Patency and characteristics of lower extremity vein grafts requiring multiple revisions

Landry, Gregory J.; Moneta, Gregory L.; Taylor, Lloyd M.; Edwards, James M.; Yeager, Richard A.; Porter, John M.

doi:10.1067/mva.2000.107306

Cited by 18 publications

(12 citation statements)

References 18 publications

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“…2 Therefore, it may be reasonable to assume that early lesions are indicative of poor initial conduit, a characteristic associated with compromised outcomes. 7,8 Despite the unfavorable failure rate of maintenance procedures performed on grafts with early lesions, overall late graft survival Ͼ48 months (primary assisted patency) for such grafts was not different compared with grafts undergoing similar procedures for later appearing lesions. This appears to be largely the result of aggressive intervention and reintervention on culprit lesions, further validating the need for maintenance intervention.…”

Section: Discussionmentioning

confidence: 97%

Target lesion characteristics in failing vein grafts predict the success of endovascular and open revision

Hagino

Sheehan

Jung

et al. 2007

Journal of Vascular Surgery

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Grafts that develop early lesions fare poorly regardless of treatment modality. Lesions involving anastomoses of failing grafts are better treated with open revision, but patency after treatment of such lesions is still worse than treatment of mid-graft lesions. In contrast, the method of treatment does not influence outcome after treatment of mid-graft target lesions. Thus, endovascular therapy should be reserved for focal, late-appearing lesions involving the mid-graft.

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Section: Discussionmentioning

confidence: 97%

Target lesion characteristics in failing vein grafts predict the success of endovascular and open revision

Hagino

Sheehan

Jung

et al. 2007

Journal of Vascular Surgery

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“…These differences are comparable to the differences we have observed between strains of cells from vein grafts that remain patent or eventually develop stenosis. While these may appear to be modest differences in growth rate, they may be sufficient given that lesion growth in vivo in vein grafts appears to take months39,40. Whether differences in PDGF receptor levels exist between SMCs of veins from patients that develop graft stenosis and SMCs from veins of patients with patent grafts is not known.…”

Section: Discussionmentioning

confidence: 99%

Proliferative capacity of vein graft smooth muscle cells and fibroblasts in vitro correlates with graft stenosis

Kenagy

Fukai

Min³

et al. 2009

Journal of Vascular Surgery

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Objective About a quarter of peripheral vein grafts fail due in part to intimal hyperplasia. The proliferative capacity and response to growth inhibitors of medial smooth muscle cells and adventitial fibroblasts in vitro were studied to test the hypothesis that intrinsic differences in cells of vein grafts are associated with graft failure. Methods Cells were grown from explants of the medial and adventitial layers of samples of vein grafts obtained at the time of implantation. Vein graft patency and function were monitored over the first 12 months using ankle pressures and Duplex ultrasound to determine vein graft status. Cells were obtained from veins from 11 patients whose grafts remained patent (non-stenotic) and from 7 patients whose grafts developed stenosis. Smooth muscle cells (SMCs) derived from media and fibroblasts derived from adventitia were growth arrested in serum-free medium and then stimulated with 1 μM sphingosine-1-phosphate (S1P), 10 nM thrombin, 10 ng/ml epidermal growth factor (EGF), 10 ng/ml platelet-derived growth factor-BB (PDGF-BB), PDGF-BB plus S1P, or PDGF-BB plus thrombin for determination of incorporation of [3H]-thymidine into DNA. Cells receiving PDGF-BB or thrombin were also treated with or without 100 μg/ml heparin, which is a growth inhibitor. Cells receiving thrombin were also treated with or without 100 nM AG1478, an EGF receptor kinase inhibitor. Results SMCs and fibroblasts from veins of patients that developed stenosis responded more to the growth factors, such as PDGF-BB alone or in combination with thrombin or S1P, than cells from veins of patients that remained patent (P=.012). In addition, while PDGF-BB-mediated proliferation of fibroblasts from grafts that remained patent was inhibited by heparin (P<.03), PDGF-BB-mediated proliferation of fibroblasts from veins that developed stenosis was not (P>.5). Conclusions Inherent differences in the proliferative response of vein graft cells to PDGF-BB and heparin may explain, in part, the variability among patients regarding long term patency of vein grafts.

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“…2 For example, the acceptance by many of the value of identifying graft stenosis and carrying out prompt corrective surgery leads to many patients undergoing further surgery. 2,3 The outcome of bypass surgery is traditionally reported in terms of patency (i.e., the percentage of grafts free from occlusion), 4 but this may give little information regarding the patient's quality of life after surgery. 5 Perioperative complications, repeated admissions to the hospital, and particularly further surgery all interfere with recovery from bypass surgery.…”

Section: Discussionmentioning

confidence: 99%

Critical Assessment of the Outcome of Infrainguinal Vein Bypass

et al. 2001

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Patency and characteristics of lower extremity vein grafts requiring multiple revisions

Cited by 18 publications

References 18 publications

Target lesion characteristics in failing vein grafts predict the success of endovascular and open revision

Target lesion characteristics in failing vein grafts predict the success of endovascular and open revision

Proliferative capacity of vein graft smooth muscle cells and fibroblasts in vitro correlates with graft stenosis

Critical Assessment of the Outcome of Infrainguinal Vein Bypass

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