Towards a solution for saphenous vein graft failure

Reduction of Lipid Peroxidation with Intraoperative Superoxide Dismutase Treatment Decreases Intimal Hyperplasia in Experimental Vein Grafts

“…Our finding of increased MDA concentration in 3-day vein grafts (as compared to the ungrafted jugular veins) further suggests that lipid peroxidation is augmented early with bypass surgery. This increase in lipid peroxidation would coincide with the early inflammatory response previously observed in vein grafts and could conceivably be related to the generation of free radicals by the infiltrating leukocytes [1,3,4,15]. Moreover, the decrease in lipid peroxidation achieved with PEG-SOD treatment was associated with a significant reduction in the formation of intimal hyperplasia.…”

“…Although the universal development of intimal hyperplasia in vein grafts is generally regarded as an adaptive response to the arterial milieu, it is also recognized as the leading cause of vein graft failure [1,3,4,8,20]. Many factors are known to influence the hyperplastic response; however, the biological events that initiate, control, and accelerate intimal hyperplasia remain ill-defined.…”

“…The formation of intimal hyperplastic lesions, which is characterized by the accumulation of smooth muscle cells and changes in vasomotor function, is well accepted as the major cause of vein graft failure [1,3,4]. Many factors are known to influence the development of vein graft intimal hyperplasia [1,3,4]. However, the mechanisms involved in the initiation and control of this hyperplastic process remain ill-defined.…”

“…Although direct evidence linking the generation of free radicals and the hyperplastic response is lacking, an early leukocytic infiltration (predominantly polymorphonuclear cells, major producers of free radicals) is known to precede the formation of intimal hyperplasia in balloon-injured arteries and vein grafts [14,15]. In addition, the process of vein harvest and reimplantation inevitably incites ischemia-reperfusion events with the production of free radicals [1,3,4].…”

Local treatment with recombinant tissue factor pathway inhibitor reduces the development of intimal hyperplasia in experimental vein grafts

“…[1][2][3] Endothelial injury is a recognized precursor to the formation of intimal hyperplasia. [4][5][6] Many factors are believed to contribute to the formation of intimal hyperplasia in vein grafts, including hemodynamic forces, neutrophil-endothelial interaction, platelet activation, growth and coagulation factors, and cytokines. 6,7…”