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Das P, Sayyed A, Bharath S, Shales S, Das M, Pattari S, Narayan P. Impact of distension pressure on saphenous vein endothelial injury in coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 2024; 40:424-432. [PMID: 38919177 PMCID: PMC11194250 DOI: 10.1007/s12055-024-01731-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction Long saphenous vein grafts (LSVGs) are pivotal conduits in coronary artery bypass grafting (CABG), yet concerns persist regarding early failure and long-term patency. Endothelial damage, a potent initiator of graft failure, necessitates exploration of factors contributing to endothelial injury during LSVG preparation. Methods A prospective, single-center study was conducted, assessing the impact of unregulated distension pressure on LSVG endothelium during CABG. Histological and CD31 (cluster of differentiation 31) immunohistochemical analyses were performed on 21 paired vein samples, categorized into non-distended (group A) and distended (group B) groups. Pressure recordings were obtained using different syringe sizes during vein distension. Results Histological examination revealed a significantly higher percentage of endothelial cell loss in distended veins (31.95% ± 31.31) compared to non-distended veins (11.67% ± 28.65) (p = 0.034). CD31 immunohistochemistry corroborated greater endothelial cell loss in distended veins (p = 0.001). The pressure recordings with a 20-cc syringe, as opposed to using a 10-cc syringe, were considerably lower (44.5 mmHg vs. 92.75 mmHg) emphasizing the inverse relationship between syringe size and pressure generated. In our study, pre-existing endothelial injury was observed in one-third of diabetic patients (36%), with all instances of such injury exclusively identified in individuals with diabetes. Conclusion Unregulated distension pressure during LSVG preparation is associated with greater endothelial damage, as evidenced by histological and immunohistochemical analyses. The inverse relationship between syringe size and pressure underscores the importance of controlled distension.
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Affiliation(s)
- Patralekha Das
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
| | - Azhar Sayyed
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
| | - Sundar Bharath
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
| | - Sufina Shales
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
| | - Mrinalendu Das
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
| | - Sanjib Pattari
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
| | - Pradeep Narayan
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
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Raval AJ, Parikh JK, Desai MA. A review on the treatment of intimal hyperplasia with perivascular medical devices: role of mechanical factors and drug release kinetics. Expert Rev Med Devices 2023; 20:805-819. [PMID: 37559556 DOI: 10.1080/17434440.2023.2244875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Intimal hyperplasia (IH) is a significant factor limiting the success of revascularization surgery for blood flow restoration. IH results from a foreign body response and mechanical disparity that involves complex biochemical reactions resulting in graft failure. The available treatment option utilizes either different pharmacological interventions or mechanical support to the vascular grafts with limited success. AREAS COVERED This review explains the pathophysiology of IH, responsible mechanical and biological factors, and treatment options, emphasizing perivascular devices. They are designed to provide mechanical support and pharmacology actions. The perivascular drug delivery concept has successfully demonstrated efficacy in various animal studies. Accurate projections of drug release mechanisms using mathematical modeling could be used to formulate prolonged drug elution devices. Numerical modeling aspects for the prediction of design outcomes have been given due importance that fulfills the unmet clinical need for better patient care. EXPERT OPINION IH could be effectively prevented by simultaneous mechanical scaffolding and sustained local drug delivery. Future perivascular medical devices could be designed to integrate these essential features. Numerical modeling for device performance prediction should be utilized in the development of next-generation perivascular devices.
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Affiliation(s)
- Ankur J Raval
- Department of Chemical Engineering, Sardar Vallabhbhai National of Technology, Surat, Gujarat, India
- Research and Development Department, Sahajanand Medical Technologies Ltd, Surat, Gujarat, India
| | - Jigisha K Parikh
- Department of Chemical Engineering, Sardar Vallabhbhai National of Technology, Surat, Gujarat, India
| | - Meghal A Desai
- Department of Chemical Engineering, Sardar Vallabhbhai National of Technology, Surat, Gujarat, India
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Wadey KS, Somos A, Leyden G, Blythe H, Chan J, Hutchinson L, Poole A, Frankow A, Johnson JL, George SJ. Pro-inflammatory role of Wnt/β-catenin signaling in endothelial dysfunction. Front Cardiovasc Med 2023; 9:1059124. [PMID: 36794234 PMCID: PMC9923234 DOI: 10.3389/fcvm.2022.1059124] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/14/2022] [Indexed: 01/18/2023] Open
Abstract
Background Endothelial dysfunction is a critical component of both atherosclerotic plaque formation and saphenous vein graft failure. Crosstalk between the pro-inflammatory TNF-α-NFκB signaling axis and the canonical Wnt/β-catenin signaling pathway potentially plays an important role in regulating endothelial dysfunction, though the exact nature of this is not defined. Results In this study, cultured endothelial cells were challenged with TNF-α and the potential of a Wnt/β-catenin signaling inhibitor, iCRT-14, in reversing the adverse effects of TNF-α on endothelial physiology was evaluated. Treatment with iCRT-14 lowered nuclear and total NFκB protein levels, as well as expression of NFκB target genes, IL-8 and MCP-1. Inhibition of β-catenin activity with iCRT-14 suppressed TNF-α-induced monocyte adhesion and decreased VCAM-1 protein levels. Treatment with iCRT-14 also restored endothelial barrier function and increased levels of ZO-1 and focal adhesion-associated phospho-paxillin (Tyr118). Interestingly, inhibition of β-catenin with iCRT-14 enhanced platelet adhesion in cultured TNF-α-stimulated endothelial cells and in an ex vivo human saphenous vein model, most likely via elevating levels of membrane-tethered vWF. Wound healing was moderately retarded by iCRT-14; hence, inhibition of Wnt/β-catenin signaling may interfere with re-endothelialisation in grafted saphenous vein conduits. Conclusion Inhibition of the Wnt/β-catenin signaling pathway with iCRT-14 significantly recovered normal endothelial function by decreasing inflammatory cytokine production, monocyte adhesion and endothelial permeability. However, treatment of cultured endothelial cells with iCRT-14 also exerted a pro-coagulatory and moderate anti-wound healing effect: these factors may affect the suitability of Wnt/β-catenin inhibition as a therapy for atherosclerosis and vein graft failure.
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Affiliation(s)
- Kerry S. Wadey
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, United Kingdom,*Correspondence: Kerry S. Wadey,
| | - Alexandros Somos
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Genevieve Leyden
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Hazel Blythe
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Jeremy Chan
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Lawrence Hutchinson
- School of Physiology, Pharmacology and Neuroscience, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Alastair Poole
- School of Physiology, Pharmacology and Neuroscience, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Aleksandra Frankow
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Jason L. Johnson
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Sarah J. George
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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Rizzi S, Mantero S, Boschetti F, Pesce M. Luminal endothelialization of small caliber silk tubular graft for vascular constructs engineering. Front Cardiovasc Med 2022; 9:1013183. [PMID: 36465472 PMCID: PMC9708712 DOI: 10.3389/fcvm.2022.1013183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/31/2022] [Indexed: 09/29/2023] Open
Abstract
The constantly increasing incidence of coronary artery disease worldwide makes necessary to set advanced therapies and tools such as tissue engineered vessel grafts (TEVGs) to surpass the autologous grafts [(i.e., mammary and internal thoracic arteries, saphenous vein (SV)] currently employed in coronary artery and vascular surgery. To this aim, in vitro cellularization of artificial tubular scaffolds still holds a good potential to overcome the unresolved problem of vessel conduits availability and the issues resulting from thrombosis, intima hyperplasia and matrix remodeling, occurring in autologous grafts especially with small caliber (<6 mm). The employment of silk-based tubular scaffolds has been proposed as a promising approach to engineer small caliber cellularized vascular constructs. The advantage of the silk material is the excellent manufacturability and the easiness of fiber deposition, mechanical properties, low immunogenicity and the extremely high in vivo biocompatibility. In the present work, we propose a method to optimize coverage of the luminal surface of silk electrospun tubular scaffold with endothelial cells. Our strategy is based on seeding endothelial cells (ECs) on the luminal surface of the scaffolds using a low-speed rolling. We show that this procedure allows the formation of a nearly complete EC monolayer suitable for flow-dependent studies and vascular maturation, as a step toward derivation of complete vascular constructs for transplantation and disease modeling.
