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Mikami T, Furuhashi M, Sakai A, Numaguchi R, Harada R, Naraoka S, Kamada T, Higashiura Y, Tanaka M, Ohori S, Sakurada T, Nakamura M, Iba Y, Fukada J, Miura T, Kawaharada N. Antiatherosclerotic Phenotype of Perivascular Adipose Tissue Surrounding the Saphenous Vein in Coronary Artery Bypass Grafting. J Am Heart Assoc 2021; 10:e018905. [PMID: 33779243 PMCID: PMC8174366 DOI: 10.1161/jaha.120.018905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Perivascular adipose tissue (PVAT) is associated with metabolically driven chronic inflammation called metaflammation, which contributes to vascular function and the pathogenesis of vascular disease. The saphenous vein (SV) is commonly used as an essential conduit in coronary artery bypass grafting, but the long‐term patency of SV grafts is a crucial issue. The use of the novel “no‐touch” technique of SV harvesting together with its surrounding tissue has been reported to result in good long‑term graft patency of SV grafts. Herein, we investigated whether PVAT surrounding the SV (SV‐PVAT) has distinct phenotypes compared with other PVATs of vessels. Methods and Results Fat pads were sampled from 48 patients (male/female, 32/16; age, 72±8 years) with coronary artery disease who underwent elective coronary artery bypass grafting. Adipocyte size in SV‐PVAT was significantly larger than the sizes in PVATs surrounding the internal thoracic artery, coronary artery, and aorta. SV‐PVAT and PVAT surrounding the internal thoracic artery had smaller extents of fibrosis, decreased gene expression levels of fibrosis‐related markers, and less metaflammation, as indicated by a significantly smaller extent of cluster of differentiation 11c–positive M1 macrophage infiltration, higher gene expression level of adiponectin, and lower gene expression levels of inflammatory cytokines, than did PVATs surrounding the coronary artery and aorta. Expression patterns of adipocyte developmental and pattern‐forming genes were totally different among the PVATs of the vessels. Conclusions The phenotype of SV‐PVAT, which may result from inherent differences in adipocytes, is closer to that of PVAT surrounding the internal thoracic artery than that of PVAT surrounding the coronary artery or that of PVAT surrounding the aorta. SV‐PVAT has less metaflammation and consecutive adipose tissue remodeling, which may contribute to high long‐term patency of grafting when the no‐touch technique of SV harvesting is used.
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Affiliation(s)
- Takuma Mikami
- Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Masato Furuhashi
- Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Akiko Sakai
- Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Ryosuke Numaguchi
- Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Syuichi Naraoka
- Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Takeshi Kamada
- Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Yukimura Higashiura
- Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Marenao Tanaka
- Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Shunsuke Ohori
- Department of Cardiovascular Surgery Hokkaido Ohno Memorial Hospital Sapporo Japan
| | - Taku Sakurada
- Department of Cardiovascular Surgery Sapporo Central Hospital Sapporo Japan
| | - Masanori Nakamura
- Department of Cardiovascular Surgery Sapporo City General Hospital Sapporo Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery Teine Keijinkai Hospital Sapporo Japan
| | - Joji Fukada
- Department of Cardiovascular Surgery Otaru City General Hospital Otaru Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
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Harky A, MacCarthy‐Ofosu B, Grafton‐Clarke C, Pousios D, Muir AD. Long saphenous vein harvesting techniques and their effect on graft patency. J Card Surg 2019; 34:821-828. [DOI: 10.1111/jocs.14153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Amer Harky
- Department of Cardiothoracic SurgeryLiverpool Heart and ChestLiverpool UK
| | | | | | - Dimitrios Pousios
- Department of Cardiothoracic SurgeryLiverpool Heart and ChestLiverpool UK
| | - Andrew D. Muir
- Department of Cardiothoracic SurgeryLiverpool Heart and ChestLiverpool UK
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Hastaoğlu İO, Toköz H, Özgen A, Bilgen F. Comparison of the one-year patency rates of radiocephalic arteriovenous fistulas created using no-touch versus conventional technique. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2019; 27:43-48. [PMID: 32082826 PMCID: PMC7021369 DOI: 10.5606/tgkdc.dergisi.2019.16136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/21/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aims to compare the patency rates of radiocephalic arteriovenous fistulas prepared preserving the perivenous vascular tissues versus those prepared using the conventional technique. METHODS A total of 169 patients (107 males, 62 females; mean age 59.5 years; range, 39 to 87 years) who underwent a radiocephalic arteriovenous fistula construction were included in this study. In 95 patients, the tissues surrounding the cephalic vein were stripped off as per the conventional method, while the no-touch technique preserving the perivenous vascular tissues was utilized for vein harvesting in 74 patients. Patients were followed-up to compare primary and secondary patency rates of the arteriovenous fistulas at one year. RESULTS Fistula failure developed in 22 patients within the first year resulting in primary patency rates of 90.5% versus 84.2% for the no-touch and the conventional groups, respectively (p=0.225). Likewise, secondary patency rates were 94.6% versus 93.7% for the no-touch and the conventional groups, respectively (p=0.803). The two groups did not differ with regards to primary or secondary patency rates. CONCLUSION Findings of this study were not in favor of the no-touch technique compared to the conventional methods in terms of arteriovenous fistula patency at one year.
