Subacute mechanical stenosis due to twisted saphenous vein graft identified by intravascular ultrasound

Ichimoto, Eiji; Horie, Sawako; Hasegawa, Atsushi; Miyahara, Hirofumi; Nameki, Mizuo

doi:10.1007/s12928-016-0433-x

Cited by 2 publications

(2 citation statements)

References 2 publications

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“…Furthermore, late failure occurs due to SVG arteriosclerosis (10). Advanced endovascular imaging technology sheds light on the potential mechanisms and physiology of SVG failure progression, such as twisted SVG leading to acute mechanical stenosis (11), and "upside down" venous valve leading to late SVG stenosis following 12-year-CABG (12). The cases above demonstrated another mechanism that led to the SVG failure.…”

Section: Discussionmentioning

confidence: 99%

Underlying mechanisms of saphenous vein graft stenosis after coronary artery bypass caused by clipping of the side branches: an experimental study

Ren¹,

Song²,

Li³

et al. 2022

J Thorac Dis

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Background: Saphenous veins are regular bypass conduits selected in non-left anterior descending artery (LAD) coronary artery bypass graft (CABG) surgery. Despite the technical errors, acute thrombosis, intimal hyperplasia and arteriosclerosis which could lead to saphenous vein graft (SVG) failure, the metal-clippingrelated SVG failure is unique and rare. This study was conducted to investigate the clinical and underlying mechanisms of the metal-clipping-related SVG failure. Methods: We collected 6 typical cases of the metal-clipping-related SVG failure in 41 patients who were diagnosed graft stenosis by coronary angiograph after CABG in the Department of Cardiology, Beijing Anzhen Hospital, from January 2020 to September 2021. Furthermore, we built an in vitro model to verify the identical intravascular ultrasound (IVUS) pattern of metal clip.Results: There were 6 in 41 cases of SVG stenosis caused by clipping of the side branches. We found that the stenosis of SVG caused by metal clipping mostly occurred at the corner and multipole clipping points. In this situation, great resistance could be felt when pushing the instruments through the stenosis and crystallized cholesterol was rarely caught by the distal protection device. We verified the similar IVUS pattern of metal clip at the side-branches of SVG in vitro. Conclusions:The metal-clipping-related stenosis may lead to SVG failure. The stenosis of SVG caused by metal clipping mostly occurred at the corner and multipole clipping points. IVUS showed great modality for clarification.

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Section: Discussionmentioning

confidence: 99%

Underlying mechanisms of saphenous vein graft stenosis after coronary artery bypass caused by clipping of the side branches: an experimental study

Ren¹,

Song²,

Li³

et al. 2022

J Thorac Dis

View full text Add to dashboard Cite

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“…Torsion of vein grafts is a commonly indicated risk factor for vascular thrombosis in the clinical setting. [2][3][4][5][6] This thrombosis may occur due to the increased potential of graft kinking. 12 In our study, we did not find any increased risk of vascular thrombosis for twisted vein grafts in the acute postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Torsion Does Not Affect Early Vein Graft Patency in the Rat Femoral Artery Model

Harb

Levi

Kozato

et al. 2018

J reconstr Microsurg

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Background Torsion of vein grafts is a commonly cited reason for graft failure in clinical setting. Many microsurgery training courses have incorporated vein graft procedures in their curricula, and vein graft torsion is a common technical error made by the surgeons in these courses. To improve our understanding of the clinical reproducibility of practicing vein graft procedures in microsurgery training courses, this study aims to determine if torsion can lead to early vein graft failure in nonsurvival surgery rat models. Methods Sprague-Dawley rats were divided into five cohorts with five rats per cohort for a total of 25 rats. Cohorts were labeled based on degree of vein graft torsion (0, 45, 90, 135, and 180 degrees). Torsion was created in the vein grafts at the distal arterial end by mismatching sutures placed between the proximal end of the vein graft and the distal arterial end. Vein graft patency was then verified 2 and 24 hours postoperation. Results All vein grafts were patent 2 and 24 hours postoperation. At 2 hours, the average blood flow rate measurements for 0, 45, 90, 135, and 180 degrees of torsion were 0.37 ± 0.02, 0.38 ± 0.04, 0.34 ± 0.01, 0.33 ± 0.01, and 0.29 ± 0.02 mL/min, respectively. At 24 hours, they were 0.94 ± 0.07, 1.03 ± 0.15, 1.26 ± 0.22, 1.41 ± 0.11, and 0.89 ± 0.15 mL/min, respectively. Conclusion Torsion of up to 180 degrees does not affect early vein graft patency in rat models. To improve the clinical reproducibility of practicing vein graft procedures in rat models, we suggest that microsurgery instructors assess vein graft torsion prior to clamp release, as vessel torsion does not seem to affect graft patency once the clamps are removed.

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Subacute mechanical stenosis due to twisted saphenous vein graft identified by intravascular ultrasound

Cited by 2 publications

References 2 publications

Underlying mechanisms of saphenous vein graft stenosis after coronary artery bypass caused by clipping of the side branches: an experimental study

Underlying mechanisms of saphenous vein graft stenosis after coronary artery bypass caused by clipping of the side branches: an experimental study

Torsion Does Not Affect Early Vein Graft Patency in the Rat Femoral Artery Model

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