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Affiliation(s)
- Stefano Rizzi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Ph.D. Program in Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - Sara Mantero
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Federica Boschetti
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
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Abstract
Cardiovascular defects, injuries, and degenerative diseases often require surgical intervention and the use of implantable replacement material and conduits. Traditional vascular grafts made of synthetic polymers, animal and cadaveric tissues, or autologous vasculature have been utilized for almost a century with well-characterized outcomes, leaving areas of unmet need for the patients in terms of durability and long-term patency, susceptibility to infection, immunogenicity associated with the risk of rejection, and inflammation and mechanical failure. Research to address these limitations is exploring avenues as diverse as gene therapy, cell therapy, cell reprogramming, and bioengineering of human tissue and replacement organs. Tissue-engineered vascular conduits, either with viable autologous cells or decellularized, are the forefront of technology in cardiovascular reconstruction and offer many benefits over traditional graft materials, particularly in the potential for the implanted material to be adopted and remodeled into host tissue and thus offer safer, more durable performance. This review discusses the key advances and future directions in the field of surgical vascular repair, replacement, and reconstruction, with a focus on the challenges and expected benefits of bioengineering human tissues and blood vessels.
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Affiliation(s)
- Kaleb M. Naegeli
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Mehmet H. Kural
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Yuling Li
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Juan Wang
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | | | - Laura E. Niklason
- Department of Anesthesiology and Biomedical Engineering, Yale University, New Haven, CT (L.E.N.)
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Saito T, Kurazumi H, Suzuki R, Matsunaga K, Tsubone S, Lv B, Kobayashi S, Nagase T, Mizoguchi T, Samura M, Suehiro K, Harada T, Morikage N, Mikamo A, Hamano K. Perivascular Adipose Tissue Is a Major Source of Nitric Oxide in Saphenous Vein Grafts Harvested via the No-Touch Technique. J Am Heart Assoc 2022; 11:e020637. [PMID: 35043661 PMCID: PMC9238502 DOI: 10.1161/jaha.120.020637] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Saphenous vein grafts (SVGs) are broadly used in coronary artery bypass grafting despite their inferior patency compared with arterial grafts. Recently, the no‐touch technique (NT), in which an SVG is harvested with a pedicle of perivascular adipose tissue (PVAT) without conduit distension, was shown to improve long‐term patency compared with conventional preparation (CV), wherein outer tissue is removed with distension. The NT was also reportedly associated with reduced atherosclerosis. Although endothelial damage provoked by conventional distension may underlie poor patency when CV is performed, the precise mechanisms underlying the salutary effects of the NT have been unclear. Methods and Results Residual SVGs prepared with CV (CV‐SVGs) or NT (NT‐SVGs) were obtained during coronary artery bypass grafting. Nitric oxide (NO2−/NO3− (NOx)) levels after 24 hours of tissue culture were quantified. The protein expression and localization were analyzed. The isometric force of SVG strips was measured. NT‐SVGs showed superior NOx production to CV‐SVGs. PVAT generated the majority of NOx in NT‐SVGs. PVAT highly expressed arginosuccinate synthase 1, a rate‐limiting enzyme in the molecular circuit for NO synthesis, thereby continuously providing the substrate for NO. A substantial level of endothelial NO synthase was also expressed in PVAT. Pharmacological inhibition of arginosuccinate synthase 1 or endothelial NO synthase significantly suppressed the NOx production in NT‐SVGs. PVAT induced vasorelaxation through NO production, even in the endothelium‐denuded SVG strips. Conclusions Preserving PVAT was predominantly involved in the superior NOx production in NT‐SVGs. Since NO plays crucial roles in suppressing atherosclerosis, this mechanism may greatly contribute to the excellent patency in NT‐SVGs.
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Affiliation(s)
- Toshiro Saito
- Department of Surgery and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Hiroshi Kurazumi
- Department of Surgery and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Ryo Suzuki
- Department of Surgery and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Kazumasa Matsunaga
- Department of Surgery and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Sarii Tsubone
- Department of Surgery and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Bochao Lv
- Department of Molecular and Cellular Physiology Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Sei Kobayashi
- Department of Molecular and Cellular Physiology Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Takashi Nagase
- Department of Surgery and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Takahiro Mizoguchi
- Department of Surgery and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Makoto Samura
- Department of Surgery and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Kotaro Suehiro
- Department of Surgery and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Takasuke Harada
- Department of Surgery and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Noriyasu Morikage
- Department of Surgery and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Akihito Mikamo
- Department of Surgery and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science Yamaguchi University Graduate School of Medicine Yamaguchi Japan
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Wadey KS, Somos A, Cross SJ, Reolizo LM, Johnson JL, George SJ. Monitoring Cellular Proliferation, Migration, and Apoptosis Associated with Atherosclerosis Plaques In Vitro. Methods Mol Biol 2022; 2419:133-167. [PMID: 35237963 DOI: 10.1007/978-1-0716-1924-7_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Bromodeoxyuridine/5-bromo-2'-deoxyuridine (BrdU) is a nucleoside analog of thymidine and its incorporation into DNA during replication within S-phase of the cell cycle is used to quantify cell proliferation. Quantification of incorporated BrdU is considered the most direct measure of cell proliferation, and here we describe BrdU incorporation into cultured vascular smooth muscle cells (VSMCs) and endothelial cells in vitro. Incorporation of fluorescent-labeled ethynyldeoxyuridine/5-ethynyl-2'-deoxyuridine (EdU) is a novel alternative to BrdU assays and presents significant advantages. This method of detection of EdU based on a simple "click" chemical reaction, which covalently bonds EdU to a fluorescent dye is also outlined in this chapter with a protocol for quantitative analysis of EdU incorporation using a Fiji-based macro. We also describe how proliferation can be assessed by quantification of classical proliferative markers such as phopsho-Ser807/811 retinoblastoma (Rb), proliferating cell nuclear antigen (PCNA) and cyclin D1 by Western blotting. As these markers are involved in different aspects of the cell cycle regulation, examining their expression levels can not only reveal the relative population of proliferating cells but can also improve our understanding of the mechanism of action of a given treatment or intervention. The scratch wound assay is a simple and cost-effective technique to quantify cell migration. A protocol which involves creating a wound in a cell cultured monolayer and measuring the distance migrated by the cells after a predefined time period is also described. Gap creation can also be achieved via physical cell exclusion where cells are seeded in distinct reservoirs of a cell culture insert which reveal a gap upon removal. Cell migration may then be quantified by monitoring the rate of gap closure. The presence of cleaved caspase-3 is a marker of programmed cell death (apoptosis). To detect cleaved caspase-3 in vitro, immunocytochemistry and fluorescence can be performed as outlined in this chapter.
