Entwicklung neointimaler Matrix nach Einheilen moderner Prothesen: Vergleich zwischen ePTFE und Dacron

Zusammenfassung

Hintergrund: In der Therapie der peripheren arteriellen Verschlusskrankheit bestehen insbesondere beim Einsatz alloplastischer Materialien Unzulänglichkeiten bzgl. der Thrombogenität und der biologischen Compliance. In den 1960er-Jahren versuchte Sparks durch Verwendung eingewachsener Prothesen, die Vorteile der alloplastischen Prothese mit denen eines autologen Gefäßersatzes zu kombinieren. Eine ausgeprägte myointi­male Hyperplasie fehlte, aber neben Infektionen waren vor allem die aneurysmatische Aufweitung der implantierten Prothesen limitierende Faktoren in der klinischen Anwendung. Material und Methoden: Im Rahmen eines Tierversuches an Hunden wurde in der vorliegen­den Studie das Einwachsverhalten moderner ­Pro­thesenmaterialien ohne Anschluss an das ­Gefäßsystem bzgl. der Dicke der Neointima und des prozentualen Anteils von glatten Muskelzellen untersucht. Ergebnisse: Hierbei zeigte sich, dass die Dicke der Neointima in Dacronprothesen stärker zunahm als in PTFE-Prothesen mit einem Peak am 70. Tag (p = 0,022), zusätzlich zeigte sich ein signifikant höherer prozentualer Anteil glatter Muskelzellen in Dacronprothesen als in PTFE-Prothesen nach 44 und 58 Tagen (p = 0,008; p = 0,036). Schlussfolgerung: PTFE-Prothesen sollten daher aufgrund der geringeren eingewachsenen Matrix sowie des geringeren Anteils an glatten Muskelzellen bei peripheren arteriellen Gefäßrekonstruktionen den Vorzug erhalten.

Abstract

Background: In the therapy for peripheral arterial occlusive disease there remain inadequacies in the use of alloplastic material concerning thrombogenicity and biological compliance. In the 1960s, Sparks tried to combine the advantages of alloplastic prostheses with those of autologous reconstructions by using incorporated prostheses. No extensive myointimal hyperplasia was noted, but besides infections aneurysmatic dilatation were limiting factors in clinical practice. Material and Methods: The incorporation of modern alloplastic prostheses without connection to circulation concerning the thickness of neo­intima as well as the percentage of smooth muscle cells was examined in a dog model. Results: The thickness of the neointima increased significantly in Dacron grafts with a peak on day 70 (p = 0.022), additionally a significantly greater percentage of smooth muscle cells was noted in Dacron grafts after 44 and 58 days (p = 0.008, p = 0.036). Conclusion: Due to the decreased thickness of the incorporating matrix as well as the lower percent­age of smooth muscle cells, PTFE grafts should be preferred for peripheral arterial revascularisa­tion.

Bypass-Material - Gefäßchirurgie

bypass material - vascular surgery

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