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Affiliation(s)
| | - Hamdi Toköz
- Department of Cardiovascular Surgery, Private Erdem Hospital, Istanbul, Turkey
| | - Ayça Özgen
- Department of Cardiovascular Surgery, Private Erdem Hospital, Istanbul, Turkey
| | - Fuat Bilgen
- Department of Cardiovascular Surgery, Private Erdem Hospital, Istanbul, Turkey
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Koukis I, Siminelakis S, Argiriou M, Theakos N, Takou A, Pounis G, Charitos C, Apostolakis E. Antegrade cardioplegia as a possible cause of acute saphenous vein endothelial damage in patients undergoing on pump coronary artery bypass surgery. J Thorac Dis 2018; 10:4302-4310. [PMID: 30174877 DOI: 10.21037/jtd.2018.06.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The administration of antegrade cardioplegia through vein grafts after the completion of each distal anastomosis is a common practice. However, the cardioplegic solution may disrupt the vein endothelium and contribute to late vein graft atherosclerotic disease. This study aimed at evaluating the possible impact of the cardioplegic solution on vein graft endothelium. Methods Total of 52 patients (16 women and 36 men) aged 68±8.5 years old that underwent on pump coronary revascularization with at least one vein graft were enrolled. Sections of grafts from the greater saphenous vein were obtained prior to and after delivery of potassium antegrade cardioplegic solution through them. These sections were then examined histologically with immunochemical stain and CD34 index. The endothelial damage and length of vein specimens of both graft sections were evaluated. Results The endothelial damage of vein specimens appeared to be increased significantly with exposure to antegrade cardioplegia in male and female patients (P from Wilcoxon tests <0.001, for both genders). The increase in the length of vein specimens was significant too (P from Wilcoxon test <0.001 for men and P=0.001 for women). Conclusions Antegrade cardioplegia delivered through vein grafts causes substantial damage on vein endothelium. This may have an adverse effect on long-term graft patency.
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Affiliation(s)
- Ioannis Koukis
- Department of Cardiac Surgery, 401 Army General Hospital, Athens, Greece
| | - Stavros Siminelakis
- Department of Cardiac Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Michalis Argiriou
- Department of Cardiac Surgery, Evangelismos General Hospital, Athens, Greece
| | - Nikolaos Theakos
- Department of Cardiac Surgery, Evangelismos General Hospital, Athens, Greece
| | - Anna Takou
- Department of Pathology, Evangelismos General Hospital, Athens, Greece
| | - George Pounis
- Department of Cardiac Surgery, 401 Army General Hospital, Athens, Greece
| | - Christos Charitos
- Department of Cardiac Surgery, Evangelismos General Hospital, Athens, Greece
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Lohsiriwat V, Wilson VG, Scholefield JH, Dashwood MR. Regional Distribution of Nitric Oxide Synthase in Human Anorectal Tissue: A Pilot Study on the Potential Role for Nitric Oxide in Haemorrhoids. Curr Vasc Pharmacol 2018; 18:43-49. [PMID: 30058493 DOI: 10.2174/1570161116666180730101532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To study the distribution of nitric oxide synthase (NOS) isoforms and protein levels in human haemorrhoids and rectal tissue. METHODS Protein expression of NOS1, NOS2 and NOS3 was compared between haemorrhoids (n=14) and normal rectal submucosa (n=6) using Western blot analysis. The localisation of all NOS isoforms to specific structures was determined by immunohistochemistry. RESULTS Western blot analysis showed median (interquartile range) protein levels of all NOS isoforms were 1.5-2.4 times higher in haemorrhoids than rectal tissue; 121.4 (55.2-165.5) vs 50.0 (25.5-73.7) for NOS1 (p=0.020), 32.2 (23.8-140.6) vs 14.8 (9.6-34.0) for NOS2 (p=0.109), and 80.1 (62.0-139.5) vs 54.3 (48.7 -61.7) for NOS3 (p=0.015). Immunohistochemistry revealed a different distribution and location of all NOS isoforms in vascular and non-vascular structure of haemorrhoids and rectal tissues. The number of haemorrhoid specimens showing positive immunoreactivity of NOS in the vascular endothelium was significantly higher than that in rectal tissue for NOS1 (11/14 (79%) vs 1/6 (17%); p=0.018) and NOS3 (8/14 (57%) vs 0/6 (0%); p=0.042), but not for NOS2 (6/14 (43%) vs 4/6 (67%); p=0.63). CONCLUSION Haemorrhoids have significantly higher protein levels of NOS1 and NOS3 than rectal tissue. The vascular endothelium of haemorrhoids also has significantly higher positive immunoreactivity of NOS1 and NOS3 than rectal tissue suggesting that blood vessels in haemorrhoids are exposed to higher NO concentrations than those of rectal tissue. Since haemorrhoids exhibit marked vascular dilatation and present with bleeding or swelling, a reduction in NOS - by applying NOS inhibitors - may potentially improve the symptoms of haemorrhoids.
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Affiliation(s)
- Varut Lohsiriwat
- The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, United Kingdom.,Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vincent G Wilson
- The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, United Kingdom
| | - John H Scholefield
- The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, United Kingdom
| | - Michael R Dashwood
- Surgical and Interventional Sciences, Royal Free and University College Medical School, London, United Kingdom
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Papakonstantinou NA, Baikoussis NG, Goudevenos J, Papadopoulos G, Apostolakis E. Novel no touch technique of saphenous vein harvesting: Is great graft patency rate provided? Ann Card Anaesth 2016; 19:481-8. [PMID: 27397453 PMCID: PMC4971977 DOI: 10.4103/0971-9784.185537] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/25/2016] [Indexed: 11/09/2022] Open
Abstract
Coronary artery bypass grafting surgery effectively relieves signs and symptoms of myocardial ischemia. The left internal thoracic artery (LITA) graft is the gold standard having 90-95% patency rate at 10 years, whereas only 50% of saphenous vein (SV) grafts are patent at 10 years. However, there is a novel "no touch" technique in order to harvest an SV complete with its cushion of surrounding tissue, thus maintaining its endothelium-intact. Significantly superior short- and long-term graft patency rates comparable to LITA grafts can be achieved. Consequently, the SV may be revived as an important conduit in coronary artery bypass surgery.