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Affiliation(s)
- Kerry S Wadey
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alexandros Somos
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephen J Cross
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lien M Reolizo
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jason L Johnson
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah J George
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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Shapira OM. Reply: Valveless saphenous vein grafts for coronary artery bypass grafting: First, do no harm. JTCVS OPEN 2021; 8:382. [PMID: 36004180 PMCID: PMC9390455 DOI: 10.1016/j.xjon.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Vecherskiĭ II, Manvelian DV, Zatolokin VV, Shipulin VM, Kozlov BN. [Method of optimal hydraulic dilatation of venous conduits for coronary artery bypass grafting]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:127-134. [PMID: 34166353 DOI: 10.33529/angio2021210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Hydraulic dilatation is used in everyday cardiac surgical practice for assessment of leak-proofness and prevention of spasm of autovenous shunts. The classical technique envisages manual high-pressure solution injection, which exerts a negative effect on venous conduits and is one of the causes of incompetence of shunts in the postoperative period. Limiting pressure during hydraulic dilatation is necessary to minimize morphological changes and preserve functional viability of venous conduits. The purpose of the present study was to develop and assess efficacy of a standardized methodology of controlled hydraulic dilatation of venous conduits. We worked out an original technique of controlled hydraulic dilatation of venous conduits under perfusion pressure of artificial circulation. This was followed by assessing morphological changes and functional viability of venous segments after controlled hydraulic dilatation as compared with veins after conventional uncontrolled hydraulic dilatation and the control intact veins. Uncontrolled hydraulic dilatation was accompanied by endothelial damage (p<0.05), multiple conduit wall tears (p<0.05) according to the findings of light microscopy, leading to a significant decrease in the functional vitality of the venous conduit (a decreased reaction to hyperpotassium solution, phenylephrine, acetylcholine and sodium nitroprusside (p<0.05) according to the findings of biophysical examination. Our original technique of controlled hydraulic dilatation of venous conduits under perfusion pressure of artificial circulation made it possible not only to evaluate leak-proofness of the vessel but also to achieve comparable to the control segments parameters of structural integrity of the venous wall and functional viability of the conduit. Thus, using the developed method of controlled hydraulic dilatation makes it possible to minimize morphofunctional alterations in venous conduits, influencing the function of autovenous shunts.
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Affiliation(s)
- Iu Iu Vecherskiĭ
- Cardiovascular Surgery Department, Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - D V Manvelian
- Cardiovascular Surgery Department, Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - V V Zatolokin
- Cardiovascular Surgery Department, Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - V M Shipulin
- Cardiovascular Surgery Department, Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - B N Kozlov
- Cardiovascular Surgery Department, Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
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Saito T, Kurazumi H, Suzuki R, Matsuno Y, Mikamo A, Hamano K. Preserving the endothelium in saphenous vein graft with both conventional and no-touch preparation. J Cardiothorac Surg 2020; 15:317. [PMID: 33059713 PMCID: PMC7566069 DOI: 10.1186/s13019-020-01352-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/28/2020] [Indexed: 01/21/2023] Open
Abstract
Background Despite the inferior patency compared to arterial grafts, a saphenous vein graft (SVG) is widely used for coronary artery bypass grafting (CABG). A lower atherosclerosis rate and higher patency have been reported for SVG obtained via the no-touch technique (NT) than via conventional preparation (CV). Although CV-mediated endothelial dysfunction is implied, the precise mechanism underlying the higher patency with NT is poorly understood. Methods Human residual SVGs during CABG and SVG sections after autopsy were analyzed. The endothelial surface was observed using scanning electron microscopy (SEM) and blindly compared between CV and NT. The endothelial integrity was also analyzed with immunohistochemistry. Results Unexpectedly, the hyperfine structure on SEM was comparable between CV and NT before grafting, and microvillus, a characteristic of endothelium, was indistinguishable between them. Von Willebrand Factor, an endothelial marker, was equally detected throughout the vascular wall in both groups from residual and postmortem sections. Conclusions The morphological integrity of the endothelium was successfully preserved in SVG with CV, even at an ultrastructural level. Although its functionality remains to be addressed, other factors than the endothelium may be involved in the high patency obtained by NT. The present findings suggest that the characteristics of NT and surgical methodology should be reconsidered.
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Affiliation(s)
- Toshiro Saito
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Hiroshi Kurazumi
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Ryo Suzuki
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Yutaro Matsuno
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Akihito Mikamo
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi, 755-8505, Japan.
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USLU Ü, GONCA S, CUMBUL A, SEN O. Koroner arter bypass grefti için farklı yöntemler kullanılarak alınan safenöz veninin apoptotik indeksinin karşılaştırılması. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.662453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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12
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Ran J, Liu Y, Li Y, Li Q, Tang Y, Deng L, Song Y. The effect of endoscopic vein harvesting in coronary artery bypass surgery. J Thorac Dis 2020; 12:1991-1998. [PMID: 32642102 PMCID: PMC7330341 DOI: 10.21037/jtd-20-250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To compare the clinical outcomes, quality of saphenous vein (SV) grafts, and wound complications between endoscopic vein harvesting (EVH) technique and open vein harvesting (OVH) technique in patients with coronary artery bypass graft (CABG) surgery. Methods We reviewed one hundred patients with multi-vessel coronary artery disease who underwent elective CABG and agreed to preserve their SV specimens for study. Fifty patients (OVH group) underwent OVH, and the remaining (EVH group) underwent EVH. The median follow-up time was 12 months. Clinical outcomes, 1-year graft patency rates, endothelium integrity of SV grafts and wound complications were assessed. Results The follow-up time was 12 [12-13] months. Recurrence of angina was observed in 5 patients, with 3 (6.1%) in EVH group and 2 (4%) in OVH group (P=0.68). The endothelium integrity of specimens before distension was similar in both the groups (EVH: 81.1%±6.11% vs. OVH: 80.8%±6.58%, P=0.83). After distension, the endothelium integrity was still similar (EVH: 70.7%±9.73%; OVH: 68.3%±9.60%; P=0.22). Grafts of 5 (11.6%) patients in EVH group were classified as occluded, and 4 (9.8%) patients in OVH group showed occlusion of SV grafts (P=1.0). After day 7, the postoperative leg pain was significantly milder in EVH group than OVH group (1.16±0.76 vs. 2.50±0.91, P<0.01). Conclusions These findings suggest that EVH is not associated with worse clinical outcomes or conduit quality. However, it may have advantage in wound healing.
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Affiliation(s)
- Jun Ran
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yun Liu
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Yuan Li
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Qi Li
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yajie Tang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Long Deng
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yunhu Song
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Commentary: Composite internal thoracic artery-saphenous vein grafts for coronary bypass: Can the two be used together? J Thorac Cardiovasc Surg 2020; 162:1544-1545. [PMID: 32173098 DOI: 10.1016/j.jtcvs.2020.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 11/22/2022]
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14
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Fouquet O, Blossier JD, Dang Van S, Robert P, Barbelivien A, Pinaud F, Binuani P, Eid M, Henrion D, Baufreton C, Loufrani L. Do storage solutions protect endothelial function of arterialized vein graft in an experimental rat model? J Cardiothorac Surg 2020; 15:34. [PMID: 32041642 PMCID: PMC7011455 DOI: 10.1186/s13019-020-1077-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/30/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This study aims to compare the effects of storage solutions commonly used in coronary artery bypass grafting on the vascular reactivity in vein graft interposed in arterial position in syngeneic rats. METHODS Twenty-seven male Lewis rats were sacrified to sample a vein graft implanted 6 weeks ago into abdominal aorta position. The vein grafts were inferior venae cavae initially pretreated with heparinized saline solution (HS) or autologous heparinized blood (AHB) or our referent solution, GALA. The endothelial functionality, the in situ Reactive Oxygen Species (ROS) levels and the histological characteristics were conducted from segments of arterialized vein graft. RESULTS At 6 weeks, graft thrombosis occurred respectively in 22% of AHB group, 62.5% in the HS group and 82.5% in the GALA group. In each group, significative intimal hyperplasia was observed. After 6 weeks, an endothelium-remodeling layer associated with an increase of wall thickness was observed in each group. Endothelium-dependent tone was reduced in the vein graft regardless of the group. No difference was observed concerning the ROS in vein graft between the different groups. In distal aortic sections, ROS levels were increased in HS and GALA groups. CONCLUSIONS Storage solutions used in this experimental model of vein graft implanted in arterial position cause graft injury and a complete disappearance of vascular reactivity. GALA solution did not reduce intimal risk hyperplasia when the vein graft was exposed to arterial flow in a rat model.
