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The influence of out-of-plane geometry on the flow within a distal end-to-side anastomosis

JOURNAL OF BIOMECHANICAL ENGINEERING-TRANSACTIONS OF THE ASME 2000年第1期122卷 86-95页

作者： Sherwin, SJ Shah, O Doorly, DJ Peiró, J Papaharilaou, Y Watkins, N Caro, CG Dumoulin, CL Univ London Imperial Coll Sci Technol & Med Dept Aeronaut Biomed Flow Grp London SW7 2BY England Univ London Imperial Coll Sci Technol & Med Dept Biol & Med Syst London SW7 2BX England GE Corp Res & Dev Schenectady NY 12309 USA

This paper describes a computational and experimental investigation of flow in a proto-type model geometry, of a fully occluded 45 deg distal end-to-side anastomosis. Previous investigations have considered a similar configuration where the centerlines of the bypass and host vessels lie within a plane, thereby producing a plane of symmetry within the flow. We have extended these investigations by deforming the bypass vessel out of the plane of symmetry, thereby breaking the symmetry of the flow and producing a nonplanar geometry. Experimental data were obtained using magnetic resonance imaging of flow within perspex models and computational data were obtained from simulations using a high-order spectral/hp element method. We found that the nonplanar three-dimensional flow notably alters the distribution of wall shear stress at the bed of the anastomosis, reducing the peak wall shear stress peak by approximately 10 percent when compared with the planar model. Furthermore, an increase in the absolute flux of velocity into the occluded region, proximal to the anastomosis, of 80 percent was observed in the nonplanar geometry when compared with the planar geometry. [S0148-0731(00)00401-5].

关键词：算法吻合术外科/副作用动脉硬化/并发症计算机模拟移植物闭塞血管/病因学移植物闭塞血管/病理生理学血液流变学增生模型心血管数值分析计算机辅助搏动血流结果可重复性血管内膜/病理学

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Conduit choice for above-knee femoropopliteal bypass grafting in patients with limb-threatening ischemia

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ANNALS OF VASCULAR SURGERY 2002年第1期16卷 95-101页

作者： Curi, MA Skelly, CL Meyerson, SL Woo, DH Desai, TR McKinsey, JF Bassiouny, HS Katz, D Gewertz, BL Schwartz, LB Univ Chicago Dept Surg Vasc Surg Sect Chicago IL 60637 USA

Many surgeons consider PTFE to be the conduit of choice for above-knee femoropopliteal bypass grafting, since PTFE is relatively easy to implant and spares autogenous saphenous vein (ASV) for subsequent peripheral or coronary artery bypass grafting (CABG). This practice has recently been challenged, as some studies have suggested that ASV may exhibit superior patency in certain patient subgroups. The purpose of this retrospective study was to examine the contemporary outcome of above-knee femoropopliteal bypass grafting in patients with limb-threatening ischemia. Between January 1995 and December 2000, 159 above-knee femoropopliteal bypass grafts were created for limb-threatening ischemia (rest pain or tissue loss). There was a high incidence of comorbid illness, including open foot wounds at the time of operation (62%), hypertension (58%), coronary artery disease (53%), diabetes mellitus (36%), cerebrovascular disease (23%), prior contralateral bypass or amputation (21%), disadvantaged or "blind" outflow (19%), prior ipsilateral bypass (14%), prior CABG (11%) end-stage renal failure (7%). The use of PTFE predominated (n = 11), with a minority of grafts comprising single-segment ipsilateral or contralateral ASV (n = 18). Although the small number of patients undergoing ASV grafting limited the statistical power of comparison, our results suggest that above-knee ASV performs better than PTFE in patients with limb-threatening ischemia.

