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Abstract
The distal anastomoses of thrombosed saphenous vein (11), bovine (4), Dacron (7),
and polytetrafluoroethylene (PTFE) (27) grafts removed en bloc during reoperation
or amputation were studied with light microscopy, scanning electron microscopy, and
transmission electron microscopy. Analysis of the ultrastructures of the distal anastomostic
regions was done to characterize morphogenesis of intimal hyperplasia and neointimal
proliferation. Complete reendothelialization occurred in all vein grafts. In bovine
heterografts, there were isolated areas of endothelia. Thrombosed PTFE grafts were
lined with gelatinous, proteinaceous material with no consistent organized cellular
pattern. In contrast, laminated fibrous tissue produced by fibroblasts lined the Dacron
grafts. Intimal hyperplasia was found in 6 of 11 vein grafts and in all prosthetic
grafts examined. Regardless of the type of graft used, intimal hyperplasia was found
predominantly at the heel of the graft and on the floor of the artery. Beneath the
endothelia, collagenous ground substance and myofibroblasts mixed with smooth muscle
cells were seen, characterized by pyknotic nuclei, reduced cytoplasm/nuclei ratio,
and loss of cytoplasmic organelles. Endothelialization occurred exclusively in vein
grafts. Prosthetic grafts lacked endothelia, with the neointima consisting of fibroblasts
and fibrous matrix. In intimal hyperplasia, two forms of smooth muscle cell pathomorphogenesis
were recognized. Formation of myofibroblasts induced medial fibroplasia, whereas degeneration
of muscle cells progressed to medial necrosis. Smooth muscle cells seem to play a
role not previously recognized in the pathogenesis of graft failure.
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Article info
Footnotes
☆Presented at the Sixth Annual Meeting of the Midwestern Vascular Surgical Society, Milwaukee, Wis., Sept. 24–25, 1982.
☆☆Supported in part by the Northwestern Vascular Foundation, the Bell's Award, and Michigan Heart Association.
Identification
Copyright
© 1983 Published by Elsevier Inc.