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Affiliation(s)
- Olivier Fouquet
- Department of Cardiac Surgery, University Hospital of Angers, France, 4 rue Larrey, 49933 CHU, Angers Cedex 9, France.
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France.
| | - Jean-David Blossier
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
- Department of Cardiac Surgery, CHU Dupuytren, Limoges, France
| | - Simon Dang Van
- Department of Cardiac Surgery, University Hospital of Angers, France, 4 rue Larrey, 49933 CHU, Angers Cedex 9, France
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
| | - Pauline Robert
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
| | | | - Frédéric Pinaud
- Department of Cardiac Surgery, University Hospital of Angers, France, 4 rue Larrey, 49933 CHU, Angers Cedex 9, France
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
| | - Patrice Binuani
- Department of Cardiac Surgery, University Hospital of Angers, France, 4 rue Larrey, 49933 CHU, Angers Cedex 9, France
| | - Maroua Eid
- Department of Cardiac Surgery, University Hospital of Angers, France, 4 rue Larrey, 49933 CHU, Angers Cedex 9, France
| | - Daniel Henrion
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
- University Hospital of Angers, Angers, France
| | - Christophe Baufreton
- Department of Cardiac Surgery, University Hospital of Angers, France, 4 rue Larrey, 49933 CHU, Angers Cedex 9, France
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
| | - Laurent Loufrani
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
- University Hospital of Angers, Angers, France
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Sequential multidetector computed tomography assessments after venous graft treatment solution in coronary artery bypass grafting. J Thorac Cardiovasc Surg 2019; 161:96-106.e2. [PMID: 31866081 DOI: 10.1016/j.jtcvs.2019.10.115] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the effect of DuraGraft (Somahlution Inc, Jupiter, Fla), an intraoperative graft treatment, on saphenous vein grafts in patients undergoing isolated coronary artery bypass grafting. METHODS Within patients, 2 saphenous vein grafts were randomized to DuraGraft or heparinized saline. Multidetector computed tomography angiography at 1, 3, and 12 months assessed change in wall thickness (primary end point at 3 months), lumen diameter, and maximum narrowing for the whole graft and the proximal 5-cm segment. Safety end points included graft occlusion, death, myocardial infarction, and repeat revascularization. RESULTS At 3 months, no significant changes were observed between DuraGraft- and saline-treated grafts (125 each) for wall thickness, lumen diameter, and maximum narrowing. At 12 months, DuraGraft-treated grafts demonstrated smaller mean wall thickness, overall (0.12 ± 0.06 vs 0.20 ± 0.31 mm; P = .02) and in the proximal segment (0.11 ± 0.03 vs 0.21 ± 0.33 mm; P = .01). Changes in wall thickness were greater in the proximal segment of saline-treated grafts (0.09 ± 0.29 vs 0.00 ± 0.03 mm; P = .04). Increase in maximum graft narrowing was larger in the proximal segment in the saline-treated grafts (4.7% ± 12.7% vs 0.2% ± 3.8%; P = .01). Nine DuraGraft and 11 saline grafts had occluded or thrombosed. One myocardial infarction was associated with a saline graft occlusion. No deaths or revascularizations were observed. CONCLUSIONS DuraGraft demonstrated a favorable effect on wall thickness at 12 months, particularly in the proximal segment. Longer-term follow-up in larger studies is needed to evaluate the effect on clinical outcomes.
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16
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Caliskan E, Sandner S, Misfeld M, Aramendi J, Salzberg SP, Choi YH, Satishchandran V, Iyer G, Perrault LP, Böning A, Emmert MY. A novel endothelial damage inhibitor for the treatment of vascular conduits in coronary artery bypass grafting: protocol and rationale for the European, multicentre, prospective, observational DuraGraft registry. J Cardiothorac Surg 2019; 14:174. [PMID: 31615560 PMCID: PMC6794868 DOI: 10.1186/s13019-019-1010-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/30/2019] [Indexed: 11/15/2022] Open
Abstract
Background Vein graft disease (VGD) impairs graft patency rates and long-term outcomes after coronary artery bypass grafting (CABG). DuraGraft is a novel endothelial-damage inhibitor developed to efficiently protect the structural and functional integrity of the vascular endothelium. The DuraGraft registry will evaluate the long-term clinical outcomes of DuraGraft in patients undergoing CABG procedures. Methods This ongoing multicentre, prospective observational registry will enrol 3000 patients undergoing an isolated CABG procedure or a combined procedure (ie, CABG plus valve surgery or other surgery) with at least one saphenous vein grafts or one free arterial graft (ie, radial artery or mammary artery). If a patient is enrolled, all free grafts (SVG and arterial will be treated with DuraGraft. Data on baseline, clinical, and angiographic characteristics as well as procedural and clinical events will be collected. The primary outcome measure is the occurrence of a major adverse cardiac event (MACE; defined as death, non-fatal myocardial-infarction, or need for repeat-revascularisation). Secondary outcome measures are the occurrence of major adverse cardiac and cerebrovascular events (MACCE; defined as death, non-fatal myocardial-infarction, repeat-revascularisation, or stroke), patient-reported quality of life, and health-economic data. Patient assessments will be performed during hospitalisation, at 1-month, 1-year, and annually thereafter to 5 years post-CABG. Events will be adjudicated by an independent clinical events committee. This European, multi-institutional registry will provide detailed insights into clinical outcome associated with DuraGraft. Discussion This European, multi-institutional registry will provide detailed insights into clinical outcome associated with the use of DuraGraft. Beyond that, and given the comprehensive data sets comprising of patient, procedural, and graft parameters that are being collected, the registry will enable for multiple subgroup analyses targeting focus groups or specific clinical questions. These may include analysis of subpopulations such as patients with diabetes or multimorbid high-risk patients (patient level), evaluation of relevance of harvesting technique including endoscopic versus open conduit harvesting (procedural level), or particular graft-specific aspects (conduit level). Trial registration ClinicalTrials.gov NCT02922088. Registered October 3, 2016. Ethics and dissemination The regional ethics committees have approved the registry. Results will be submitted for publication.
