Amplatz血栓消融器对静脉壁损伤机制的实验研究

目的:观察Amplatz血栓消融器(ATD)在不同管径的静脉内操作时对静脉壁的损伤及程度,并探讨其损伤的机制。方法:采用Seldinger插管技术,将启动状态的ATD置于猪的髂静脉和下腔静脉内模拟血栓消融术,再以非启动状态的ATD置于对侧髂静脉内模拟血栓消融术作为对照。测量下腔静脉和髂静脉管径大小,对ATD所经过的静脉进行HE组织学染色检查。结果:ATD损伤仅累及血管内膜,中膜和外膜结构保持完整。ATD造成下腔静脉(10.92±1.33mm)内皮细胞点状剥脱;髂静脉(5.66±0.43mm)内皮细胞不同程度剥脱,实验组剥脱内皮细胞数明显大于下腔静脉组和对照组(P<0.05)。结论:ATD在静脉内操作时造成静脉壁损伤,其程度和机制可能与血管管径有一定关系。

Experimental study of the mechanism of injury from Amplatz thrombectomy device to venous wall

Objective: To explore the mechanism of injury from Amplatz thrombectomy device(ATD) to venous wall by observing the morphologic signs of venous wall injury after the use of ATD in inferior vena cava and iliac veins in swines. Methods: A femoral vein access was established using the Seldinger technique. The ATD catheter was introduced in inferior vena cava and iliac veins and activated simulateing thrombectomy. The other side iliac veins which ATD was not activated were taken as contrast groups. The diameters of inferior vena cava and iliac veins were measured. The segments of the ATD-treated veins were carefully explanted and stored in formaldehyde for histopathologic examination with hematoxylin-eosin staining to look for venous endothelium cell change and extent of the injury. Results: The ATD only injured the venous endothelium cell layer, while the internal elastic lamina, media and the out adventitia were intact in all cases. The minimal focal endothelial denudation was observed on segments of the inferior vena cava. The different degrees of the endothelial denudation were found on segments of the iliac veins. The number of the endothelial denudation which the activated ATD on the iliac veins was obviously higher than the inferior vena cava and the contrast groups(P < 0.05). Conclusion: The endothelium cells are lost and shed when the ATD catheter through the veins. The extent and the mechanism of injury from ATD to venous wall are related to the diameter of the veins.