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Affiliation(s)
- Nikolaos A. Papakonstantinou
- Department of Cardiothoracic Surgery, University Hospital of Ioannina, School of Medicine, 45500 Ioannina, Greece
- Department of Cardiothoracic Surgery, General Hospital of Athens “Evangelismos”, Athens, Greece
| | - Nikolaos G. Baikoussis
- Department of Cardiothoracic Surgery, General Hospital of Athens “Evangelismos”, Athens, Greece
| | - John Goudevenos
- Department of Cardiology, University Hospital of Ioannina, School of Medicine, 45500 Ioannina, Greece
| | - George Papadopoulos
- Department of Anesthesiology, University Hospital of Ioannina, School of Medicine, 45500 Ioannina, Greece
| | - Efstratios Apostolakis
- Department of Cardiothoracic Surgery, University Hospital of Ioannina, School of Medicine, 45500 Ioannina, Greece
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7
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No-Touch Technique for Radiocephalic Arteriovenous Fistula – Surgical Technique and Preliminary Results. J Vasc Access 2015; 17:6-12. [DOI: 10.5301/jva.5000456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose The radiocephalic arteriovenous fistula (RC-AVF) has significant failure rates due to occlusions and failure to mature. The size and quality of the veins are considerable limiting factors for the procedure. The aim of this pilot study was to describe the No-Touch technique (NTT) to create RC-AVF and present the results up to 1 year of follow-up. Methods Thirty-one consecutive patients who were referred for surgery for a RC-AVF were included (17 men, mean age 63 years, range 35-84) and operated by NTT where the vein and artery were dissected with a tissue cushion around it. Twenty-two patients had small veins or arteries (≤2 mm), 12 patients had a small cephalic vein (≤2 mm), and the mean distal cephalic vein diameter was 2.4 mm (range 1.0-4.1 mm). Results Technical surgical success and immediate patency were obtained in all patients. Clinical success was achieved in 23 of the 27 (85%) patients who required hemodialysis. The proportion of primary patency at 30 days and 6 months was 84% and 64%, respectively. Secondary patency at 30 days and 6 months was 97% and 83%, respectively. At 1-year follow-up, primary patency was 54% and secondary patency was 80%. There was no major difference in patency due to preoperative vein diameter. Conclusions The results of this study indicate that NTT can be used for primary radio-cephalic fistula surgery with very good results. This method offers the potential to create a RC-AVF in patients who are not usually considered appropriate for a distal arm fistula due to a small cephalic vein.
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Harskamp RE, Alexander JH, Schulte PJ, Brophy CM, Mack MJ, Peterson ED, Williams JB, Gibson CM, Califf RM, Kouchoukos NT, Harrington RA, Ferguson TB, Lopes RD. Vein graft preservation solutions, patency, and outcomes after coronary artery bypass graft surgery: follow-up from the PREVENT IV randomized clinical trial. JAMA Surg 2014; 149:798-805. [PMID: 25073921 DOI: 10.1001/jamasurg.2014.87] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE In vitro and animal model data suggest that intraoperative preservation solutions may influence endothelial function and vein graft failure (VGF) after coronary artery bypass graft (CABG) surgery. Clinical studies to validate these findings are lacking. OBJECTIVE To evaluate the effect of vein graft preservation solutions on VGF and clinical outcomes in patients undergoing CABG surgery. DESIGN, SETTING, AND PARTICIPANTS Data from the Project of Ex-Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study, a phase 3, multicenter, randomized, double-blind, placebo-controlled trial that enrolled 3014 patients at 107 US sites from August 1, 2002, through October 22, 2003, were used. Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 planned vein grafts. INTERVENTIONS Preservation of vein grafts in saline, blood, or buffered saline solutions. MAIN OUTCOMES AND MEASURES One-year angiographic VGF and 5-year rates of death, myocardial infarction, and subsequent revascularization. RESULTS Most patients had grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%]) and buffered saline (507 [16.8%]). Baseline characteristics were similar among groups. One-year VGF rates were much lower in the buffered saline group than in the saline group (patient-level odds ratio [OR], 0.59 [95% CI, 0.45-0.78; P < .001]; graft-level OR, 0.63 [95% CI, 0.49-0.79; P < .001]) or the blood group (patient-level OR, 0.62 [95% CI, 0.46-0.83; P = .001]; graft-level OR, 0.63 [95% CI, 0.48-0.81; P < .001]). Use of buffered saline solution also tended to be associated with a lower 5-year risk for death, myocardial infarction, or subsequent revascularization compared with saline (hazard ratio, 0.81 [95% CI, 0.64-1.02; P = .08]) and blood (0.81 [0.63-1.03; P = .09]) solutions. CONCLUSIONS AND RELEVANCE Patients undergoing CABG whose vein grafts were preserved in a buffered saline solution had lower VGF rates and trends toward better long-term clinical outcomes compared with patients whose grafts were preserved in saline- or blood-based solutions. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00042081.
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Affiliation(s)
- Ralf E Harskamp
- Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina2Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - John H Alexander
- Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Phillip J Schulte
- Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Colleen M Brophy
- Division of Vascular Surgery, Vanderbilt University, Nashville, Tennessee
| | - Michael J Mack
- Cardiopulmonary Research Science and Technology Institute, Dallas, Texas
| | - Eric D Peterson
- Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Judson B Williams
- Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | | | - Robert M Califf
- Department of Medicine, Duke Translational Medicine Institute, Duke University, Durham, North Carolina
| | | | | | - T Bruce Ferguson
- Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina
| | - Renato D Lopes
- Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
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Li FD, Eagle S, Brophy C, Hocking KM, Osgood M, Komalavilas P, Cheung-Flynn J. Pressure control during preparation of saphenous veins. JAMA Surg 2014; 149:655-62. [PMID: 24759942 DOI: 10.1001/jamasurg.2013.5067] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
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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Affiliation(s)
- Fan Dong Li
- General Hospital of Jinan Military District, Jinan, China
| | - Susan Eagle
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Colleen Brophy
- Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kyle M Hocking
- Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael Osgood
- Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Padmini Komalavilas
- Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joyce Cheung-Flynn
- Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Souza DSR, Arbeus M, Botelho Pinheiro B, Filbey D. The no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting surgery. Multimed Man Cardiothorac Surg 2014; 2009:mmcts.2008.003624. [PMID: 24413611 DOI: 10.1510/mmcts.2008.003624] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A new 'no-touch' (NT) technique of saphenous vein (SV) preparation for coronary artery bypass grafting (CABG) surgery was developed where the vein is harvested with a pedicle of surrounding tissue, which protects the vein from spasm therefore obviating the need for distension. The adventitial layer and the structures contained within the cushion of surrounding tissue possess both mechanical and functional properties that protect the vein from spasm and ischemia. In addition, the surrounding tissue supports excessively long vein grafts and prevents kinking. A detailed description of the technique is presented and this is the first time we publish the technique as a videoclip.
