Saphenous vein biopsy: A predictor of vein graft failure

Marin, Michael L.; Veith, Frank J.; Panetta, Thomas F.; Gordon, Ronald E.; Wengerter, Kurt R.; Suggs, William D.; Sánchez, Luis A.; Parides, Michael K.

doi:10.1016/0741-5214(93)90258-n

Cited by 69 publications

(40 citation statements)

References 9 publications

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“…Finally, Aaltomaa et al (26) showed that SV endothelial cells of diabetic patients have a greater tendency to proliferate compared with those cells harvested from normal subjects, suggesting an abnormal intrinsic regulation of endothelial functions. These findings suggest that diabetes may exacerbate the postoperative maladaptive changes of venous conduits (27,28). Diabetes, however, does not invariably alter vascular integrity, particularly at the venous district.…”

Section: Discussionmentioning

confidence: 78%

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

et al. 2003

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Recent studies have reported a high incidence of postoperative unfavorable cardiac-related events in patients with diabetes who underwent coronary artery bypass grafting (CABG). Structural and functional characteristics of CABG conduits, which have been shown to play an important role in patient outcome after myocardial revascularization, have not been fully investigated in diabetic subjects. Therefore, we sought to determine the influence of adult-onset diabetes on vasoreactivity and morphological profile of venous and arterial grafts. Of the 160 consecutive patients enrolled in the study, 90 were diagnosed with type 2 diabetes and 70 did not have diabetes (control group). All patients underwent evaluation of glucose control before surgery. Tissue specimens were collected from left internal thoracic artery (LITA) and saphenous vein (SV) grafts harvested during elective CABG. Functional tests were performed to assess contractile and vasodilative responses of bypass conduits. Histological evaluation was carried out to examine vessel wall structure. Univariate and multivariate analyses were performed to correlate the preoperative factors related to the control of the endocrine disorder with histological findings. Patient medical history and demographics did not differ between the groups. Diabetic patients showed significant microalbuminuria and higher plasma levels of C-peptide and GHb as compared with nondiabetic subjects. Functional tests of the LITA segments revealed no difference between groups with regard to contractile and vasodilative responses. In contrast, significant impairment in the endothelium-related vasodilation of the SV grafts was observed in diabetic subjects. Histological studies showed structural preservation of the arterial conduits in both groups. However, marked intimal abnormalities (also atherosclerotic calcified plaques) were detected in SV grafts harvested from diabetic patients. Logistic regression analysis showed that high levels of proteinuria and GHb were independent predictors of advanced structural degeneration of SV conduits. Treatment modality, duration of diabetes, and other demographic or metabolic factors were found to have no influence on the morphological characteristics of SV conduits. In conclusion, biological properties of LITA conduits for CABG were preserved in diabetic patients. However, these patients frequently showed impairment of the endothelium-dependent vasorelaxation and intimal degeneration of SV grafts. The extent of structural abnormalities of SV grafts was inversely correlated with the efficacy of the metabolic control of the endocrine disorder. Further studies are required to conclusively correlate preoperative SV graft abnormalities with postoperative conduit patency rate and the occurrence of adverse cardiac-related events in diabetic subjects.

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Section: Discussionmentioning

confidence: 78%

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

et al. 2003

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“…Neither better preoperative patient selection nor improved intraoperative handling of vascular conduits has been sufficient to eliminate the disparity between SVGs and AGs. 2,3 Recent studies have increasingly focused on biological differences between venous and arterial conduits that may affect their response to surgery. 4,5 In addition to structural differences (eg, less-developed elastic tissues), the cellular composition of veins is dissimilar to that of arteries.…”