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Affiliation(s)
- Etem Caliskan
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Sigrid Sandner
- Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Martin Misfeld
- University Clinic of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Jose Aramendi
- Division of Cardiac Surgery, Hospital de Cruces, Barakaldo, Spain
| | | | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | | | | | - Louis P Perrault
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Andreas Böning
- Department of Cardiovascular Surgery, Justus-Liebig University Gießen, Gießen, Germany
| | - Maximilian Y Emmert
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany. .,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
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17
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Wadey K, Lopes J, Bendeck M, George S. Role of smooth muscle cells in coronary artery bypass grafting failure. Cardiovasc Res 2019; 114:601-610. [PMID: 29373656 DOI: 10.1093/cvr/cvy021] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/22/2018] [Indexed: 01/30/2023] Open
Abstract
Atherosclerosis is the underlying pathology of many cardiovascular diseases. The formation and rupture of atherosclerotic plaques in the coronary arteries results in angina and myocardial infarction. Venous coronary artery bypass grafts are designed to reduce the consequences of atherosclerosis in the coronary arteries by diverting blood flow around the atherosclerotic plaques. However, vein grafts suffer a high failure rate due to intimal thickening that occurs as a result of vascular cell injury and activation and can act as 'a soil' for subsequent atherosclerotic plaque formation. A clinically-proven method for the reduction of vein graft intimal thickening and subsequent major adverse clinical events is currently not available. Consequently, a greater understanding of the underlying mechanisms of intimal thickening may be beneficial for the design of future therapies for vein graft failure. Vein grafting induces inflammation and endothelial cell damage and dysfunction, that promotes vascular smooth muscle cell (VSMC) migration, and proliferation. Injury to the wall of the vein as a result of grafting leads to the production of chemoattractants, remodelling of the extracellular matrix and cell-cell contacts; which all contribute to the induction of VSMC migration and proliferation. This review focuses on the role of altered behaviour of VSMCs in the vein graft and some of the factors which critically lead to intimal thickening that pre-disposes the vein graft to further atherosclerosis and re-occurrence of symptoms in the patient.
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Affiliation(s)
- Kerry Wadey
- Bristol Medical School, Research Floor Level 7, Bristol Royal Infirmary, Bristol BS2 8HW, UK
| | - Joshua Lopes
- Translational Biology and Engineering Program, University of Toronto, Toronto, ON M5G 1M1, Canada
| | - Michelle Bendeck
- Translational Biology and Engineering Program, University of Toronto, Toronto, ON M5G 1M1, Canada
| | - Sarah George
- Bristol Medical School, Research Floor Level 7, Bristol Royal Infirmary, Bristol BS2 8HW, UK
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18
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Gooch KJ, Firstenberg MS, Shrefler BS, Scandling BW. Biomechanics and Mechanobiology of Saphenous Vein Grafts. J Biomech Eng 2019; 140:2666246. [PMID: 29222565 DOI: 10.1115/1.4038705] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Indexed: 11/08/2022]
Abstract
Within several weeks of use as coronary artery bypass grafts (CABG), saphenous veins (SV) exhibit significant intimal hyperplasia (IH). IH predisposes vessels to thrombosis and atherosclerosis, the two major modes of vein graft failure. The fact that SV do not develop significant IH in their native venous environment coupled with the rapidity with which they develop IH following grafting into the arterial circulation suggests that factors associated with the isolation and preparation of SV and/or differences between the venous and arterial environments contribute to disease progression. There is strong evidence suggesting that mechanical trauma associated with traditional techniques of SV preparation can significantly damage the vessel and might potentially reduce graft patency though modern surgical techniques reduces these injuries. In contrast, it seems possible that modern surgical technique, specifically endoscopic vein harvest, might introduce other mechanical trauma that could subtly injure the vein and perhaps contribute to the reduced patency observed in veins harvested using endoscopic techniques. Aspects of the arterial mechanical environment influence remodeling of SV grafted into the arterial circulation. Increased pressure likely leads to thickening of the medial wall but its role in IH is less clear. Changes in fluid flow, including increased average wall shear stress, may reduce IH while disturbed flow likely increase IH. Nonmechanical stimuli, such as exposure to arterial levels of oxygen, may also have a significant but not widely recognized role in IH. Several potentially promising approaches to alter the mechanical environment to improve graft patency are including extravascular supports or altered graft geometries are covered.
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Affiliation(s)
- Keith J Gooch
- Department of Biomedical Engineering, The Ohio State University, 290 Bevis Hall 1080 Carmack Drive, Columbus, OH 43210.,Davis Heart Lung Research Institute, The Ohio State University, Columbus, OH 43210 e-mail:
| | - Michael S Firstenberg
- Surgery and Integrative Medicine, Northeast Ohio Medical Universities, Akron, OH 44309
| | - Brittany S Shrefler
- Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
| | - Benjamin W Scandling
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210
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19
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Ammann KR, DeCook KJ, Li M, Slepian MJ. Migration versus proliferation as contributor to in vitro wound healing of vascular endothelial and smooth muscle cells. Exp Cell Res 2019; 376:58-66. [PMID: 30660619 PMCID: PMC6988716 DOI: 10.1016/j.yexcr.2019.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/31/2018] [Accepted: 01/10/2019] [Indexed: 12/27/2022]
Abstract
Wound closure, as a result of collective cell growth, is an essential biological response to injury. In the field of vascular biology, the response of vascular smooth muscle cells (SMCs) and endothelial cells (ECs) to injury and substrate surface is important in therapeutic clinical treatment interventions such as angioplasty and atherectomy. Specifically, the mechanism by which cells close wounds (i.e. proliferation versus migration) in response to injury stimuli is of interest to better modulate recurrent vascular stenosis, prevent thrombus formation, occlusion, and life-threatening cardiovascular events. Here, we examine growth extent and temporal sequence of events following wound or gap introduction to a confluent monolayer of vascular SMCs or ECs. Significant differences in the preferred mechanisms of these cells to close wounds or gaps were observed; after 48 h, 73% of SMC wound closure was observed to be due to proliferation, while 75% of EC wound closure resulted from migration. These mechanisms were further modulated via addition or removal of extracellular matrix substrate and injury, with ECs more responsive to substrate composition and less to injury, in comparison to SMCs. Our results indicate that ECs and SMCs heal wounds differently, and that the time and mode of injury and associated substrate surface all impact this response.
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Affiliation(s)
- Kaitlyn R Ammann
- Department of Biomedical Engineering, College of Engineering, University of Arizona,1127 E James E Rogers Way, PO Box 210020, Tucson, AZ 85721, USA
| | - Katrina J DeCook
- Department of Biomedical Engineering, College of Engineering, University of Arizona,1127 E James E Rogers Way, PO Box 210020, Tucson, AZ 85721, USA
| | - Maxwell Li
- Department of Biomedical Engineering, College of Engineering, University of Arizona,1127 E James E Rogers Way, PO Box 210020, Tucson, AZ 85721, USA
| | - Marvin J Slepian
- Department of Biomedical Engineering, College of Engineering, University of Arizona,1127 E James E Rogers Way, PO Box 210020, Tucson, AZ 85721, USA; Department of Medicine, Sarver Heart Center, University of Arizona, 1501 N Campbell Ave, PO Box 245035, Tucson, AZ 85724, USA.
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20
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The effect of storage solutions on endothelial function and saphenous vein graft patency. Indian J Thorac Cardiovasc Surg 2018; 34:258-265. [PMID: 33060947 DOI: 10.1007/s12055-018-0720-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022] Open
Abstract
Vein graft failure is a complex mechanism that can be triggered immediately after surgical harvesting. Storage solutions have a major role in preventing endothelial cell damage during harvesting. While normal saline is still widely used, buffered solutions seem to better preserve endothelial integrity and function. This review aims to summarize the current literature surrounding vein graft storage solutions.
