Study of anastomotic neointimal hyperplasia after vascular prosthesis implantation. Its mechanism and prevention.

吻合口新生内膜肥大(ANH)被认为是导致最后一次移植物闭塞的一个因素。为减少和预防ANH，在犬体内植入了5种小口径移植物：聚亚安酯(PUG)、纤维长度为30、50、90微米的膨体聚四氟乙烯(EPTFE)和自体静脉移植物(AV)，并在光镜和扫描电子显微镜下进行病理观察，术后3月通畅率为50%，ANH发生率为27%。ANH在PUG组显着，在房室组最小，但增厚率在5组间无显着性差异。激光吻合与缝合吻合的增厚率差异无统计学意义，但激光吻合似乎是一种微血管吻合，血管内膜愈合良好。建议用激光吻合术预防ANH，为减少预防ANH药物的影响，移植犬植入后给予抗血小板药物治疗。药物处理组移植血管通畅率高于对照组，但增厚率与对照组无显着性差异。提示抗血小板药物对ANH的预防作用不明显。

Anastomotic neointimal hypertrophy (ANH) is suggested to be a contributing factor of last graft occlusion. To asess and to prevent ANH,five kind of small caliber grafts, polyurethane (PUG), expanded polytetrafluoroetylene (ePTFE) with 30,50 and 90 micron of fibrile length, and autovein graft (AV) were implanted in dog and pathological observation was performed by light microscopy and SEM.Cmulutative patency rate 3 months after implantation was 50% and ANH was occured in 27% of 26 grafts. ANH was markedly in PUG and was minimal in AV but there was no significant different of thickening rate between the five groups. Compareing anastomotic method of laser with suture, there was no different of thickening rate between the two method but laser anastomosis was seemed to be minilal ANH with good healing of he intima. Laser anastomosis is suggested to prevent ANH.To asess the influence of drug for preventing ANH,antiplatelet drug was administrated to the dog after graft implantation. Graft patency of the drug treatening group was higher than the control group but there was no significant difference of thickening rate between the drug treatening group and the control group. These results suggest that the antiplatelet drug is not effective to prevent ANH.