关键词：血管假体植入/方法股动脉/外科学移植物闭塞血管/病因学缺血/外科学腿/血液供给四肢救助/方法腘动脉/外科学回顾性研究隐静脉/外科学存活率分析老年人女(雌)性人类男(雄)性中年人

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Effectiveness of rotational atherectomy in aortocoronary saphenous vein grafts

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第1期86卷 88-+页

作者： Thomas, WJ Cowley, MJ Vetrovec, GW Malloy, W Goudreau, E Virginia Commonwealth Univ Div Cardiol Richmond VA 23298 USA

In carefully selected patients with prior coronary by-pass surgery, rotational atherectomy can be safely and effectively performed for anastomotic saphenous vein graft lesions. Rotational atherectomy can also be used ... 详细信息

关键词：斑块切除术冠状动脉冠状血管造影术冠状动脉分流术/方法移植物闭塞血管/病因学移植物闭塞血管/放射摄影术移植物闭塞血管/外科学心肌缺血/放射摄影术心肌缺血/外科学再手术回顾性研究隐静脉/移植治疗结果老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Histopathologic comparison of human coronary instent and post-balloon angioplasty restenotic tissue

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第4期84卷 462-+页

作者： Moreno, PR Palacios, IF Leon, MN Rhodes, J Fuster, V Fallon, JT Univ Kentucky Gill Heart Inst Lexington KY USA Harvard Univ Sch Med Cardiac Unit Boston MA USA Mt Sinai Sch Med Dept Pathol New York NY USA Mt Sinai Sch Med Cardiovasc Inst New York NY USA

Recent postmortem histopathologic studies of patients dying after coronary stenting have shown that in-stent restenosis results from smooth muscle cell proliferation and extracellular matrix formation.(1,2) Conversely, restenosis after percutaneous transluminal coronary angioplasty (PTCA) is considered to be a combination of negative vascular remodeling and intimal hyperplasia.(3) Nevertheless, detailed, systematic histopathologic analysis comparing coronary in-stent and post-balloon PTCA restenosis in living patients are limited. This study analyzes the cellular and extracellular composition of in-stent restenotic lesions in vivo and establishes histopathologic differences between in-stent and post-balloon PTCA restenotic tissue in patients with symptomatic restenosis after percutaneous revascularization.

关键词：斑块切除术冠状动脉细胞分裂冠状血管造影术冠状血管/病理学冠状血管/超声检查细胞外基质/病理学移植物闭塞血管/诊断移植物闭塞血管/病因学移植物闭塞血管/外科学肌平滑血管/病理学肌平滑血管/超声检查假体失效支架超声检查介入性老年人女(雌)性人类男(雄)性中年人

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Small-caliber mesothelial cell-layered polytetraflouroethylene vascular grafts in New Zealand white rabbits

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ANNALS OF VASCULAR SURGERY 2002年第1期16卷 73-76页

作者： Sparks, SR Tripathy, U Broudy, A Bergan, JJ Kumins, NH Owens, EL Univ Calif San Diego Med Ctr Dept Surg Div Vasc Surg San Diego CA 92103 USA

Reduction in the thrombogenicity of small-caliber synthetic vascular grafts by lining them with mesothelial cell has been suggested as a method to reduce thrombosis. The purpose of this research is to determine whether creation of a mesothelial lining on the inner surface of a synthetic vascular graft would improve the patency rate of a small-caliber vascular grafts. Carotid interposition grafting was performed using mesothelial-lined grafts (MLG) in 30 New Zealand rabbits and compared with similar carotid interposition grafts using non-mesothelial-lined grafts (NLG) on the contralateral side. The mesothelial lining was created by suturing a piece of harvested peritoneum with the visceral surface toward the lumen onto a 2-mm polytetraflouroethylene (PTFE) graft, Graft patency was studied by in vivo Dopler. In vitro evaluations were done with hematoxylin-eosin stains, broadband cytokeratin staining, and monoclonal antibodies for macrophages. Explanation of the grafts was done in terminal operation at 7, 14, and 21 days. The MLG showed progressive fibroblastic proliferation in direct proportion to the age of the graft, but this did not lead to graft occlusion. However, a significant number of NLG were not patent at each time period studied. We concluded that mesothelial cell lining of smallcaliber PTFE grafts could enhance the short-term patency more than using the PTFE without the mesothelial lining. The use of such hybrid small-caliber grafts has a potential for improving the patency of these artificial vascular graft substitutes.