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21
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Haime M, McLean RR, Kurgansky KE, Emmert MY, Kosik N, Nelson C, Gaziano MJ, Cho K, Gagnon DR. Relationship between intra-operative vein graft treatment with DuraGraft® or saline and clinical outcomes after coronary artery bypass grafting. Expert Rev Cardiovasc Ther 2018; 16:963-970. [PMID: 30285502 DOI: 10.1080/14779072.2018.1532289] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Miguel Haime
- VA Boston Healthcare System, Harvard Medical School, West Roxbury, MA, USA
| | - Robert R. McLean
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Katherine E. Kurgansky
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Maximilian Y. Emmert
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Nicole Kosik
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Constance Nelson
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Michael J. Gaziano
- VA Boston Healthcare System, Harvard Medical School, West Roxbury, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
| | - Kelly Cho
- VA Boston Healthcare System, Harvard Medical School, West Roxbury, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
| | - David R. Gagnon
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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22
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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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23
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Ben Ali W, Voisine P, Olsen PS, Jeanmart H, Noiseux N, Goeken T, Satishchandran V, Cademartiri F, Cutter G, Veerasingam D, Brown C, Emmert MY, Perrault LP. DuraGraft vascular conduit preservation solution in patients undergoing coronary artery bypass grafting: rationale and design of a within-patient randomised multicentre trial. Open Heart 2018; 5:e000780. [PMID: 29682294 PMCID: PMC5905829 DOI: 10.1136/openhrt-2018-000780] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/21/2018] [Accepted: 03/06/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Saphenous vein grafts (SVGs) remain the most often used conduits in coronary artery bypass grafting (CABG). However, they are prone to vein graft disease (VGD) during follow-up, which may compromise clinical outcomes. Injury to the SVG endothelium during harvesting and storage promotes neointimal hyperplasia that can advance to atherosclerosis characterised by SVG failure. This trial investigates the potential benefit of DuraGraft, a novel, one-time intraoperative graft treatment developed to efficiently protect the structural and functional integrity of the vascular endothelium, on the development and progression of VGD in CABG patients. Methods and analysis This ongoing prospective randomised, double-blinded multicentre trial (NCT02272582/NCT02774824) includes patients undergoing isolated CABG requiring at least two SVGs. It compares the impact of DuraGraft, a novel treatment against VGD versus the standard-of-care (SOC; heparinised saline) using a within-patient randomisation (with one SVG treated with DuraGraft and the other treated with SOC). Besides clinical assessments, patients undergo longitudinal 64-slice or better multidetector CT (MDCT) angiography of paired grafts (within each patient) at 4–6 weeks, 3 months and 12 months. Primary endpoints will be the magnitude of change in mean wall thickness and lumen diameter (stenosis) of paired grafts, at 3 and 12 months, respectively. Besides the evaluation of overall safety, longitudinal assessment of each graft (secondary endpoint) is performed in order to obtain insight into graft behaviour after CABG. Enrolment of 119 patients was successfully completed, and analysis of MDCT angiography follow-up is ongoing with the completed analysis becoming available by end of first quarter of 2018. Ethics and dissemination The regional ethics committees have approved the trial. Results will be submitted for publication. Clinical trial identifier NCT02272582 and NCT02774824.
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Affiliation(s)
- Walid Ben Ali
- Department of Surgery, Montreal Heart Institute, Montréal, Canada
| | - Pierre Voisine
- Institut Universitaire de Cardiologie et de Pneumologie, Quebec City, Canada
| | - Peter Skov Olsen
- Dept. of Cardiac Surgery, Rigshopitalet University of Copenhagen, Copenhagen, Denmark
| | | | - Nicolas Noiseux
- Department of Surgery, Montreal Heart Institute, Montréal, Canada
| | | | | | | | | | | | - Craig Brown
- New Brunswick Heart Centre, Saint John, Canada
| | | | - Louis P Perrault
- Department of Surgery, Montreal Heart Institute, Montréal, Canada
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24
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Ben Ali W, Bouhout I, Perrault LP. The effect of storage solutions, gene therapy, and antiproliferative agents on endothelial function and saphenous vein graft patency. J Card Surg 2018; 33:235-242. [DOI: 10.1111/jocs.13608] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Walid Ben Ali
- Department of Cardiac Surgery; Montreal Heart Institute; Quebec Canada
| | - Ismail Bouhout
- Department of Surgery; Université de Montréal; Quebec Canada
| | - Louis P. Perrault
- Department of Cardiovascular Surgery; Montreal Heart Institute; Quebec Canada
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25
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Tseng CN, Chang YT, Lengquist M, Kronqvist M, Hedin U, Eriksson EE. Platelet adhesion on endothelium early after vein grafting mediates leukocyte recruitment and intimal hyperplasia in a murine model. Thromb Haemost 2017; 113:813-25. [DOI: 10.1160/th14-07-0608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/08/2014] [Indexed: 12/23/2022]
Abstract
SummaryIntimal hyperplasia (IH) is the substrate for accelerated atherosclerosis and limited patency of vein grafts. However, there is still no specific treatment targeting IH following graft surgery. In this study, we used a mouse model of vein grafting to investigate the potential for early intervention with platelet function for later development of graft IH. We transferred the inferior vena cava (IVC) from donor C57BL/6 mice to the carotid artery in recipients using a cuff technique. We found extensive endothelial injury and platelet adhesion one hour following grafting. Adhesion of leukocytes was distinct in areas of platelet adhesion. Platelet and leukocyte adhesion was strongly reduced in mice receiving a function-blocking antibody against the integrin αIIbβ3. This was followed by a reduction of IH one month following grafting. Depletion of platelets using antiserum also reduced IH at later time points. These findings indicate platelets as pivotal to leukocyte recruitment to the wall of vein grafts. In conclusion, the data also highlight early intervention of platelets and inflammation as potential treatment for later formation of IH and accelerated atherosclerosis following bypass surgery.
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26
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Wise ES, Hocking KM, Evans BC, Duvall CL, Cheung-Flynn J, Brophy CM. Unregulated saphenous vein graft distension decreases tissue viscoelasticity. Perfusion 2017; 32:489-494. [PMID: 28820033 DOI: 10.1177/0267659117697814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Unregulated intraoperative distension of human saphenous vein (SV) graft leads to supraphysiologic luminal pressures and causes acute physiologic and cellular injury to the conduit. The effect of distension on tissue viscoelasticity, a biophysical property critical to a successful graft, is not well described. In this investigation, we quantify the loss of viscoelasticity in SV deformed by distension and compare the results to tissue distended in a pressure-controlled fashion. MATERIALS AND METHODS Unmanipulated porcine SV was used as a control or distended without regulation and distended with an in-line pressure release valve (PRV). Rings were cut from these tissues and suspended on a muscle bath. Force versus time tracings of tissue constricted with KCl (110 mM) and relaxed with sodium nitroprusside (SNP) were fit to the Hill model of viscoelasticity, using mean absolute error (MAE) and r2-goodness of fit as measures of conformity. RESULTS One-way ANOVA analysis demonstrated that, in tissue distended manually, the MAE was significantly greater and the r2-goodness of fit was significantly lower than both undistended tissues and tissues distended with a PRV (p<0.05) in KCl-induced vasoconstriction and SNP-induced vasodilation. CONCLUSIONS Unregulated manual distension of SV graft causes loss of viscoelasticity and such loss may be mitigated with the use of an in-line PRV.
