Saphenous Vein Graft Failure After Coronary Artery Bypass Surgery

Harskamp, Ralf E.; Lópes, Renato D.; Baisden, Clinton E.; Winter, Robbert J. de; Alexander, John H.

doi:10.1097/sla.0b013e318288c38d

Cited by 308 publications

(267 citation statements)

References 139 publications

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“…The patency rates of saphenous vein grafts were 71-87% at 1 year after surgery in previous studies [16][17][18] and up to 50% at 10 years [16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 88%

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The Choice of Graft Conduits in Coronary Artery Bypass Grafting

Murashita¹

2017

Coronary Artery Bypass Graft Surgery

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The use of the left internal mammary artery (IMA) has been shown to improve longterm survival and has been a gold standard in coronary artery bypass grafting (CABG). However, the choice of second or third graft conduit is still controversial. Multiple studies demonstrated the beneit of using multiple arterial grafts such as right IMA and radial artery in addition to left IMA in terms of long-term survival and graft patency. However, most of the centers still perform CABG with one IMA and vein grafts in a real world. The challenges for bilateral IMA utilization include longer operative time and concerns for higher rates of perioperative morbidity and mortality associated with increased sternal wound infection. Several studies reported that skeletonization technique can reduce the risk of sternal wound infection. Radial artery is another arterial conduit, which does not increase the risk of sternal wound infection and is easy to harvest. The superiority between radial artery and right IMA has been controversial. In the meantime, multiple trials have been made to improve the patency of vein grafts. The choice of graft conduits in CABG should be well considered preoperatively based on each patient's backgrounds.

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“…The patency rates of saphenous vein grafts were 71-87% at 1 year after surgery in previous studies [16][17][18] and up to 50% at 10 years [16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 88%

“…However, the long-term patency of SVG is reported to be poor [16][17][18][19][20][21]. The late-term SVG failure is mainly due to atherosclerotic obstruction occurring on a foundation of neointimal hyperplasia [64].…”

Section: Cabg Using Saphenous Vein Graftsmentioning

confidence: 99%

The Choice of Graft Conduits in Coronary Artery Bypass Grafting

Murashita¹

2017

Coronary Artery Bypass Graft Surgery

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“…In a recent analysis of vein graft failure, early denudation of endothelium attributed to surgical trauma, longitudinal wall (shear) stress, and venous exposure to increased arterial pressure were found to be the primary triggers toward the development of intimal hyperplasia. 9 When a vein is exposed to arterial pressure, there is an increase in wall shear stress, triggering an adaptive response of vessel dilatation to accommodate the increased blood pressure and flow. This aggressive vessel dilatation increases wall tension, which leads to medial thickening, an additional adaptive response.…”

mentioning

confidence: 99%

Photochemical Tissue Passivation Reduces Vein Graft Intimal Hyperplasia in a Swine Model of Arteriovenous Bypass Grafting

Goldstone

McCormack

Khan

et al. 2016

JAHA

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Background--Bypass grafting remains the standard of care for coronary artery disease and severe lower extremity ischemia. Efficacy is limited by poor long-term venous graft patency secondary to intimal hyperplasia (IH) caused by venous injury upon exposure to arterial pressure. We investigate whether photochemical tissue passivation (PTP) treatment of vein grafts modulates smooth muscle cell (SMC) proliferation and migration, and inhibits development of IH.

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“…1,2 However, several lines of evidence have suggested that about 40% of these autologous grafts are ultimately unsuccessful, as pathologic vascular restenosis and wall thickening re-occurs, a process called intimal hyperplasia (IH). [3][4][5] The pathogenesis of the intimal hyperplastic lesion is still poorly understood and no successful clinical intervention has been identified. It is believed that restenosis is a result of vascular smooth muscle cell (vSMC) proliferation and differentiation.…”

mentioning

confidence: 99%

γ-Secretase inhibitor DAPT attenuates intimal hyperplasia of vein grafts by inhibition of Notch1 signaling

Xiao

Wang

Gong

et al. 2014

Laboratory Investigation

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The proliferation and high plasticity of vascular smooth muscle cells (vSMCs) are the major reasons for restenosis of vein grafts. N-[N-(3, 5-difluorophenacetyl)-l-alanyl]-S-phenylglycine t-butyl ester (DAPT), specific inhibitor of g-secretase, has been shown to regulate vSMC proliferation and differentiation through the Notch signaling pathway, but the pathophysiological importance of these findings in venous grafts has not yet been determined. A rat vein graft model was employed wherein the left jugular vein was surgically interposed into the left common carotid artery. Daily subcutaneous injections of DAPT or placebo (DMSO) were administered postoperatively (control animals received no treatment). We showed that DAPT can inhibit restenosis of vein grafts by inhibiting vSMC proliferation and increasing apoptosis in vivo. Notch1 signaling was highly active during the development of intima thickening. By blocking the Notch signaling pathway, the g-secretase inhibitor DAPT can significantly attenuated intima thickening. These changes in vein grafts coincided with enhanced binding of myocardin to the smooth muscle-specific protein SM22 and smooth muscle myosin heavy chain at the promoters of vSMC differentiation-specific genes. These studies showed that DAPT can restore the vSMC phenotype and inhibit vSMC proliferation through suppression of the Notch1 signaling pathway, and thus opens a new avenue for the treatment of restenosis in vein grafts.

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Saphenous Vein Graft Failure After Coronary Artery Bypass Surgery

Cited by 308 publications

References 139 publications

The Choice of Graft Conduits in Coronary Artery Bypass Grafting

The Choice of Graft Conduits in Coronary Artery Bypass Grafting

Photochemical Tissue Passivation Reduces Vein Graft Intimal Hyperplasia in a Swine Model of Arteriovenous Bypass Grafting

γ-Secretase inhibitor DAPT attenuates intimal hyperplasia of vein grafts by inhibition of Notch1 signaling

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