关键词：内皮/细胞学内皮血管/细胞学上皮/病理学移植物闭塞血管/病因学移植物闭塞血管/预防和控制模型动物腹膜/细胞学聚四氟乙烯/治疗应用假体设计血栓形成/病因学血栓形成/预防和控制超声检查多普勒动物男(雄)性兔

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Comparison of percutaneous interventions for unstable angina pectoris in patients with and without previous coronary artery bypass grafting

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第9期86卷 931-937页

作者： Mathew, V Berger, PB Lennon, RJ Gersh, BJ Holmes, DR Mayo Clin & Mayo Fdn Rochester MN 55905 USA

An increasing number of patients who have undergone previous coronary artery bypass grafting (CABG) are referred for percutaneous coronary revascularization. We identified patients who underwent percutaneous intervention for unstable angina from 1990 to 1998 at our institution and assigned them into 2 groups based on whether or not they had undergone previous CABG. There were 1,431 patients with and 4,629 patients without previous CABG. Previous CABG patients were older, had more atherosclerotic risk factors, more heart failure, lower ejection fraction, more multivessel disease, more multilesion treatment, more complex lesions, and less complete revascularization. Adjusting for baseline differences, previous CABG was associated with worse long-term mortality (RR 1.47, 95% confidence intervals [CI] 1.22 to 1.77, p <0.001) and death, myocardial infarction, and/or revascularization (RR 1.16, 95% CI 1.04 to 1.30, p = 0.01);treatment of native lesions in patients with previous CABG versus treatment of vein graft lesions was associated with a reduction in this composite end point (RR 0.75, 95% CI 0.65 to 0.87, p <0.001). Post-CABG patients treated between 1995 and 1998 had lower long-term mortality (RR 0.76, 95% CI 0.59 to 0.99, p = 0.04) and death, myocardial infarction, and/or revascularization (RR 0.76, 95% CI 0.66 to 0.88, p <0.001) compared with those treated between 1990 and 1994. Thus, in patients with unstable angina referred for percutaneous revascularization, previous CABG is associated with reduced event-free survival, although the outcome of post-CABG patients treated from 1995 to 1998 is superior to that observed in patients treated from 1990 to 1994. In patients who underwent previous CABG, treatment of native lesions affords better long-term outcome than vein graft intervention. (C)2000 by Excerpta Medico, Inc.

关键词：方差分析心绞痛不稳定型/死亡率心绞痛不稳定型/外科学血管成形术经腔经皮冠状动脉/方法血管成形术经腔经皮冠状动脉/死亡率卡方分布冠状动脉分流术/方法随访研究移植物闭塞血管/病因学移植物闭塞血管/放射摄影术移植物闭塞血管/治疗比值比概率前瞻性研究登记存活率治疗结果女(雌)性人类男(雄)性中年人

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Association of B7-1 co-stimulation with the development of graft arterial disease - Studies using mice lacking B7-1, B7-2, or B7-1/B7-2

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AMERICAN JOURNAL OF PATHOLOGY 2000年第2期157卷 473-484页

作者： Furukawa, Y Mandelbrot, DA Libby, P Sharpe, AH Mitchell, RN Harvard Univ Sch Med Brigham & Womens Hosp Dept PatholDiv Immunol Boston MA 02115 USA Harvard Univ Sch Med Brigham & Womens Hosp Dept Med Boston MA 02115 USA Harvard Univ Sch Med Brigham & Womens Hosp Cardiovasc DivVasc Med & Atherosclerosis Unit Boston MA 02115 USA

