The Structural Study of the Saphenous Vein

Cheanvechai, Chalit; Effler, Donald B.; Hooper, Joseph R.; Eschenbruch, E.; Sheldon, William C.; Sones, F. Mason; Levin, Howard S.; Hawk, William A.

doi:10.1016/s0003-4975(10)65755-4

Cited by 59 publications

(19 citation statements)

References 6 publications

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“…Qaetano et al (1980) found that morphological changes were present almost constantly in the walls of the fresh "normal" saphenous veins before their use as aortocoronary conduits. In other studies it was reported in 12%-87% of long saphenous veins prior to their use as bypass conduits (Brody et al, 1972;Cheanvechal et al, 1975;Batayias et al, 1977;Qaetano et al, 1980;Waller et al, 1985;Davies et al, 1992;Ascher et al, 2001). It was also reported in three out of four cephalic vein samples prior to their use for lower limb bypasses (Davies et al, 1993).…”

Section: Discussionmentioning

confidence: 91%

“…If pre-existing cephalic vein disease is suspected or identified, one should anticipate an increased risk of shunt failure . Several reports have evaluated the importance of altered pathophysiologic condition and structure of the saphenous vein in the genesis of graft stenosis (Cheanvechal et al, 1975;Marin et al, 1991;Davies et al, 1992). The presence of pre-existing disease, including those changes resulting from previous thrombophlebitis, has been shown to reduce the patency of the grafts containing these alterations .…”

Section: Discussionmentioning

confidence: 99%

“…There have been many studies on the morphological changes that occur in veins that have been used for arterial grafting. Only in the last 25 years, has the pre-bypass vein structure been investigated (Brody et al, 1972;Cheanvechal et al, 1975;Batayias et al, 1977;Waller and Roberts, 1985). Qaetano et al (1980) found that morphological changes were present almost constantly in the walls of the fresh "normal" saphenous veins before their use as aortocoronary conduits.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Intimal Changes in the Cephalic Vein of Renal Failure Patients before Arterio-Venous Fistula (AVF) Construction

Wali

Eid

Dewan

et al. 2003

J. Smooth Muscle Res.

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Native cephalic vein remains the superior dialysis conduit, even thirty years after it was first described. However, up to 37% of hemodialysis patients develop progressive stenosis in the venous circuit of arterio-venous fistula (AVF), which may later cause thrombosis and occlusion. To study the pre-existing morphological changes in the wall of the cephalic vein before AVF construction, we collected 23 cephalic vein specimens from 3 normal, young trauma and twenty renal failure patients. The samples were collected at the time of vascular repair in the first group and AVF construction in the second group. Sections were prepared and stained for both light and transmission electron microscopy (TEM) examination. Compared with normal cephalic vein, all pre-access cephalic veins showed thickening of the wall and intimal hyperplasia. Other changes were loss of internal elastic lamina in 9 (45%) patients, loss of endothelial cell layer in 6 (30%), inflammatory cell infiltration of the wall in 5 (25%), mural calcification in 3 (15%) and telangiectasia in 2 (10%). Other ultrastructural changes observed were intimal hypertrophy, degeneration and loss of the endothelial cells, degeneration and fraying of smooth muscle cells (SMCs) and loss of wall components into the lumen. In conclusion, most of the apparently normal cephalic veins of renal failure patients showed morphological abnormalities at the time of AVF construction, which may well influence the outcome of shunts in terms of future stenosis and failure. It seems likely that the later development of AVF stenosis may be the result of pre-existing disease rather than the direct insult of arterialization.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intimal Changes in the Cephalic Vein of Renal Failure Patients before Arterio-Venous Fistula (AVF) Construction

Wali

Eid

Dewan

et al. 2003

J. Smooth Muscle Res.

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“…However, evidence of unsuspected pre-existing venous wall changes in otherwise macroscopically normal saphenous veins prior to bypass has been presented, and the morphological similarities of these changes to the intimal hyperplasia seen in vein grafts has lead to the hypothesis that they may be related (Marin et al, 1991). Cheanvechai et al (1975) described phlebosclerosis in unused segments of long saphenous veins from patients undergoing coronary artery bypass surgery. They described intimal plaques composed of acellular collagen and hypertrophy of the tunica media in approximately one quarter of veins.…”

Section: Discussionmentioning

confidence: 99%

Smooth Muscle Changes in the Cephalic Vein of Renal Failure Patients before Use as an Arteriovenous Fistula(AVF).

Wali

Eid

Al-Homrany

2002

J. Smooth Muscle Res.

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Complications in arteriovenous fistula (AVF) occur in up to 35% of renal failure patients on hemodialysis. The most frequent complication is thrombosis, usually from stenotic lesions in the venous outflow system. To study the pre-existing smooth muscle changes in the cephalic vein of these patients, we prospectively collected a total of 17 cephalic vein specimens from 3 normal controls and 14 renal failure patients undergoing primary AVF construction on the chosen limb. After preparation, ultrathin sections were stained with uranyl and lead acetate and were examined under the transmission electron microscope (TEM). Compared with the normal controls, abnormal fibrous infiltration of the intima and the media and varying degrees of smooth muscle degenerative changes were observed in all the cephalic vein sections of renal failure patients. Smooth muscle cells (SMCs) lost their normal fusiform shape and were widely separated by increased amount of irregularly disposed, extracellular collagen fibers. Other cellular abnormalities included irregular cell membrane, granular cytoplasm, Peri- and Paranuclear vacuoles and mega mitochondria. SMCs also showed morphological expression of phagocytosis of collagen and elastic fibers as a sign of remodeling of the vein wall. In conclusion, pre-existing wall and smooth muscle changes were observed in all the cephalic vein sections of renal failure patients, which may contribute to the later complications of AVFs.

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“…However, should local levels of shear stress and wall tension be impeded from reaching or reestablishing baseline conditions – due to either local environmental conditions, flow disturbances, or intrinsic vein disease - the proliferative intimal reaction would be expected to continue and stenosis to supervene. [30, 31] Therefore one explanation for segmental stenosis may be a hyper-proliferative response superimposed on a restrictive pattern of inadequate outward remodeling, Figure 2.…”

Section: The Remodeling Of Human Vein Bypassmentioning

confidence: 99%

Vein graft failure

Owens

Gasper

Rahman

et al. 2015

Journal of Vascular Surgery

119

107

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Following the creation of an autogenous lower extremity bypass graft, the vein must undergo a series of dynamic structural changes to stabilize the arterial hemodynamic forces. These changes, commonly referred to as remodeling, include an inflammatory response, the development of a neointima, matrix turnover, and cellular proliferation and apoptosis. The sum total of these processes results in dramatic alterations in the physical and biomechanical attributes of the arterialized vein. The most clinically obvious and easily measured of these is lumen remodeling of the graft. However, though somewhat less precise, wall thickness, matrix composition, and endothelial changes can be measured in vivo within the healing vein graft. Recent translational work has demonstrated the clinical relevance of remodeling as it relates to vein graft patency and the systemic factors influencing it. By correlating histologic and molecular changes in the vein, insights into potential therapeutic strategies to prevent bypass failure and areas for future investigation are explored.

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The Structural Study of the Saphenous Vein

Cited by 59 publications

References 6 publications

Intimal Changes in the Cephalic Vein of Renal Failure Patients before Arterio-Venous Fistula (AVF) Construction

Intimal Changes in the Cephalic Vein of Renal Failure Patients before Arterio-Venous Fistula (AVF) Construction

Smooth Muscle Changes in the Cephalic Vein of Renal Failure Patients before Use as an Arteriovenous Fistula(AVF).

Vein graft failure

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