Saphenous Vein Grafts Display Poor Endothelium-Dependent and Endothelium-Independent Dilation—Implications for the Pathogenesis of Vein Graft Atherosclerosis

Kilian, J.; Thanyasiri, Panuratn; Celermajer, David S.; Adams, Mark

doi:10.1016/j.hlc.2007.07.001

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…Previous studies have reported a similar lack of vascular reactivity in SV grafts in the longer term. 12,22 The evolution of loss of vasoreactivity over time in SV grafts, so that they become passive conduits, may be one of the mechanisms that may contribute to the less favorable patency rate in SV compared with RA aortocoronary conduits in the longer term. 16 The IMA was the first successful arterial conduit adopted to routine coronary artery bypass surgery and has been shown to have better preserved endothelial integrity compared with SV both in vitro 9 and in vivo.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Endothelial function is a predictor of coronary events in patients with coronary artery disease 7,8 and is associated with short-term coronary graft performance. 2 Greater endothelium-dependent relaxation occurs in vitro in precontracted IMA compared with SV after harvesting for coronary artery bypass surgery, 9,10 and although exposure of vein grafts to arterial pressure might be expected to result in further dysfunction of the endothelium, 11,12 heterogeneity in endothelium-dependent relaxation response, not related to duration of arterialization but to localized areas of intimal hyperplasia, has been reported. 13 Previous studies have shown preserved IMA graft vascular reactivity in vivo a number of years after surgery 14,15 ; however, at present there are few data describing the vascular function of the RA as an in vivo coronary conduit over the longer term.…”

Section: Editorial See P 857 Clinical Perspective On P 867mentioning

confidence: 99%

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Vascular Reactivity and Flow Characteristics of Radial Artery and Long Saphenous Vein Coronary Bypass Grafts

et al. 2010

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Background-Radial artery (RA) aortocoronary bypass grafts anastomosed to a branch of the circumflex coronary artery have significantly better patency rates than saphenous vein (SV) grafts at 5 years, but the physiological characteristics and mechanisms involved are not clearly defined. We compared RA and SV graft vasomotor and flow responses to endothelium-dependent and -independent stimuli 5 years after surgery in a subgroup of patients enrolled in the Radial artery versus Saphenous Vein Patency (RSVP) trial. Methods and Results-Twenty-seven patients were included in the study (RA, nϭ15; SV, nϭ12). Graft blood flow was calculated from flow velocity, measured by intracoronary Doppler, and luminal diameter, measured by quantitative coronary angiography, before and after intragraft infusions of adenosine, acetylcholine, and isosorbide dinitrate. At rest, RA luminal diameters were significantly smaller than SV luminal diameters (Pϭ0.029), blood flow velocity was greater in RA than SV (Pϭ0.008), and volume blood flows were similar. RA but not SV dilated in response to adenosine and isosorbide dinitrate (all PϽ0.05, RA versus SV, percent change from baseline), and there were no significant differences in the diameter responses to acetylcholine. Volume blood flow responses to adenosine, acetylcholine, and isosorbide dinitrate were comparable. Conclusions-Five years after surgery, RA coronary bypass conduits grafted to a single coronary territory demonstrated preserved flow-mediated vasodilatation, whereas SV grafts did not. Our results may provide insight into the more favorable patency of RA grafts over SV grafts. Clinical Trial Registration-http://www.clinicaltrials.gov.

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Section: Discussionmentioning

confidence: 99%

Section: Editorial See P 857 Clinical Perspective On P 867mentioning

confidence: 99%

Vascular Reactivity and Flow Characteristics of Radial Artery and Long Saphenous Vein Coronary Bypass Grafts

et al. 2010

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“…Previous in vivo studies of human coronary SVG used acetylcholine as an agonist to study receptor-mediated, endothelium-dependent vasodilation. The role of the physiologically relevant stimulus, blood flow, remains unexplored (4–6)Harvesting of the GSV and preparation for bypass injures the vein, denudes the endothelial cell surface, and subjects it to ischemia and reperfusion. (7; 8) This damage induces an inflammatory response within the vessel wall and has been shown to decrease the amount and function of endothelial nitric oxide synthase (eNOS) and endothelium-derived nitric oxide (NO), hence impairing normal homeostatic mechanisms of the vessel.…”

Section: Introductionmentioning

confidence: 99%

In vivo human lower extremity saphenous vein bypass grafts manifest flow mediated vasodilation