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Affiliation(s)
- Domingos S R Souza
- Department of Thoracic and Cardiovascular Surgery, örebro University Hospital, örebro, Sweden
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Cai X. Regulation of smooth muscle cells in development and vascular disease: current therapeutic strategies. Expert Rev Cardiovasc Ther 2014; 4:789-800. [PMID: 17173496 DOI: 10.1586/14779072.4.6.789] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Vascular smooth muscle cells (SMCs) exhibit extensive phenotypic diversity and rapid growth during embryonic development, but maintain a quiescent, differentiated state in adult. The pathogenesis of vascular proliferative diseases involves the proliferation and migration of medial vascular SMCs into the vessel intima, possibly reinstating their embryonic gene expression programs. Multiple mitogenic stimuli induce vascular SMC proliferation through cell cycle progression. Therapeutic strategies targeting cell cycle progression and mitogenic stimuli have been developed and evaluated in animal models of atherosclerosis and vascular injury, and several clinical studies. Recent discoveries on the recruitment of vascular progenitor cells to the sites of vascular injury suggest new therapeutic potentials of progenitor cell-based therapies to accelerate re-endothelialization and prevent engraftment of SMC-lineage progenitor cells. Owing to the complex and multifactorial nature of SMC regulation, combinatorial antiproliferative approaches are likely to be used in the future in order to achieve maximal efficacy and reduce toxicity.
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MESH Headings
- Animals
- Cell Differentiation
- Cellular Senescence
- Clinical Trials as Topic
- Disease Progression
- Drug Delivery Systems
- Gene Expression
- Genetic Therapy
- Humans
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/embryology
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/cytology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Phenotype
- Stents
- Vascular Diseases/drug therapy
- Vascular Diseases/genetics
- Vascular Diseases/metabolism
- Vascular Diseases/pathology
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Affiliation(s)
- Xinjiang Cai
- Duke University Medical Center, Departments of Medicine (Cardiology) & Cell Biology, Durham, North Carolina 27710, USA.
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12
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Li FD, Sexton KW, Hocking KM, Osgood MJ, Eagle S, Cheung-Flynn J, Brophy CM, Komalavilas P. Intimal thickness associated with endothelial dysfunction in human vein grafts. J Surg Res 2012; 180:e55-62. [PMID: 22763213 DOI: 10.1016/j.jss.2012.06.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 05/10/2012] [Accepted: 06/08/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Intimal hyperplasia is a complex process thought to be initiated by injury and is the leading cause of vein graft failure. In the present investigation, we hypothesized that the basal intimal thickness in the 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 the endothelial-dependent relaxation. The vein segments were fixed in 10% buffered formalin and grown for 14 d in high-serum culture and then fixed in formalin. The fixed tissues were stained with Verhoeff-Van Gieson, and the average intimal and medial thicknesses were calculated using light microscopy and a computerized image analysis system. RESULTS The human saphenous veins displayed varying amounts of basal intimal thickness (range 18.80-241.3 μm). The endothelial-dependent relaxation of the veins was highly variable, with values ranging from 0% to 27.59%. Human saphenous veins with a basal intimal thickness greater than 120 μm had significantly less endothelial-dependent relaxation (8.90% ± 6.32%) than those with a basal intimal thickness less than 120 μm (21.97% ± 10.64%). Endothelial dysfunction correlated with a basal intimal thickness greater than 120 μm (P = 0.02). The basal intimal thickness also correlated with increased intimal thickness after 14 d in organ culture (P = 0.0001). CONCLUSIONS A basal intimal thickness greater than 120 μm is a predictor of endothelial dysfunction. Also, because a greater basal intimal thickness correlated with an increased intimal thickness after organ culture, the basal intimal thickness might predict vein graft failure owing to intimal hyperplasia.
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Affiliation(s)
- Fan Dong Li
- Department of Surgery, Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Suvorava T, Dao VTV, Bas M, Kojda G. Nitric oxide and the CABG patient. Curr Opin Pharmacol 2012; 12:195-202. [PMID: 22285392 DOI: 10.1016/j.coph.2012.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/06/2012] [Accepted: 01/09/2012] [Indexed: 10/14/2022]
Abstract
The post surgery success of coronary artery bypass grafting (CABG) is counteracted by thrombosis and de-endothelialization, intimal hyperplasia and, over the long term, atherosclerosis. There are many reasons to assume that in CABG patients vascular bioavailability of NO generated by the endothelium plays an important role for graft function. This holds true for factors such as graft type, harvesting and storage, the type of surgery, non-pharmacologic prevention of risk factors, for example, regular physical activity (if feasible), and drug therapy. Although the precise role of graft endothelial NO bioavailability for graft patency and clinical endpoints is still uncertain, current data rather speak in favor of NO indicating that the potential of vasoprotective activities of NO in the CABG patient deserves further investigation.
