Early remodeling of lower extremity vein grafts: Inflammation influences biomechanical adaptation

Abstract

Early positive remodeling of vein grafts is a shear-dependent response that is modulated by systemic inflammation. These data suggest that baseline inflammation influences vein graft healing, and therefore, inflammation may be a relevant therapeutic target to improve early vein graft adaptation.

Aspirin-Triggered Lipoxin and Resolvin E1 Modulate Vascular Smooth Muscle Phenotype and Correlate with Peripheral Atherosclerosis

“…13 Accordingly, elevated hsCRP levels correlate with preoperative PAD severity, as well as adverse postoperative events in a cohort of patients undergoing lower extremity vein bypass surgery. 12,22 The results of the present study demonstrate that both ATL and RvE1 attenuate PDGF-stimulated VSMC migration and receptor phosphorylation without altering PDGF-R expression levels. This receptor cross talk is consistent with previous reports which showed that lipoxins decrease PDGF-R phosphorylation in mesangial cells.…”

An Integrated Biochemical Prediction Model of All-Cause Mortality in Patients Undergoing Lower Extremity Bypass Surgery for Advanced Peripheral Artery Disease

“…The exception to this was hsCRP which we modeled as a dichotomized variable as we have done in the past. [10,12] Multivariable Cox proportional hazard modeling was performed on survival outcomes and hazard ratios and 95% confidence intervals are presented. A test of the proportional hazard assumption was performed for each covariate and globally using a formal significance test based on the unscaled and scaled Schoenfeld residuals.…”

“…[10] Further, patients with CRP levels above 5 mg/ L exhibit impaired vein graft remodeling compared to patients with lower levels of CRP, implying that this value is clinically relevant in terms of vein graft-related outcomes. [12] In addition, the sensitivity and specificity of hsCRP > 5 mg/L for subsequent midterm mortality were 70.2% and 72.0%, respectively. This represents the highest sum of sensitivity and specificity and therefore is an optimal cutoff for this analyte.…”

“…[10,12,13] Patients were invited to participate in this study if planned to undergo a lower extremity bypass operation for disabling claudication or critical limb ischemia due to atherosclerotic obstructive disease. As the hypothesis to be tested was that baseline inflammatory and biochemical profile was predictive of mortality, we excluded anyone with active infection or concurrent illness that would cause a spurious increase in the plasma concentration of inflammatory biomarkers beyond the baseline state.…”

“…[10,12,17] In brief, 202 bypass grafts were constructed from single segment or composite great saphenous vein and 23 were from arm vein. There were 111 femoral-popliteal, 78 femoral-tibial, and 36 femoral or popliteal-pedal bypass grafts.…”