Arterial and venous conduits for coronary artery bypassA current review

Abstract

Poor long-term patency of saphenous vein grafts limits the long-term success of the coronary artery bypass operation. If this is to be improved, either measures that increase the patency of saphenous vein grafts or alternative conduits are required. The benefits of using the left internal mammary artery as a pedicled graft to the left anterior descending coronary artery have prompted increasing use of arterial grafts to further improve outcome. Concurrently advances in the understanding of the pathological processes underlying saphenous vein graft occlusion raise the possibility of improving vein graft patency. In this paper we review the problem of vein graft occlusion and possible solutions, the theoretical benefits of arterial grafts and the clinical results associated with their use.

Heparin nanomodification improves biocompatibility and biomechanical stability of decellularized vascular scaffolds

“…1,2 Autologous vessels and vascular allografts are ideal alternative vessels, but an insufficient supply of donor vessels limits their widespread clinical application. 3 Synthetic vascular grafts perform well in large vessel reconstruction, and there is a plentiful supply, but low graft patency greatly limits surgical utilization of small-caliber synthetic grafts because of thrombosis. 1,4 We recently reported on in vivo use of decellularized bovine jugular vein (BJV) scaffolds to reconstruct pulmonary and right ventricular tissue in a dog model, with potential regeneration.…”

Differential Expression of Connexin43 and Desmin Defines Two Subpopulations of Medial Smooth Muscle Cells in the Human Internal Mammary Artery

“…The internal mammary artery is relatively resistant to atherosclerosis, and is the preferred choice of vessel for coronary artery bypass surgery, 22 but our knowledge of the cellular basis of these properties has so far remained limited. The primary reason for selecting this vessel for study is that, in its distal region, it has an unusual histological pattern, ranging from elastic to elastomuscular to muscular, 23 with SMCs of correspondingly distinctive morphology and intermediate filament expression patterns, 24 thus providing an opportunity to compare the relationship between Cx43 expression and SMC heterogeneity within a single vessel.…”

Age-Related Contractile Force of Human Vessels

“…Compared to Internal Thoracic Arteries (ITA) Human Saphenous Veins (HSV) demonstrate worse patency when used for Coronary Artery Bypass Grafting (CABG) [5,6]. After 10 years only about 50-60% of HSV grafts remain patent while patency for the ITA after 10 years is up to 96% [7][8][9][10][11][12]. Patent venous grafts are even associated with an increased risk of disease progression in the native coronary arteries compared with patent arterial grafts [13].…”

“…Patent venous grafts are even associated with an increased risk of disease progression in the native coronary arteries compared with patent arterial grafts [13]. Handling, storage solution and distension to overcome spasm and identify leaking branches have been suggested to be responsible for the thrombosis, neointimal hyperplasia and atherosclerosis that contribute to vein graft failure in Coronary Artery Bypass Graft (CABG) operations [11,14,15]. By contrast, the ITA never has been exposed to those forces and show little if any evidence of atherosclerosis when used for Coronary Artery Bypass Grafting (CABG).…”