To investigate the roles of B7-1 and/or B7-2 co-stimulatory molecule in the development of graft arterial disease (GAD), major histocompatibility complex (MHC) class It-mismatched allograft hearts were transplanted into wild-type, B7-1(-/-), B7-2(-/-), or B7-1/B7-2(-/-) recipient mice. Grafts were explanted at 4 or 8 weeks and used for histological and immunohistochemical analyses, RNase protection assay, and now cytometry of graft infiltrating cells. Grafts In wild-type recipients showed macrophage, recipient MHC class II, and B7 molecule co-localization by immunohistochemistry to GAD lesions. Flow cytometry revealed that CD11b(+) and MHC class II(+) graft infiltrating cells expressed B7-1 more than B7-2, whereas B7-2 expression was predominant in CD11b(-) cells at 4 and 8 weeks. GAD was significantly attenuated in the allografts in B7-1(-/-) and B7-1/B7-2(-/-) but not in B7-2-/- recipients compared to wild-type hosts. Interferon-gamma mRNA levels were comparable in all graft combinations, whereas interleukin-4 mRNA levels decreased in grafts in B7-2 deficient hosts, but did not correlate with GAD attenuation. The findings indicate distinct roles for B7-1 and B7-2 co-stimulatory molecules in the development of GAD, potentially because of differential expression of B7-1 and B7-2 molecules on distinct stimulator and/or effector cell populations.

关键词：抗原呈递细胞/生理学抗原 CD/分析抗原 CD/遗传学抗原 CD/生理学抗原 CD80/分析抗原 CD80/遗传学抗原 CD80/生理学抗原 CD86 B淋巴细胞/化学 B淋巴细胞/细胞学 CD4阳性T淋巴细胞/化学 CD4阳性T淋巴细胞/细胞学 CD8阳性T淋巴细胞/化学 CD8阳性T淋巴细胞/细胞学炎症趋化因子类/遗传学细胞因子类/遗传学流式细胞术基因表达调控基因型移植物闭塞血管/病因学移植物排斥/并发症移植物排斥/病理生理学心脏移植组织相容性抗原Ⅱ类/分析免疫组织化学巨噬细胞/化学巨噬细胞/细胞学膜糖蛋白类/分析膜糖蛋白类/遗传学膜糖蛋白类/生理学小鼠近交C57BL 时间因素移植同种动物女(雌)性男(雄)性小鼠

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Durability of the dorsalis pedis artery reconstruction in diabetics and nondiabetics: Is there a difference?

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ANNALS OF VASCULAR SURGERY 2002年第1期16卷 102-107页

作者： Maharaj, D Ozsvath, KJ Darling, RC Roddy, SP Paty, PSK Krelenberg, PB Chang, BB Lloyd, WE Shah, DM Albany Med Coll Inst Vasc Hlth & Dis Albany NY 12208 USA

Originally thought to be a disadvantaged outflow source, the dorsalis pedis artery is associated with excellent patency and limb salvage in the diabetic population, The aim of this study was to demonstrate that the dorsalis pedis artery is as durable in nonbiabetics as in their diabetic counterparts. During a 21-year period from 1979 to 1999, 299 long lower limb bypasses to the dorsalis pedis artery were performed at our institution. Patient data and outcomes were reviewed from the vascular registry. Statistical analysis and patency rates were compared using chi-squared and log-rank analysis. This study confirms that the dorsalis pedis can be used as an outflow source with durability that is comparable in both diabetics and nondiabetics. No significant difference exists in morbidity, mortality and patency rates. In the nondiabetic, when the dorsalis pedis is the only patent distal vessel, amputation can be avoided if one considers this a suitable option as an outflow source.