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Affiliation(s)
- Eric S Wise
- 1 Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,2 Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Kyle M Hocking
- 1 Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,3 Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Brian C Evans
- 1 Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,3 Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Craig L Duvall
- 3 Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Joyce Cheung-Flynn
- 1 Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Colleen M Brophy
- 1 Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,4 VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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Vogiatzi G, Toutouzas K, Synetos A, Latsios G, Tousoulis D. Re-intervention of a fibrotic lesion in a saphenous vein graft: Insights into procedural characteristics using the right transradial approach. Hellenic J Cardiol 2017; 58:297-299. [DOI: 10.1016/j.hjc.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 02/25/2017] [Indexed: 10/20/2022] Open
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Wheeler AR, Kendrick DE, Allemang MT, Gosling AF, Kim AH, Hausladen A, Kashyap VS. Endothelial Function Is Preserved in Veins Harvested by Either Endoscopic or Surgical Techniques. Ann Vasc Surg 2017; 44:317-324. [PMID: 28495542 DOI: 10.1016/j.avsg.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Endoscopic vein harvest for lower extremity arterial bypass grafting has been questioned due to concern for endothelial damage during procurement. We sought to compare nitric oxide (NO)-mediated endothelial-dependent relaxation (EDR) in vein segments harvested using open surgical techniques (OH) versus endoscopic vein harvest (EH) techniques. METHODS Saphenous vein segments were harvested for lower extremity bypass, and a single, minimally handled section of saphenous vein, free of branches, was taken from the end of the graft. Four 4-mm venous ring segments were then cut and mounted on force transducers. Segments were mounted in 37° oxygenated Krebs-Henseleit solution and maximally contracted using KCl. Individual ring segments that did not react to KCl were excluded from the study. Norepinephrine (NE) was used to achieve submaximal contraction. EDR was determined using increasing concentrations of bradykinin (BDK). Endothelial-independent relaxation (EIR) was confirmed using sodium nitroprusside. Two-way analysis of variance (ANOVA) was used to analyze differences between harvest techniques across BDK concentration and a Student's t-test was used to analyze single comparisons. RESULTS Vein segments harvested from patients (n = 13) led to 28 viable rings that exhibited a positive reaction to KCl (11 rings; 5 patients EH vs. 17 rings; 8 patients OH). Both vein groups achieved moderate relaxation to maximal BDK concentration, [10-6 M]; (49.5% EH vs. 40.55% OH, P = 0.270). Analysis by 2-way ANOVA for mean % relaxation for BDK concentration [10-11-10-6 M] showed improved EDR in EH samples compared with OH (P = 0.029). Mean nitrite/nitrate (NO(x)) tissue bath concentration measurements post-BDK were 139.8 nM (EH) vs. 97.2 nM (OH; P = 0.264). Histology and positive factor VIII immunohistochemistry staining provided evidence for the presence of intact endothelium in our sample segments. EIR was preserved and was similar in the two groups. CONCLUSIONS Endothelial function is preserved when utilizing endoscopic harvesting techniques. The advantages of minimally invasive vein procurement for lower extremity bypass can be obtained without concern for damaging venous endothelium.
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Affiliation(s)
- Adam R Wheeler
- Department of Vascular Surgery, University Hospitals, Cleveland, OH
| | | | - Matt T Allemang
- Department of Vascular Surgery, University Hospitals, Cleveland, OH
| | - Andre F Gosling
- Department of Vascular Surgery, University Hospitals, Cleveland, OH
| | - Ann H Kim
- Department of Vascular Surgery, University Hospitals, Cleveland, OH
| | - Alfred Hausladen
- Institute for Transformative Molecular Medicine, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | - Vikram S Kashyap
- Department of Vascular Surgery, University Hospitals, Cleveland, OH.
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Boire TC, Balikov DA, Lee Y, Guth CM, Cheung-Flynn J, Sung HJ. Biomaterial-Based Approaches to Address Vein Graft and Hemodialysis Access Failures. Macromol Rapid Commun 2016; 37:1860-1880. [PMID: 27673474 PMCID: PMC5156561 DOI: 10.1002/marc.201600412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/15/2016] [Indexed: 12/19/2022]
Abstract
Veins used as grafts in heart bypass or as access points in hemodialysis exhibit high failure rates, thereby causing significant morbidity and mortality for patients. Interventional or revisional surgeries required to correct these failures have been met with limited success and exorbitant costs, particularly for the US Centers for Medicare & Medicaid Services. Vein stenosis or occlusion leading to failure is primarily the result of neointimal hyperplasia. Systemic therapies have achieved little long-term success, indicating the need for more localized, sustained, biomaterial-based solutions. Numerous studies have demonstrated the ability of external stents to reduce neointimal hyperplasia. However, successful results from animal models have failed to translate to the clinic thus far, and no external stent is currently approved for use in the US to prevent vein graft or hemodialysis access failures. This review discusses current progress in the field, design considerations, and future perspectives for biomaterial-based external stents. More comparative studies iteratively modulating biomaterial and biomaterial-drug approaches are critical in addressing mechanistic knowledge gaps associated with external stent application to the arteriovenous environment. Addressing these gaps will ultimately lead to more viable solutions that prevent vein graft and hemodialysis access failures.
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Affiliation(s)
- Timothy C Boire
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
| | - Daniel A Balikov
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
| | - Yunki Lee
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
| | - Christy M Guth
- Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Joyce Cheung-Flynn
- Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Hak-Joon Sung
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
- Severance Biomedical Science Institute, College of Medicine, Yonsei University, Seoul, 120-752, Republic of Korea
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30
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Vechersky YY, Zatolokin VV, Petlin KA, Shipulin VM. [Endoscopic harvesting of great saphenous vein for coronary artery bypass grafting]. Khirurgiia (Mosk) 2016:86-90. [PMID: 27447009 DOI: 10.17116/hirurgia2016586-90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Yu Yu Vechersky
- Research Institute of Cardiology, Siberian Department of RAS, Tomsk, Russia
| | - V V Zatolokin
- Research Institute of Cardiology, Siberian Department of RAS, Tomsk, Russia
| | - K A Petlin
- Research Institute of Cardiology, Siberian Department of RAS, Tomsk, Russia
| | - V M Shipulin
- Research Institute of Cardiology, Siberian Department of RAS, Tomsk, Russia
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Wise ES, Hocking KM, Luo W, Feldman DL, Song J, Komalavilas P, Cheung-Flynn J, Brophy CM. Traditional graft preparation decreases physiologic responses, diminishes viscoelasticity, and reduces cellular viability of the conduit: A porcine saphenous vein model. Vasc Med 2016; 21:413-421. [PMID: 27216870 DOI: 10.1177/1358863x16649040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Traditional methods of intraoperative human saphenous vein preparation for use as bypass grafts can be deleterious to the conduit. The purpose of this study was to characterize acute graft preparation injury, and to mitigate this harm via an improved preparation technique. Porcine saphenous veins were surgically harvested (unprepared controls, UnP) and prepared using traditional (TraP) and improved preparations (ImP). The TraP used unregulated radial distension, marking with a surgical skin marker and preservation in heparinized normal saline. ImP used pressure-regulated distension, brilliant blue FCF-based pen marking and preservation in heparinized Plasma-Lyte A. Rings from each preparation were suspended in a muscle bath for characterization of physiologic responses to vasoactive agents and viscoelasticity. Cellular viability was assessed using the methyl thiazolyl tetrazolium (MTT) assay and the terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay for apoptosis. Contractile responses to potassium chloride (110 mM) and phenylephrine (10 µM), and endothelial-dependent and independent vasodilatory responses to carbachol (0.5 µM) and sodium nitroprusside (1 µM), respectively, were decreased in TraP tissues compared to both UnP and ImP tissues (p ⩽ 0.05). TraP tissues demonstrated diminished viscoelasticity relative to UnP and ImP tissues (p ⩽ 0.05), and reduced cellular viability relative to UnP control (p ⩽ 0.01) by the MTT assay. On the TUNEL assay, TraP tissues demonstrated a greater degree of apoptosis relative to UnP and ImP tissues (p ⩽ 0.01). In conclusion, an improved preparation technique prevents vascular graft smooth muscle and endothelial injury observed in tissues prepared using a traditional approach.