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Affiliation(s)
- Tatsiana Suvorava
- Institute of Pharmacology and Clinical Pharmacology, Heinrich Heine University, Duesseldorf, Germany
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14
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Yaktubay Döndaş N, Sucu N, Coşkun Yilmaz B, Kaplan HM, Özeren M, Karaca MK, Vezir Ö, Şingirik E. Molecular mechanism of vasorelaxant and antiatherogenic effects of the statins in the human saphenous vein graft. Eur J Pharmacol 2011; 666:150-7. [DOI: 10.1016/j.ejphar.2011.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 04/18/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
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15
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Eagle S, Brophy CM, Komalavilas P, Hocking K, Putumbaka G, Osgood M, Sexton K, Leacche M, Cheung-Flynn J. Surgical Skin Markers Impair Human Saphenous Vein Graft Smooth Muscle and Endothelial Function. Am Surg 2011. [DOI: 10.1177/000313481107700732] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Marking human saphenous vein graft (HSV) with a surgical skin marker to prevent twisting on implantation is a common practice in peripheral and coronary artery bypass procedures. This study is designed to examine the effects of surgical skin markers on the HSV smooth muscle and endothelial functional responses. De-identified HSV remnants were collected during peripheral and coronary artery bypass procedures. Physiologic responses of the HSV were measured using a muscle bath. Veins that were marked with surgical skin markers intraoperatively generated significantly less contractile force to depolarizing KC1 (110 mM) and receptor-mediated contractile agonists than unmarked HSV, suggesting that surgical skin markers impaired HSV smooth muscle contractility. To directly access the effects of chemical components in the surgical skin markers, unmarked HSV was exposed to isopropyl alcohol (a solvent commonly used in surgical skin markers) or methylene blue (a dye). Smooth muscle contractility was significantly reduced by isopropyl alcohol and methylene blue. Endothelial-dependent relaxation to carbachol was significantly reduced after exposure to surgical skin markers. Our data demonstrated that marking HSV with surgical skin markers reduces smooth muscle and endothelial functional viability.
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Affiliation(s)
- Susan Eagle
- Departments of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Colleen M. Brophy
- Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Padmini Komalavilas
- Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kyle Hocking
- Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Michael Osgood
- Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin Sexton
- Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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16
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Gielis JF, Lin JY, Wingler K, Van Schil PEY, Schmidt HH, Moens AL. Pathogenetic role of eNOS uncoupling in cardiopulmonary disorders. Free Radic Biol Med 2011; 50:765-76. [PMID: 21172428 DOI: 10.1016/j.freeradbiomed.2010.12.018] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Revised: 11/14/2010] [Accepted: 12/10/2010] [Indexed: 12/23/2022]
Abstract
The homodimeric flavohemeprotein endothelial nitric oxide synthase (eNOS) oxidizes l-arginine to l-citrulline and nitric oxide (NO), which acutely vasodilates blood vessels and inhibits platelet aggregation. Chronically, eNOS has a major role in the regulation of blood pressure and prevention of atherosclerosis by decreasing leukocyte adhesion and smooth muscle proliferation. However, a disturbed vascular redox balance results in eNOS damage and uncoupling of oxygen activation from l-arginine conversion. Uncoupled eNOS monomerizes and generates reactive oxygen species (ROS) rather than NO. Indeed, eNOS uncoupling has been suggested as one of the main pathomechanisms in a broad range of cardiovascular and pulmonary disorders such as atherosclerosis, ventricular remodeling, and pulmonary hypertension. Therefore, modulating uncoupled eNOS, in particular eNOS-dependent ROS generation, is an attractive therapeutic approach to preventing and/or treating cardiopulmonary disorders, including protective effects during cardiothoracic surgery. This review provides a comprehensive overview of the pathogenetic role of uncoupled eNOS in both cardiovascular and pulmonary disorders. In addition, the related therapeutic possibilities such as supplementation with the eNOS substrate l-arginine, volatile NO, and direct NO donors as well as eNOS modulators such as the eNOS cofactor tetrahydrobiopterin and folic acid are discussed in detail.
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Affiliation(s)
- Jan F Gielis
- Department of Vascular and Thoracic Surgery, University of Antwerp, Antwerp, Belgium
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17
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Viaro F, Capellini VK, Celotto AC, Carlotti CG, Rodrigues AJ, Reis GS, dos Santos Augusto V, Evora PRB. Immunohistochemical evaluation of three nitric oxide synthase isoforms in human saphenous vein exposed to different degrees of distension pressures. Cardiovasc Pathol 2010; 19:e211-20. [DOI: 10.1016/j.carpath.2009.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 10/19/2009] [Accepted: 11/11/2009] [Indexed: 10/20/2022] Open
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18
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Califano JP, Reinhart-King CA. Exogenous and endogenous force regulation of endothelial cell behavior. J Biomech 2010; 43:79-86. [DOI: 10.1016/j.jbiomech.2009.09.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2009] [Indexed: 01/08/2023]
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19
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Owens CD. Adaptive changes in autogenous vein grafts for arterial reconstruction: clinical implications. J Vasc Surg 2009; 51:736-46. [PMID: 19837532 DOI: 10.1016/j.jvs.2009.07.102] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Revised: 07/20/2009] [Accepted: 07/24/2009] [Indexed: 01/22/2023]
Abstract
For patients with the most severe manifestations of lower extremity arterial occlusive disease, bypass surgery using autogenous vein has been the most durable reconstruction. However, the incidence of bypass graft stenosis and graft failure remains substantial and wholesale improvements in patency are lacking. One potential explanation is that stenosis arises not only from over exuberant intimal hyperplasia, but also due to insufficient adaptation or remodeling of the vein to the arterial environment. Although in vivo human studies are difficult to conduct, recent advances in imaging technology have made possible a more comprehensive structural examination of vein bypass maturation. This review summarizes recent translational efforts to understand the structural and functional properties of human vein grafts and places it within the context of the rich existing literature of vein graft failure.
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Affiliation(s)
- Christopher D Owens
- Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, CA 94143, USA.