关键词：动脉闭塞性疾病/并发症动脉闭塞性疾病/外科学血管假体植入/方法糖尿病并发症糖尿病血管病变/并发症糖尿病血管病变/外科学足/血液供给移植物闭塞血管/病因学隐静脉/外科学治疗结果成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Design and methodology of the ESPRIT trial: Evaluating a novel dosing regimen of eptifibatide in percutaneous coronary intervention

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AMERICAN HEART JOURNAL 2000年第6期140卷 834-839页

作者： O'Shea, JC Madan, M Cantor, WJ Pacchiana, CM Greenberg, S Joseph, DM Kitt, MM Lorenz, TJ Tcheng, JE Duke Clin Res Inst Durham NC 27705 USA Sunnybrook & Womens Coll Hlth Sci Ctr Toronto ON Canada COR Therapeut S San Francisco CA USA

Background Clinical trials of the glycoprotein (GP) IIb/IIIa inhibitors have shown that these potent antiplatelet agents ore effective in reducing the ischemic complications of percutaneous coronary interventions. However, even though stents ore now implanted in >75% of percutaneous interventional procedures, only one study, a trial of the monoclonal antibody abciximab, has formally evaluated adjunctive GP IIb/IIIa inhibition in this setting. Methods and Results Eptifibatide, a nonimmunogenic and rapidly reversible inhibitor of the platelet receptor integrin IIb/IIIa, has also undergone evaluation as an adjunct to coronary intervention. In clinical trials performed heretofore, however, it has appeared to have less relative clinical efficacy than the monoclonal antibody abciximab. Since the early seminal trials, ii has been recognized that the doses of eptifibatide previously used achieved only 30% to 50% of maximal platelet GP IIb/IIIa integrin inhibition. This is considerably less than the 80% level of receptor inhibition that has been proposed to prevent coronary thrombus formation in animal models and that has been achieved in clinical trials with abciximab. Conclusions The Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial was designed to test the safety and efficacy of a high-dose, "180/2.0/180" double-bolus regimen of eptifibatide (a 180-mug/kg bolus followed 10 minutes later by a second 180-mug/kg bolus of eptifibatide combined with a 2.0-mug/kg per minute infusion) as an adjunct to nonacute percutaneous coronary intervention with stent implantation. In this report, we review the rationale, design, and methods of this clinical investigation.

关键词：冠心病/治疗移植物闭塞血管/病因学移植物闭塞血管/死亡率移植物闭塞血管/预防和控制注射静脉内肽类/投药和剂量血小板聚集抑制剂/投药和剂量血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂研究设计存活率人类

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Gunshot injuries of the popliteal artery

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BRITISH JOURNAL OF SURGERY 2000年第5期87卷 602-607页

作者： Nair, R Abdool-Carrim, ATO Robbs, JV Univ Natal Dept Surg Metropolitan Vasc Serv ZA-4013 Congella South Africa

Background: Guidelines for the management of popliteal artery trauma emanate mainly from military experience. This study was undertaken to describe the management of popliteal injuries in a civilian vascular surgical unit with a large trauma workload. Methods: A retrospective review of records of patients treated between 1983 and 1997 was undertaken. Results: Some 117 popliteal artery gunshot injuries were treated (83 low velocity, 16 high velocity, 18 shotgun), Associated fractures occurred in 44 patients and 40 had popliteal vein injuries. Treatment of the arterial injury included vein graft interposition in 71, primary reanastomosis in 19, prosthetic graft interposition in four, lateral suture in one, vein patch in one and ligation in one patient;84 fasciotomies were performed. No perioperative deaths occurred, There were 20 primary and 14 secondary amputations. Factors associated with amputation were high-velocity injuries, delay in revascularization in excess of 7h, arterial transection, associated fracture, and compartment syndrome or muscle infarction. Conclusion: Civilian popliteal gunshot injuries are attended by a high amputation rate, Prompt resuscitation and revascularization appear to be the only correctable factors that may improve limb salvage rates.

关键词：截肢术移植物闭塞血管/病因学腘动脉/损伤腘动脉/外科学回顾性研究创伤枪击/病因学创伤枪击/外科学青少年成年人女(雌)性人类男(雄)性中年人

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