Prebypass histological and ultrastructural evaluation of the long saphenous vein as a predictor of early graft failure

Kouzi-Koliakos, Kokkona; Kanellaki-Kyparissi, M.; Маринов, Г.; Knyazhev, V.; Tsalie, E.; Batzios, Christos; Kovachev, D.

doi:10.1016/j.carpath.2006.07.005

Cited by 15 publications

(12 citation statements)

References 31 publications

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“…Human saphenous vein with intimal thickness greater than 120 µm correlated with impaired endothelial–dependent relaxation (Figure 4). A link between increased basal intimal thickness and postoperative complications has been reported earlier [9]. Our study demonstrates that increased basal intimal thickness also decreases endothelial-dependent relaxation suggesting that endothelial dysfunction associated with increased thickness may partly be responsible for the postoperative complications affecting their graft patency.…”

Section: Discussionsupporting

confidence: 82%

“…Using histologic assessment, Kanellaki-Kyparissi et al , reported that prior to implantation, 91% of vein grafts have varying degrees of histological lesions such as local thickening of the vessel wall especially the intima, which was accompanied by a decrease of endothelial coverage only in the stenotic part of the vessel [8]. By histological and ultrastructural evaluation of saphenous vein grafts before implantation Kokkona et al reported that patients with early postoperative complications had a mean intimal thickness of 206.56 ± 32.29 mm, while patients who did not have postoperative complications had a mean intimal thickness of 67.44 ± 10.17 mm [9]. To evaluate the viability and quality of human saphenous vein used in coronary artery bypass operation, a functional method was used since the presence of an intact structure of the vessel wall, as obtained by morphological studies, does not necessarily imply normal function of the tissue [21].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Histological and ultrastructural evaluation of the vein graft prior to implantation have demonstrated that morphological changes of the graft wall correlate significantly with early postoperative complications [9]. Preexisting conditions such as low endothelial cell coverage, stenotic lesions of the lumen and thickness of the intima and media of the graft walls have been considered responsible for the early occlusion of grafts [9]. In fact, approximately 20% of human saphenous vein conduits used as vascular grafts are angioscopically normal, yet contain histological lesions such as atheromatous plaques, fibrous strands, and thickened valve cusps [8, 10].…”

Section: Introductionmentioning

confidence: 99%

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Intimal thickness associated with endothelial dysfunction in human vein grafts

Sexton

Hocking

et al. 2013

Journal of Surgical Research

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Objectives Intimal hyperplasia is a complex process thought to be initiated by injury and is the leading cause of vein graft failure. In this investigation we hypothesized that basal intimal thickness in human saphenous vein is a predictor of endothelial dysfunction and potentially intimal hyperplasia. Methods Human saphenous veins were obtained during coronary artery bypass surgery. The segments were contracted with phenylephrine, and relaxed with carbachol to determine endothelial-dependent relaxation. Vein segments were fixed in 10% buffered formalin, and cultured for 14 days in high serum and then fixed in formalin. The fixed tissues were stained with Verhoeff-Van Gieson and average intimal and medial thicknesses were calculated using light microscopy and a computerized image analysis system. Results Human saphenous veins displayed variable amounts of basal intimal thickness ranging from 18.80 to 241.3 µm. Endothelial-dependent relaxation of the veins was highly variable with values ranging from 0 to 27.59%. Human saphenous vein with basal intimal thickness greater than 120mm had significantly less endothelial-dependent relaxation (8.90±6.32%) than those with basal intimal thickness less than 120mm (21.97±10.64%). Endothelial dysfunction correlated with basal intimal thickness > 120µm (P = 0.02). Basal intimal thickness also correlated with increased intimal thickness after 14 days in organ culture (P=0.0001). Conclusions Basal intimal thickness greater than 120 µm is a predictor of endothelial dysfunction, and since greater basal intimal thickness also correlated with increased intimal thickness after organ culture, basal intimal thickness may predict vein graft failure due to intimal hyperplasia.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intimal thickness associated with endothelial dysfunction in human vein grafts

Sexton

Hocking

et al. 2013

Journal of Surgical Research

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“…1,2 Common causes of VGF include loss of endothelial coverage, intimal hyperplasia, and thrombosis. 3 Graft patency rates are influenced by patient characteristics, intrinsic quality of the conduit, and surgical technique. 4 Despite concerns about graft preparation techniques, beginning with the research by LoGerfo et al 5,6 in the early 1980s, preservation of endothelial and medial integrity of the conduits during graft preparation remains suboptimal, and as such, VGF is attributable at least in part to tissue handling.…”

mentioning

confidence: 99%

Pressure Control During Preparation of Saphenous Veins

Eagle

Brophy

et al. 2014

JAMA Surg

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Importance Long-term patency of human saphenous veins (HSVs) used as autologous conduits for coronary artery bypass grafting (CABG) procedures remains limited because of vein graft failure (VGF). Vein graft failure has been reported to be as high as 45% at 12 to 18 months after surgery and leads to additional surgery, myocardial infarction, recurrent angina, and death. Preparation of HSVs before implantation leads to conduit injury, which may promote VGF. Objectives To investigate whether pressure distension during vein graft preparation leads to endothelial injury and intimal thickening and whether limiting intraluminal pressure during pressure distension by using a pressure release valve (PRV) preserves endothelial function and prevents neointima thickening. Design, Setting, and Participants Segments of HSVs were collected in a university hospital from 13 patients undergoing CABG procedures immediately after harvest (unmanipulated [UM]), after pressure distension (after distension [AD]), and after typical intraoperative surgical graft preparation (after manipulation [AM]). Porcine saphenous veins (PSVs) from 7 healthy research animals were subjected to manual pressure distension with or without an in-line PRV that prevents pressures of 140 mm Hg or greater. Endothelial function of the HSVs and PSVs was determined in a muscle bath, endothelial integrity was assessed, and intimal thickening in PSVs was evaluated after 14 days in organ culture. Main outcomes and measures Endothelial function was measured in force, converted to stress, and defined as the percentage relaxation of maximal phenylephrine-induced contraction. Endothelial integrity was assessed by immunohistologic examination. Neointimal thickness was measured by histomorphometric analysis. Results Pressure distension of HSVs led to decreased mean (SEM) endothelial-dependent relaxation (5.3% [2.3%] for AD patients vs 13.7% [2.5%] for UM patients; P < .05) and denudation. In the AM group, the function of the conduits was further decreased (−3.2% [3.2%]; P < .05). Distension of the PSVs led to reduced endothelial-dependent relaxation (7.6% [4.4%] vs 61.9% [10.2%] in the control group; P < .05), denudation, and enhanced intimal thickening (15.0 [1.4] μm vs 2.2 [0.8] μm in the control group; P < .05). Distension with the PRV preserved endothelial-dependent relaxation (50.3% [9.6%]; P = .32 vs control), prevented denudation, and reduced intimal thickening (3.4 [0.8] μm; P = .56 vs controls) in PSVs. Conclusions and Relevance Use of a PRV during graft preparation limits intraluminal pressure generated by manual distension, preserves endothelial integrity, and reduces intimal hyperplasia. Integration of this simple device may contribute to improved long-term vein graft patency.

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Autogenous Vein Grafts

Berceli¹

2010

Rutherford's Vascular Surgery

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Prebypass histological and ultrastructural evaluation of the long saphenous vein as a predictor of early graft failure

Cited by 15 publications

References 31 publications

Intimal thickness associated with endothelial dysfunction in human vein grafts

Intimal thickness associated with endothelial dysfunction in human vein grafts

Pressure Control During Preparation of Saphenous Veins

Autogenous Vein Grafts

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