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20
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Lazar HL, Joseph L, San Mateo C, Frame J, Cabral HJ, McDonnell M, Chipkin S. Expression of inducible nitric oxide synthase in conduits used in patients with diabetes mellitus undergoing coronary revascularization. J Card Surg 2009; 25:120-6. [PMID: 19811579 DOI: 10.1111/j.1540-8191.2009.00932.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Expression of inducible nitric oxide synthase (iNOS) is a marker of vascular inflammation which can result in thrombosis and atherosclerosis. This study was undertaken to examine the difference in iNOS expression in the internal mammary artery (IMA) and saphenous veins (SVs) of patients with diabetes mellitus undergoing coronary artery bypass graft (CABG) surgery using both qualitative and quantitative methodology. METHODS Segments of IMA and SV harvested in 100 diabetic patients with diabetes mellitus undergoing CABG surgery were fixed in formalin and immunostained to detect the presence of iNOS. Sections were graded using a qualitative score (0 = absence of iNOS expression to 3 = extensive expression of iNOS) and a quantitative computer-aided image analysis (area of staining/area of endothelium). Linear regression analyses were performed to assess the association of the degree of iNOS expression in both the IMA and SV with the type of diabetes control (insulin, oral, diet), and the serum levels of HbAlc, glucose, free fatty acids (ffa), C-reactive protein (CRP), and low-density liproprotein (LDL) at the time of conduit harvest. RESULTS The degree of iNOS expression was significantly lower in the IMA compared to the SV by both qualitative (0.88 +/- 0.74 SD IMA vs. 1.38 +/- 0.68 SV; p < 0.0001) and quantitative (11.76 +/- 3.34% IMA vs. 17.10 +/- 2.54% SV; p = 0.01) methods. The Spearman rank correlation analysis showed a highly statistically significant association between the two methodologies (p < 0.0001). There was no correlation between iNOS expression in either the IMA or SV and the type of diabetes control, or levels of HA1c, glucose, ffa, and CRP. However, there was a significant (p = 0.04) correlation between LDL and iNOS expression in the SV graft, but not the IMA. CONCLUSIONS iNOS expression is significantly decreased in the IMA compared to the SV in patients with diabetes mellitus undergoing CABG surgery. The degree of iNOS expression is unrelated to the level of glycemic control at the time of conduit harvest, but is associated with serum LDL levels in the SV, but not in the IMA grafts.
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Affiliation(s)
- Harold L Lazar
- Department of Cardiothoracic Surgery, Boston University School of Medicine, The Boston Medical Center, Boston, Massachusetts, USA.
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21
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Owens CD, Wake N, Conte MS, Gerhard-Herman M, Beckman JA. In vivo human lower extremity saphenous vein bypass grafts manifest flow mediated vasodilation. J Vasc Surg 2009; 50:1063-70. [PMID: 19679424 DOI: 10.1016/j.jvs.2009.06.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 06/02/2009] [Accepted: 06/09/2009] [Indexed: 01/22/2023]
Abstract
OBJECTIVE As in arteries, venous endothelium modulates vessel homeostasis and tone. The effect of an arterialized environment on venous endothelial function remains poorly understood. In particular, regulation of saphenous vein graft (SVG) blood flow and lumen caliber remains undefined. We hypothesized that mature SVGs would exhibit endothelium-dependent, flow-mediated vasodilation (FMD). We further hypothesized that endothelium-derived nitric oxide (NO) was an important mediator. METHODS Patients with femoral to popliteal artery SVGs that had maintained primary patency and were at least 1 year from surgery were enrolled. High-resolution, B-mode ultrasound scans were used to measure vein graft diameter before and 1 minute after reactive hyperemia (RH) to determine FMD. RH was created through application of 220 mm Hg to the calf for 5 minutes with a sphygmomanometric cuff. After a 10-minute recovery period, nitroglycerin-mediated, endothelium-independent vasodilation was measured 3 minutes after administration of nitroglycerin 0.4 mg sublingually. Brachial artery FMD was determined by validated techniques. L-N(G)monomethyl arginine (L-NMMA; 1 mg/kg infusion over 10 minutes) was used in a subset of patients (n = 6) to competitively inhibit endothelial NO synthase. RESULTS Nineteen subjects were enrolled. The median age of the SVGs was 34.6 (21.0-49.7) months. SVG flow-mediated, endothelium-dependent vasodilation was measured at 5.28% +/- 3.1% mean change in lumen diameter (range, 1.99%-9.36%; P < .0001 for diameter change). Nitroglycerin-mediated vasodilation was 3.7% +/- 1.0%, (range, 16%-10.04%; P < .005). Intravenous administration of L-NMMA abolished SVG FMD (5.7 +/- 1.4% before L-NMMA vs 0.01 +/- 0.01% during L-NMMA infusion; P = .0088) and attenuated brachial artery FMD (7.54% +/- 1.0% vs 5.7 +/- 1.4; P = .05). CONCLUSION SVGs manifest flow-mediated, endothelium-dependent, and nitroglycerin-mediated endothelium-independent vasodilation. Vein graft endothelium-dependent FMD is likely mediated by NO. Further investigation will be required to determine the role of endothelial function in vein graft patency.
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Affiliation(s)
- Christopher D Owens
- Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, CA 94143-0222, USA.
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22
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Abstract
The saphenous vein is the most commonly used graft for revascularization procedures in patients with coronary artery disease and critical limb ischaemia. However, the patency rate of this vessel is poor, with a high proportion of patients requiring further surgery. Early graft occlusion is caused by vasoconstriction or thrombus formation, with later stages of graft failure being due to neointimal formation or atherosclerosis. Apart from its potent constrictor action, endothelin-1 is also a potent proliferative and proinflammatory peptide that is implicated in a number of vascular diseases. The surgical trauma caused during preparation of the saphenous vein as a bypass graft stimulates the release of a number of factors affecting vascular reactivity and structure, including endothelin-1. Endothelin-1 not only constricts animal and human isolated saphenous vein segments but also causes vascular smooth muscle proliferation and neointimal thickening in vitro, actions that are mediated via endothelin (A and B) receptors. Experimentally, the effects of subtype-selective and dual receptor antagonists have been shown to inhibit endothelin-1-mediated constriction and cell proliferation of the saphenous vein. In this review, data supporting a role of endothelin-1 in vein graft occlusion are presented, and the therapeutic potential of endothelin receptor antagonists in improving graft performance is discussed.
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Affiliation(s)
- M R Dashwood
- Royal Free and University College Medical School, London, UK.
