J.Jpn. Surg. Soc.. 91(9): 1142-1145, 1990

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Report on the annual meeting

PATHOGENESIS OF POSTOPERATIVE RE-THROMBOSIS IN PERIPHERAL ARTERIAL RECONSTRUCTION

The pathogenesis of postoperative re-thrombosis in peripheral arterial reconstruction was studied clinically and experimentally. The outcome of the reconstructed arterial segments was highly correlated to electromagnetically driven flow waveform and shear stress in the boundary layer adjacent to the vessel wall (τ-variation). The outcome of cases of types 0 and 1 waveforms with τ-variation higher than 50 dyne/cm² was excellent. In cases of type II waveform with 20ー40 dyne/cm² of τ-variation, early re-thrombosis was not encountered but late occlusion occurred in about 30% of cases. Cases of types III and IV waveforms with τ-variation less than 15 dyne/cm₂ were all failed within 48 hours. Fibrinolytic and PGI₂ activities of the luminal surface of the vein grafts were considerably reduced. In microscopic examinations of the vein grafts, the intimal layer was completely disrupted with focal necrosis of the media and adventitia within 3 days after implantation, however it was repopulated by endothelial like cells and neointima 2 weeks later. Neointima was often increased in thickness by excessive proliferation of smooth muscle cells. In contrast, pannus formation at the distal end-to-side anastomosis was dominant at the toe of the anastomosis in which fibroblasts and collagenous fibers were dominant cellular and extracellular substances.

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