QUANTIFICATION OF FACTORS LEADING TO VEIN GRAFT FAILURE

导致静脉移植失败的因素的量化

• 批准号: 2460048
• 负责人: DONALD E STRANDNESS
• 金额: $ 29.24万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-09-15 至 2000-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2460048
• 关键词: atherosclerosis; blood vessel transplantation; clinical research; human subject; human therapy evaluation; hyperplasia; transplant rejection; vascular endothelium; vascular smooth muscle

DESCRIPTION: The most common cause of failure of all forms of intervention on the arterial and venous side of the circulation is myointimal hyperplasia. It represents the response of the vascular wall to injury. The injury is a complex phenomenon involving the endothelium and smooth muscle of the media. when initiated, smooth muscle growth along with the deposition of matrix leads to narrowing of the vessel, which may in the extreme case, lead to thrombosis and failure. The most common site for this to occur in the peripheral arterial circulation is in saphenous vein grafts that have been placed to bypass areas of occlusion. The incidence of this is in the range of 20-40%. the purpose of this proposal is to develop sensitive quantitative methods for graft surveillance with the goal of detecting lesions before failure of the conduit occurs and when intervention will preserve the long-term function of the graft. The proposal is designed to develop and evaluate ultrasonic methods that can be used to generate three dimensional models, as well as high resolution images of the lesions themselves. In addition, by the use of high resolution ultrasound, it is proposed to test the role of the intima-media of the vein graft in preventing proliferation of the smooth muscle. The target population will be those patients who have undergone saphenous vein grafting and who can be followed at frequent intervals during the first year, which is the time in which these problems develop. At each visit, studies of flow velocity, geometry and three dimensional reconstruction of the vein graft will be carried out. for all detected lesions, their progression/regression will be monitored by these techniques. Intervention will only be done when the lesions within the graft lead to the development of a pressure gradient or symptoms return. In addition, it will be possible to monitor the status of atherosclerosis in the inflow and outflow arteries to assess its role in graft function and outcome. This is the first study designed to provide natural history data on this lesion, which is such a common cause of failure in the arterial system.

描述：所有形式的干预失败的最常见原因 在循环的动脉和静脉侧是肌内膜 增生 它代表了血管壁对损伤的反应。 损伤是一个复杂的现象，涉及内皮细胞和平滑肌细胞， 媒体的肌肉。 当启动时，平滑肌生长沿着 基质的沉积导致血管变窄， 极端情况下，导致血栓形成和失败。 最常见的发生部位是外周动脉 循环是在隐静脉移植物中， 闭塞区。 其发生率在20- 40%的范围内。 的 该提案的目的是开发敏感的定量方法， 移植物监测的目的是在移植失败前检测病变。 管道发生，当干预将保持长期功能， 移植物 该提案旨在开发和评估超声方法， 用于生成三维模型，以及高分辨率 病变本身的图像。 此外，通过使用高 分辨率超声，建议测试内膜-中膜的作用 静脉移植物在防止平滑肌增殖方面的作用。 目标人群将是接受隐静脉穿刺术的患者。 静脉移植和谁可以在第一次随访期间频繁的间隔 一年，这是这些问题发展的时间。 每次访问时， 流速、几何形状和三维重建的研究 将进行静脉移植。 对于所有检测到的病变， 将通过这些技术监测进展/消退。 干预 只有当移植物内的病变导致 压力梯度或症状复发。 另外， 监测流入和流出动脉中的动脉粥样硬化状态 评估其在移植功能和结果中的作用。 这是第一项旨在提供这方面自然历史数据的研究。 病变，这是动脉系统失败的常见原因。