Vasoreactivity of arterial grafts in the patient with diabetes mellitus: investigations on internal thoracic artery and radial artery conduits

Wendler, Olaf; Landwehr, P.; Bandner-Risch, Doris; Georg, Thomas; Schäfers, Hans‐Joachim

doi:10.1016/s1010-7940(01)00778-3

Cited by 30 publications

(19 citation statements)

References 20 publications

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“…Our findings showed normal vasomotor properties of the LITA grafts in diabetic patients and concurred with the data of Wendler et al (19), who recently showed preserved vasoreactivity of arterial conduits (internal thoracic and radial arteries) in diabetic patients who underwent myocardial revascularization. Therefore, arterial grafts of diabetic patients appear to maintain their biological integrity, even in the presence of poorly compensated glucose metabolism.…”

Section: Discussionsupporting

confidence: 93%

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: Discussionsupporting

confidence: 93%

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

et al. 2003

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“…Increased superoxide production (31,32) and peroxynitrite formation (30) were suggested to explain the NO deficiency. Endothelial dysfunction was found in isolated human diabetic small (3,33,34) and large (32,35,36) arteries, but the data were not consistent (37,38). Rarely have human studies considered perturbations in the underlying cellular mechanisms of abnormal vasomotion in diabetes (32).…”

mentioning

confidence: 98%

Compromised Arterial Function in Human Type 2 Diabetic Patients

et al. 2005

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Diabetes is associated with a perturbation of signaling pathways in vascular tissue, which causes vasomotor dysfunction such as hypertension and accelerated atherosclerosis. In the present study, the mechanisms of vasomotor dysfunction, Akt (Thr 308 and Ser 473 ) phosphorylation and expression of endothelial NO (nitric oxide) synthase, and inducible NO synthase were investigated in human diabetic internal mammary arteries. The phospho-Akt (Thr 308 ) level in arteries from diabetic patients was reduced to about one-half of the level in nondiabetic patients, suggesting impaired insulin signaling in human diabetic vascular tissue. Augmented vasoconstriction was observed in diabetic arteries, due in part to deficiency of basal and stimulated NO production. This correlated with decreased endothelial NO synthase expression and activity in diabetic vessels. The sensitivity of diabetic vessels to the NO donor, sodium nitroprusside, was reduced as well, suggesting that NO breakdown and/or decreased sensitivity of smooth muscle to NO are also responsible for abnormal vasoconstriction. In addition, the abnormal vasoconstriction in diabetic vessels was not completely abolished in the presence of N-nitro-L-arginine methyl ester, revealing that NO-independent mechanisms also contribute to vasomotor dysfunction in diabetes. In conclusion, diabetes downregulates the Akt-signaling pathway and compromises human arterial function through a decrease in NO availability as well as through NO-independent mechanisms. Diabetes 54:2415-2423, 2005

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“…5) In contrast, several groups suggested that vascular hyperreactivity, caused by hyperglycemia, is mediated by changes in the expression of signaling molecules in vascular smooth muscle cells. 6,7) Therefore, mechanisms other than endothelial dysfunction may also participate in the vascular hyperreactivity. The saphenous vein (SV) has been commonly used as a conduit for CABG because of its ready availability and suppleness.…”

mentioning

confidence: 99%

Diabetes Mellitus Induces Hyperreactivity of 5-Hydroxytryptamine (5-HT)-Induced Constriction in Human Internal Thoracic Artery and Is Associated with Increase in the Membrane Protein Level of 5-HT<sub>2A</sub> Receptor

Shiba

Yokota

Gamoh

et al. 2018

Biological & Pharmaceutical Bulletin

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Vasoreactivity of arterial grafts in the patient with diabetes mellitus: investigations on internal thoracic artery and radial artery conduits

Cited by 30 publications

References 20 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

Compromised Arterial Function in Human Type 2 Diabetic Patients

Diabetes Mellitus Induces Hyperreactivity of 5-Hydroxytryptamine (5-HT)-Induced Constriction in Human Internal Thoracic Artery and Is Associated with Increase in the Membrane Protein Level of 5-HT<sub>2A</sub> Receptor

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