腺素诱导的收缩的百分比松弛。通过免疫组织学检查评估内皮完整性。通过组织形态计量学分析测量新生内膜厚度。HSV的压力扩张导致平均（SEM）内皮依赖性舒张降低（AD患者为5.3% [2.3%] vs UM患者为13.7% [2.5%]; P <0.05）和剥脱。在AM组中，导管功能进一步下降（-3.2%[3.2%]; P <0.05）。PSV扩张导致内皮依赖性舒张减少（7.6% [4.4%] vs 61.9% [10.2%]; P <0.05），剥脱和内膜增厚增加（15.0 [1.4] μm vs 2.2 [0.8] μm; P <0.05）。在PSV中，PRV扩张保持了内皮依赖性舒张（50.3% [9.6%]; P = .32 vs对照），防止了剥脱，并减少了内膜增厚（3.4 [0.8] μm; P = .56 vs对照）。在移植物制备过程中使用PRV限制了手动扩张产生的腔内压力，保持了内皮完整性，并减少了内膜增生。这种简单装置的整合可能有助于改善静脉移植物的长期通畅性。
Long-term patency of human saphenous veins (HSVs) used as autologous conduits for coronary artery bypass grafting (CABG) procedures remains limited because of vein graft failure (VGF). Vein graft failure has been reported to be as high as 45% at 12 to 18 months after surgery and leads to additional surgery, myocardial infarction, recurrent angina, and death. Preparation of HSVs before implantation leads to conduit injury, which may promote VGF. To investigate whether pressure distension during vein graft preparation leads to endothelial injury and intimal thickening and whether limiting intraluminal pressure during pressure distension by using a pressure release valve (PRV) preserves endothelial function and prevents neointima thickening. Segments of HSVs were collected in a university hospital from 13 patients undergoing CABG procedures immediately after harvest (unmanipulated [UM]), after pressure distension (after distension [AD]), and after typical intraoperative surgical graft preparation (after manipulation [AM]). Porcine saphenous veins (PSVs) from 7 healthy research animals were subjected to manual pressure distension with or without an in-line PRV that prevents pressures of 140 mm Hg or greater. Endothelial function of the HSVs and PSVs was determined in a muscle bath, endothelial integrity was assessed, and intimal thickening in PSVs was evaluated after 14 days in organ culture. Endothelial function was measured in force, converted to stress, and defined as the percentage relaxation of maximal phenylephrine-induced contraction. Endothelial integrity was assessed by immunohistologic examination. Neointimal thickness was measured by histomorphometric analysis. Pressure distension of HSVs led to decreased mean (SEM) endothelial-dependent relaxation (5.3% [2.3%] for AD patients vs 13.7% [2.5%] for UM patients; P < .05) and denudation. In the AM group, the function of the conduits was further decreased (−3.2% [3.2%]; P < .05). Distension of the PSVs led to reduced endothelial-dependent relaxation (7.6% [4.4%] vs 61.9% [10.2%] in the control group; P < .05), denudation, and enhanced intimal thickening (15.0 [1.4] μm vs 2.2 [0.8] μm in the control group; P < .05). Distension with the PRV preserved endothelial-dependent relaxation (50.3% [9.6%]; P = .32 vs control), prevented denudation, and reduced intimal thickening (3.4 [0.8] μm; P = .56 vs controls) in PSVs. Use of a PRV during graft preparation limits intraluminal pressure generated by manual distension, preserves endothelial integrity, and reduces intimal hyperplasia. Integration of this simple device may contribute to improved long-term vein graft patency.
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影响因子：
2.2
作者：
Li, Fan Dong;Sexton, Kevin W.;Hocking, Kyle M.;Osgood, Michael J.;Eagle, Susan;Cheung-Flynn, Joyce;Brophy, Colleen M.;Komalavilas, Padmini
通讯作者：
Komalavilas, Padmini
影响因子：
4.6
作者：
Hinokiyama, Kazuhiro;Valen, Guro;Vaage, Jarle
通讯作者：
Vaage, Jarle
DOI：
10.1016/j.jtcvs.2006.04.002
发表时间：
2006-08-01
影响因子：
6
作者：
Souza, Domingos S. R.;Johansson, Benny;Dashwood, Michael R.
通讯作者：
Dashwood, Michael R.
DOI：
10.1161/01.atv.0000116690.17017.8b
发表时间：
2004-03-01
影响因子：
8.7
作者：
Cornelissen, J;Armstrong, J;Holt, CM
通讯作者：
Holt, CM
影响因子：
4.6
作者：
Khaleel, Maseeha S.;Dorheim, Tracy A.;Anderson, Daniel R.
通讯作者：
Anderson, Daniel R.