Vein graft failure

Abstract

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.

Perivascular sustained release of atorvastatin from a hydrogel-microparticle delivery system decreases intimal hyperplasia

“…In 473 fact, the acute stage of IH development occurs during the first 30 days following the intervention 474 [1]. As clHA doesn't offer the possibility of delivering the drug for a long period of time (Fig.…”

“…It 62 is performed in over one million patients per year worldwide [1]. Autologous saphenous vein 63 graft is the conduit of choice for peripheral bypasses.…”

Inhibition of vein graft remodeling and neo-intimal formation using a cobalt chrome external support

“…However, despite significant advances in the understanding of venous pathophysiology post-implantation, little progress was made in the clinical setting in which vein graft failure rate is still 30 -50% within 3 to 5 years [1,2].…”

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IntroductionThe autologous vein bypass remains the most effective and durable revascularization strategy for patients with critical limb ischemia [1]. However, despite significant advances in the understanding of venous pathophysiology post-implantation, little progress was made in the clinical setting in which vein graft failure rate is still 30 -50% within 3 to 5 years [1,2].

Early graft occlusion, within one month from implantation, is generally ascribed to technical or procedural related complications (e.g., kinking and twisting) or poor conduit quality.

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“…However, despite significant advances in the understanding of venous pathophysiology post-implantation, little progress was made in the clinical setting in which vein graft failure rate is still 30 -50% within 3 to 5 years [1,2].Early graft occlusion, within one month from implantation, is generally ascribed to technical or procedural related complications (e.g., kinking and twisting) or poor conduit quality. Late vein graft failure is attributed to the structural changes that occur in the conduit immediately post-implantation due to the exposure to Following completion of the first anastomosis, randomization was performed to allocate the experimental and control grafts in each animal.…”