Owens

Wake

Conte

et al. 2009

Journal of Vascular Surgery

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Objective As in arteries, venous endothelium modulates vessel homeostasis and tone. The effect of an arterialized environment on venous endothelial function remains poorly understood. In particular, regulation of saphenous vein graft (SVG) blood flow and lumen caliber remains undefined. We hypothesized that mature SVGs would exhibit endothelium-dependent, flow-mediated vasodilation. We further hypothesized that endothelium-derived nitric oxide (NO) was an important mediator of vascular tone. Methods Patients with femoral to popliteal artery SVGs that had maintained primary patency and were at least one year from surgery were enrolled. High-resolution, B-mode ultrasound was used to measure vein graft diameter before and one minute after reactive hyperemia (RH) to determine flow-mediated vasodilation (FMD). RH was created through application of 220 mm Hg to the calf for 5 minutes with a sphygmomanometric cuff. After a 10 minute recovery period, nitroglycerin-mediated, endothelium-independent vasodilation was measured 3 minutes after administration of nitroglycerin 0.4 mg SL. Brachial artery FMD was also measured. L-NG monomethyl arginine (L-NMMA; 1 mg/kg infusion over ten minutes) was used in a subset of patients (N=6) to competitively inhibit endothelial nitric oxide synthase. Results Nineteen subjects were enrolled. The median age of the SVGs was 34.6 (21.0–49.7) months. SVG flow-mediated, endothelium-dependent vasodilation was measured at 5.28% ± 3.1% mean change in lumen diameter (range 1.99% – 9.36%, p<.0001 for diameter change). Nitroglycerin-mediated, vasodilation was 3.7% ± 1.0%, (range .16% – 10.04%, P<.005). Intravenous administration of L-NMMA abolished SVG FMD (5.7 ± 1.4% before L-NMMA vs 0.01 ± 0.01% during L-NMMA infusion, p=.0088) and attenuated brachial artery FMD (7.54% ± 1.0% vs 5.7± 1.4; p=.05). Conclusions SVGs manifest flow-mediated, endothelium-dependent and nitroglycerin-mediated, endothelium-independent vasodilation. Vein graft endothelium-dependent FMD is likely mediated by NO. Further investigation will be required to determine the role of endothelial function in vein graft patency.

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“…Endothelial dysfunction predisposes patients to atherosclerosis and coronary artery disease; thus revascularisation procedures are almost a requirement in diabetic patients [ 8 , 9 ]. The principal method of revascularisation is coronary artery bypass grafting (CABG), frequently performed using the autologous long saphenous vein (SV) to bypass diseased coronary arteries.…”

Section: Introductionmentioning

confidence: 99%

Aberrant Phenotype in Human Endothelial Cells of Diabetic Origin: Implications for Saphenous Vein Graft Failure?

Roberts

Gohil

Hudson

et al. 2015

Journal of Diabetes Research

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Type 2 diabetes (T2DM) confers increased risk of endothelial dysfunction, coronary heart disease, and vulnerability to vein graft failure after bypass grafting, despite glycaemic control. This study explored the concept that endothelial cells (EC) cultured from T2DM and nondiabetic (ND) patients are phenotypically and functionally distinct. Cultured human saphenous vein- (SV-) EC were compared between T2DM and ND patients in parallel. Proliferation, migration, and in vitro angiogenesis assays were performed; western blotting was used to quantify phosphorylation of Akt, ERK, and eNOS. The ability of diabetic stimuli (hyperglycaemia, TNF-α, and palmitate) to modulate angiogenic potential of ND-EC was also explored. T2DM-EC displayed reduced migration (~30%) and angiogenesis (~40%) compared with ND-EC and a modest, nonsignificant trend to reduced proliferation. Significant inhibition of Akt and eNOS, but not ERK phosphorylation, was observed in T2DM cells. Hyperglycaemia did not modify ND-EC function, but TNF-α and palmitate significantly reduced angiogenic capacity (by 27% and 43%, resp.), effects mimicked by Akt inhibition. Aberrancies of EC function may help to explain the increased risk of SV graft failure in T2DM patients. This study highlights the importance of other potentially contributing factors in addition to hyperglycaemia that may inflict injury and long-term dysfunction to the homeostatic capacity of the endothelium.

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Saphenous Vein Grafts Display Poor Endothelium-Dependent and Endothelium-Independent Dilation—Implications for the Pathogenesis of Vein Graft Atherosclerosis

Cited by 4 publications

References 19 publications

Vascular Reactivity and Flow Characteristics of Radial Artery and Long Saphenous Vein Coronary Bypass Grafts

Vascular Reactivity and Flow Characteristics of Radial Artery and Long Saphenous Vein Coronary Bypass Grafts

In vivo human lower extremity saphenous vein bypass grafts manifest flow mediated vasodilation

Aberrant Phenotype in Human Endothelial Cells of Diabetic Origin: Implications for Saphenous Vein Graft Failure?

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