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23
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Dashwood MR, Savage K, Tsui JCS, Dooley A, Shaw SG, Fernández Alfonso MS, Bodin L, Souza DSR. Retaining perivascular tissue of human saphenous vein grafts protects against surgical and distension-induced damage and preserves endothelial nitric oxide synthase and nitric oxide synthase activity. J Thorac Cardiovasc Surg 2009; 138:334-40. [PMID: 19619776 DOI: 10.1016/j.jtcvs.2008.11.060] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 10/29/2008] [Accepted: 11/19/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Conventional harvesting of saphenous vein used for coronary artery bypass surgery induces a vasospasm that is overcome by high-pressure distension. Saphenous vein harvested with its cushion of perivascular tissue by a "no touch" technique does not undergo vasospasm and distension is not required, leading to an improved graft patency. The aim of this study is to investigate the effect of surgical damage and high-pressure distension on endothelial integrity and endothelial nitric oxide synthase expression and activity in saphenous vein harvested with and without perivascular tissue. METHODS Saphenous veins from patients (n = 26) undergoing coronary artery bypass surgery were prepared with and without perivascular tissue. We analyzed the effect of 300 mm Hg distension on morphology and endothelial nitric oxide synthase/nitric oxide synthase activity using a combination of immunohistochemistry, Western blot analysis, reverse transcriptase polymerase chain reaction, and enzyme assay in distended (with and without perivascular tissue) compared with nondistended (with and without perivascular tissue) segments. RESULTS Distension induced substantial damage to the luminal endothelium (assessed by CD31 staining) and vessel wall. Endothelial nitric oxide synthase expression and activity were significantly reduced by high-pressure distension and removal of, or damage to, perivascular tissue. The effect of distension was significantly less for those with perivascular tissue than for those without perivascular tissue in most cases. CONCLUSION The success of the saphenous vein used as a bypass graft is affected by surgical trauma and distension. Veins removed with minimal damage exhibit increased patency rates. We show that retention of perivascular tissue on saphenous vein prepared for coronary artery bypass surgery by the "no touch" technique protects against distension-induced damage, preserves vessel morphology, and maintains endothelial nitric oxide synthase/nitric oxide synthase activity.
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Affiliation(s)
- Michael R Dashwood
- Department of Clinical Biochemistry, Royal Free and University College Medical School, Royal Free Campus, Pond Street, London, United Kingdom.
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24
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Relation of preoperative radial artery flow-mediated dilatation to nitric oxide bioavailability in radial artery grafts used in off-pump coronary artery bypass grafting. Am J Cardiol 2009; 103:216-20. [PMID: 19121439 DOI: 10.1016/j.amjcard.2008.08.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 08/31/2008] [Accepted: 08/31/2008] [Indexed: 11/21/2022]
Abstract
The radial artery is prone to vasospasm after coronary bypass surgery, and endothelial dysfunction is likely to be a key factor. We investigated whether endothelial dysfunction in radial artery conduits is present, and can be identified, preoperatively using a simple noninvasive ultrasound test of radial artery endothelial response, flow-mediated dilatation (FMD). The study population consisted of 126 patients scheduled for coronary artery bypass grafting. The afternoon before operation, patients had noninvasive ultrasound assessment of endothelial function in the left radial artery by FMD, which measures change in arterial size after an increase in flow-an endothelial-dependent response. Surplus graft segments were obtained at operation and nitric oxide bioavailability within the vessels determined from ex vivo responses to acetylcholine. Preoperative FMD in the radial artery was associated with vasorelaxations to acetylcholine in radial artery grafts (p<0.001 for both dose-response curves and maximum relaxations), although there was weak borderline association between FMD and vasorelaxations of saphenous vein grafts (p=0.07 for dose-response curves and p<0.05 for maximum relaxations). In multivariate analysis including cardiac risk factors, FMD was a predictor of vasorelaxations of radial artery grafts (beta=0.020, SE=0.009, p=0.030), independent of classic risk factors for atherosclerosis. In conclusion, there is significant interindividual variation in the endothelial function of vessels used for coronary artery bypass surgery, particularly the radial artery. These differences are present and can be identified preoperatively by FMD.
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25
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Owens CD, Ho KJ, Conte MS. Risk Factors for Failure of Lower-Extremity Revascularization Procedures: Are They Different for Bypass and Percutaneous Procedures? Semin Vasc Surg 2008; 21:143-53. [DOI: 10.1053/j.semvascsurg.2008.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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Zócalo Y, Bia D, Pessana FM, Armentano RL. Changes in Vein Dynamics Ranging from Low to High Pressure Levels as a Determinant of the Differences in Vein Adaptation to Arterial Hemodynamic Conditions. Artif Organs 2007; 31:575-80. [PMID: 17584483 DOI: 10.1111/j.1525-1594.2007.00424.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The causes of the regional differences in venous grafts patency rates are partially understood. Differences in vein dynamics during physiological situations could determine differences in veins' capability to face arterial conditions and could contribute to the dissimilar performance of veins as arterial grafts. In vitro pressure and diameter were measured in four different veins during physiological and arterial (graft) pressure conditions. A diameter-pressure transfer function was designed. Compliance, viscous and inertial properties; circumferential stresses and deformation; and buffering function were calculated. Regional differences in veins' dynamics, but not in buffering function were found during physiological and arterial conditions. The back vein (femoral) showed the least changes when submitted to arterial conditions. Arterial conditions represent different changes in vein dynamics depending on the segment considered. The regional differences in vein dynamics, both at physiological and graft conditions, could contribute to explain the dissimilar results of venous grafts.