mentioning

confidence: 99%

Oxidative Stress and Lipid Retention in Vascular Grafts

et al. 2001

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Background-Because saphenous vein grafts (SVGs) exhibit greater cellular heterogeneity and worse clinical outcomes than arterial grafts (AGs), we examined oxidative stress and lipid retention in different vascular conduits. Methods and Results-In a porcine model of graft interposition into carotid artery, superoxide anion (⅐O 2 Ϫ ) was measured at 2 weeks after surgery. SVGs demonstrated increased ⅐O 2 Ϫ production compared with AGs (SOD-inhibitable nitro blue tetrazolium reduction, PϽ0.01). The NAD(P)H oxidase inhibitor diphenyleneiodonium (PϽ0.01) abolished SVGderived ⅐O 2 Ϫ , whereas the inhibitors of other pro-oxidant enzymes were ineffective. The change in oxidative stress was also reflected by lower activity of the endogenous antioxidant superoxide dismutase in SVGs than in AGs (PϽ0.001). SVG remodeling was associated with increased synthesis of sulfated glycosaminoglycans and augmented expression of a core protein, versican. These changes were accompanied by SVGs retaining significantly more 125 I-labeled LDL than AGs ex vivo (PϽ0.001). In hyperlipemic animals, lipid accumulation and oxidized epitopes were preferentially noted in the intima of SVGs at 1 month after surgery. Conclusions-This study demonstrated significant differences in the biology of SVGs and AGs. SVGs exhibited higher oxidative stress, LDL accumulation, and the presence of oxidized epitopes. These findings suggest that proatherogenic changes in SVGs may commence early after surgical revascularization.

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“…4 Pathology studies have shown that differences in the wall thickness of grafts are predominantly caused by differences in thickness of the intima, rather than of the media or adventitia. 5 As most patients in this study had stable or reduced wall thickness between postoperative months 1 and 12, it is likely that wall thickening is most active within the first 4 to 6 weeks after SVG implantation. We postulate that early cellular and extracellular changes mediate increased wall thickness of the first 6 weeks, which then plateaus and, in the absence of atherosclerosis, may regress.…”

Section: Discussionmentioning

confidence: 99%

“…3 Venous conduits may exhibit mild intimal or medial fibrosis pre-grafting, but most develop further intimal thickening within 4 to 6 weeks of arterial anastomosis. In angiographically normal SVG, intravascular ultrasound (IVUS) and pathological studies have shown a doubling of intimal thickness 4 and total wall thickness 5 by the end of the first postoperative year.…”

mentioning

confidence: 99%

Lumen Loss in the First Year in Saphenous Vein Grafts Is Predominantly a Result of Negative Remodeling of the Whole Vessel Rather Than a Result of Changes in Wall Thickness

Lau

Ridley²,

Bannon³

et al. 2006

Circulation

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Background-The use of saphenous vein grafts (SVG) in coronary artery bypass surgery is established but little is known of SVG remodeling during the first year in vivo. Methods and Results-The feasibility of measuring total vessel diameter (lumen plus wall), lumen diameter, and wall thickness by a novel computed tomography (CT) method was established in phantom model tubes (rϭ0.98 for lumen diameter and rϭ0.98 for wall thickness) and in an initial clinical study of 14 patients correlating CT and intravascular ultrasound measurements of SVG (rϭ0.88 for total vessel diameter, rϭ0.85 for lumen diameter and rϭ0.89 for wall thickness). In a separate group of 42 patients (aged 66Ϯ10 years; 36 male, 6 female) undergoing coronary artery bypass grafting, SVG total vessel diameter, lumen diameter, and wall thickness were determined prospectively with multi-slice CT angiography at 1 and 12 months postoperatively. Mean total vessel diameter decreased from 5.95Ϯ0.83 mm to 5.39Ϯ0.87 mm, PϽ0.001 (range, Ϫ39% to ϩ8% change). Twenty-six patients (62%) had a decrease of SVG vessel diameter (negative remodeling) Ͼ5%. Mean lumen diameter decreased from 3.69Ϯ0.66 mm to 3.36Ϯ0.68 mm, PϽ0.001, (range, Ϫ40 to ϩ11% change). Surprisingly, mean wall thickness decreased from 1.14Ϯ0.27 mm to 1.01Ϯ0.21 mm (PϽ0.001; range, Ϫ48 to ϩ33% change). Conclusions-Lumen loss in SVG between postoperative months 1 and 12 is predominantly caused by negative remodeling of the whole vessel rather than to changes in wall thickness. Therapies targeting negative remodeling may be required for optimal maintenance of SVG lumen in the first postoperative year.

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Saphenous vein biopsy: A predictor of vein graft failure

Abstract: We conclude that GSVs with thick and calcified walls or hypercellular intima at the time of grafting are at increased risk of developing intragraft lesions that may lead to graft failure. Frequent duplex ultrasonography surveillance is particularly warranted for such high-risk grafts.

Cited by 69 publications

References 9 publications

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

Oxidative Stress and Lipid Retention in Vascular Grafts

Lumen Loss in the First Year in Saphenous Vein Grafts Is Predominantly a Result of Negative Remodeling of the Whole Vessel Rather Than a Result of Changes in Wall Thickness

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