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Affiliation(s)
- Yanina Zócalo
- Physiology Department, School of Medicine, Republic University, Montevideo, Uruguay
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27
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Dashwood MR, Dooley A, Shi-Wen X, Abraham DJ, Souza DSR. Does periadventitial fat-derived nitric oxide play a role in improved saphenous vein graft patency in patients undergoing coronary artery bypass surgery? J Vasc Res 2007; 44:175-81. [PMID: 17308436 DOI: 10.1159/000099833] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 12/02/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The saphenous vein is commonly used for coronary artery bypass surgery but its patency is poor. Vascular damage occurs during conventional surgery. However, patency improves when the graft is harvested with minimal surgical trauma, partly due to preservation of vascular endothelial nitric oxide synthase (eNOS) and tissue sources of nitric oxide (NO), a factor possessing both dilatory and anti-proliferative properties. Apart from these grafts exhibiting an intact luminal endothelium they are harvested complete with a surrounding cushion of tissue, much of which is fat. METHODS Immunostaining for eNOS was performed on vein graft sections and reverse-transcriptase polymerase chain reaction and Western blotting were used to identify eNOS mRNA and protein. NO synthase activity was measured using the citrulline assay. RESULTS Immunohistochemistry identified eNOS staining of vein graft segments, including dense staining of the cushion of perivascular fat and associated structures surrounding the vein. eNOS protein was confirmed in both the vein and surrounding fat by Western blot analysis. Using the citrulline assay, the perivascular fat and underlying vein possessed comparable NO synthase activity. CONCLUSIONS Our observations suggest that perivascular fat-derived NO plays a beneficial role in saphenous veins harvested atraumatically and used as grafts in patients undergoing coronary artery bypass surgery.
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Affiliation(s)
- Michael R Dashwood
- Department of Clinical Biochemistry, Royal Free and University College Medical School, London, UK.
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28
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Cummins PM, von Offenberg Sweeney N, Killeen MT, Birney YA, Redmond EM, Cahill PA. Cyclic strain-mediated matrix metalloproteinase regulation within the vascular endothelium: a force to be reckoned with. Am J Physiol Heart Circ Physiol 2006; 292:H28-42. [PMID: 16951049 DOI: 10.1152/ajpheart.00304.2006] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The vascular endothelium is a dynamic cellular interface between the vessel wall and the bloodstream, where it regulates the physiological effects of humoral and biomechanical stimuli on vessel tone and remodeling. With respect to the latter hemodynamic stimulus, the endothelium is chronically exposed to mechanical forces in the form of cyclic circumferential strain, resulting from the pulsatile nature of blood flow, and shear stress. Both forces can profoundly modulate endothelial cell (EC) metabolism and function and, under normal physiological conditions, impart an atheroprotective effect that disfavors pathological remodeling of the vessel wall. Moreover, disruption of normal hemodynamic loading can be either causative of or contributory to vascular diseases such as atherosclerosis. EC-matrix interactions are a critical determinant of how the vascular endothelium responds to these forces and unquestionably utilizes matrix metalloproteinases (MMPs), enzymes capable of degrading basement membrane and interstitial matrix molecules, to facilitate force-mediated changes in vascular cell fate. In view of the growing importance of blood flow patterns and mechanotransduction to vascular health and pathophysiology, and considering the potential value of MMPs as therapeutic targets, a timely review of our collective understanding of MMP mechanoregulation and its impact on the vascular endothelium is warranted. More specifically, this review primarily summarizes our current knowledge of how cyclic strain regulates MMP expression and activation within the vascular endothelium and subsequently endeavors to address the direct and indirect consequences of this on vascular EC fate. Possible relevance of these phenomena to vascular endothelial dysfunction and pathological remodeling are also addressed.
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Affiliation(s)
- Philip M Cummins
- Vascular Health Research Centre, Faculty of Science and Health, Dublin City Univ., Dublin, Ireland.
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29
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Abstract
Coronary artery bypass grafting has had a significant impact on the treatment of angina, and has been the 'gold standard' since 1969. Its use and efficacy has been increased by revascularization in cardiac arrest and the use of the internal mammary artery. In parallel, catheter techniques have evolved by means of balloon dilatation and additional stenting. This has effected the referral to surgery despite the development of new arterialization techniques and minimally invasive surgery. As competing techniques, an acceptable equilibrium between surgery and stenting will be found within the next years.
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Affiliation(s)
- Olaf Stanger
- University Hopsital for Cardiac Surgery Salzburg, Müllner Hauptstrasse 48, 5020 Salzburg, Austria.
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30
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Loesch A, Dashwood MR, Souza DSR. Does the method of harvesting the saphenous vein for coronary artery bypass surgery affect venous smooth muscle cells? iNOS immunolabelling and ultrastructural findings. Int J Surg 2006; 4:20-9. [PMID: 17462310 DOI: 10.1016/j.ijsu.2005.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2005] [Revised: 11/10/2005] [Accepted: 11/19/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Coronary artery bypass surgery (CABG) using conventionally harvested saphenous vein (SV) as a graft is characterised by a high graft failure rate. It is believed that vein handling during harvesting is responsible for this, as damage to the vein's structure including its sources of endothelial nitric oxide synthase (eNOS) is apparent. Here we investigated the distribution of inducible nitric oxide synthase (iNOS) in conventionally harvested SV grafts and grafts prepared by a less-invasive 'no-touch' technique for CABG. Focus was on vascular smooth muscle cells (VSMCs). PATIENTS AND METHODS Six patients undergoing CABG were selected for the study; their SVs were harvested as grafts by conventional and 'no-touch' techniques and subsequently examined using fluorescent and transmission electron microscopy combined with immunolabelling to detect iNOS and structural changes in the grafts at the time of implantation. RESULTS The following were observed in conventionally harvested grafts: (i) damage to the VSMCs and (ii) induction of iNOS in these cells, (iii) heterogeneity of VSMCs-the presence of iNOS-positive and iNOS-negative VSMCs which were also (iv) in close contact with each other. In contrast, no damage to VSMCs and no expression of iNOS in these cells were observed in the 'no-touch' SV preparations. CONCLUSIONS The harvesting procedure influences the structure of VSMCs and the expression of iNOS in SV graft at the time of implantation. Whether rapid stimulation of iNOS in VSMCs in conventional SV grafts has a protective or harmful effect on the graft patency remains to be determined.
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Affiliation(s)
- Andrzej Loesch
- Department of Anatomy and Developmental Biology, Royal Free and University College Medical School, Hampstead Campus, Rowland Hill Street, Hampstead, London NW3 2PF, UK.
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