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Affiliation(s)
- Eric S Wise
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Kyle M Hocking
- Department of Surgery, Vanderbilt University, Nashville, TN, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Weifeng Luo
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Daniel L Feldman
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Jun Song
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Padmini Komalavilas
- Department of Surgery, Vanderbilt University, Nashville, TN, USA.,VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | | | - Colleen M Brophy
- Department of Surgery, Vanderbilt University, Nashville, TN, USA.,VA Tennessee Valley Healthcare System, Nashville, TN, USA
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32
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Blaas I, Heinz K, Würtinger P, Türkcan A, Tepeköylü C, Grimm M, Doppler C, Danzl K, Messner B, Bernhard D. Vein graft thrombi, a niche for smooth muscle cell colonization - a hypothesis to explain the asymmetry of intimal hyperplasia. J Thromb Haemost 2016; 14:1095-104. [PMID: 26875593 DOI: 10.1111/jth.13295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED Essentials Vein graft failure is the most frequent late onset complication of coronary artery bypass grafting. Cuff technique-based interposition mouse model including new anticoagulation regime was conducted. Early vein graft thrombi may serve as a niche for smooth muscle cell colonization. The focal character of early thrombi may form the basis for the asymmetry of intimal hyperplasia. SUMMARY Background Autologous saphenous veins are widely used in coronary artery bypass grafting; however, 10 years after surgery, 40% of grafts are completely occluded, and another 30% show reduced blood flow. Objective In the past, the central processes and signaling pathways responsible for this loss of patency have been identified. However, one central finding in the process of graft failure is so far not understood: the asymmetric character of intimal hyperplasia. It was the goal of the present study to address this aspect. Methods By the use of a cuff technique-based vein interposition mouse model with a new anticoagulation regime, alterations in vein grafts were analyzed 1 h, 1 day, 2 days, 3 days, 7 days and 21 days after reperfusion by means of immunolabeling, histochemistry, and high-resolution ultrasound. Results The novel and major finding of this study is that the vein graft thrombus may serve as a niche that is infiltrated and colonized by smooth muscle cells (SMCs). Fibroblast growth factor-1 and platelet-derived growth factor-B may be the SMC-attracting factors in the thrombus. The focal character of early thrombi may define the focal and asymmetric character of vein graft intimal hyperplasia. Conclusions Inhibiting the formation and reducing the size of early thrombi is an old concept for reducing vein graft failure. However, in light of the present new findings obtained under a clinic-like anticoagulation regime, early vein graft thrombus prevention/size reduction should be revisited in the prevention of graft failure.
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Affiliation(s)
- I Blaas
- Cardiac Surgery Research Laboratory, University Clinic for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - K Heinz
- Cardiac Surgery Research Laboratory, University Clinic for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - P Würtinger
- Institute of Medical and Chemical Laboratory Diagnostics (ZIMCL), Medical University of Innsbruck, Innsbruck, Austria
| | - A Türkcan
- Cardiac Surgery Research Laboratory, Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - C Tepeköylü
- Cardiac Surgery Research Laboratory, University Clinic for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - M Grimm
- Cardiac Surgery Research Laboratory, University Clinic for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - C Doppler
- Cardiac Surgery Research Laboratory, University Clinic for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - K Danzl
- Cardiac Surgery Research Laboratory, University Clinic for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - B Messner
- Cardiac Surgery Research Laboratory, Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - D Bernhard
- Cardiac Surgery Research Laboratory, University Clinic for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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A comprehensive review on learning curve associated problems in endoscopic vein harvesting and the requirement for a standardised training programme. J Cardiothorac Surg 2016; 11:45. [PMID: 27059309 PMCID: PMC4825086 DOI: 10.1186/s13019-016-0442-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/04/2016] [Indexed: 11/10/2022] Open
Abstract
Endoscopic vein harvesting is becoming one of the most favourable vein harvesting techniques in multiple bypass coronary surgery, due to its short term post-operative benefits with high patient satisfaction. However, long-term graft patency has been both supported and questioned in the literature. Graft failure can be affected by harvesting methods and operator's experience. Endoscopic vein harvesting is associated with a learning curve period, during which the incidence of vein trauma is high due to unfamiliarity with the surgical technique. There is a paucity of structured learning tools for novice practitioners, meaning that training differs significantly between hospital centres. Inconsistent training methods can lead to poor surgical technique, which can have a significant impact on vein quality and stress level of the practitioner. In turn, this can lead to increased postoperative complications and longer surgical duration. The main aim of this literature review is to understand the impact of the learning curve on the vein conduit and whether there is a requirement for a standardised training programme for the novice practitioners.
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34
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Babu A, Pandey MK, Gupta A, Ranjan P, Singhal M. Perigraft Seroma Presenting as Discharging Sinus and Spontaneous Exteriorization of Vascular Graft - A Rare Entity Following Vascular Repair with PTFE Graft. J Clin Diagn Res 2015; 9:PD15-6. [PMID: 26500951 DOI: 10.7860/jcdr/2015/12845.6470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/26/2015] [Indexed: 11/24/2022]
Abstract
Perigraft seroma presenting as discharging sinus and spontaneous exteriorization of vascular graft are rare complication of vascular injury repair with polytetrafluoroethylene (PTFE) grafts. We hereby report a case of young boy who presented with discharging sinuses and vascular graft coming out from one of the sinuses following vascular repair of femoral artery with PTFE graft after a follow-up of six months but the limb was salvaged. On evaluation PTFE graft was found to be thrombosed and collaterals were formed for distal perfusion. Because of persistent discharging sinuses, PTFE graft was removed and femoral artery was ligated proximal and distal to the graft. This case highlights an unusual complication of PTFE grafts that is commonly used in vascular surgery and also highlights the fact that these graft buy time for gradual collaterals formation for distal perfusion and hence when thrombosed and complicated can be safely removed.
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Affiliation(s)
- Annu Babu
- Senior Resident, Department of Surgical Disciplines, AIIMS , New Delhi, India
| | - Manish Kumar Pandey
- Senior Specialist Surgeon, Department of Surgery, CCL Hospital , Gandhinagar, Ranchi, Jharkhand, India
| | - Amit Gupta
- Associate Professor, Department of Surgical Disciplines, AIIMS , New Delhi, India
| | - Piyush Ranjan
- Assistant Professor, Department of Surgical Disciplines, AIIMS , New Delhi, India
| | - Maneesh Singhal
- Associate Professor, Department of Surgical Disciplines, Aiims , New Delhi, India
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35
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Vein harvesting technique for infrainguinal arterial bypass with great saphenous vein and its association with surgical site infection and graft patency. J Vasc Surg 2015; 61:1264-71.e2. [PMID: 25659457 DOI: 10.1016/j.jvs.2014.12.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/17/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the association of vein harvesting technique (VHT) with surgical site infection (SSI) and graft patency after infrainguinal arterial bypass. METHODS The Vascular Quality Initiative database was used to review VHT of all patients undergoing single-segment great saphenous vein graft infrainguinal arterial bypass from 2003 to 2013. Patients were divided into three groups according to the VHT used (continuous incision, skip incision, and endoscopic). Multinomial logistic regression was performed to estimate propensity scores for each treatment group. Propensity score adjustment was included in multivariable analysis of the primary outcomes: SSI and graft primary patency. RESULTS From 2003 to 2013, 5066 patients underwent single-segment great saphenous vein graft infrainguinal bypass. The VHT was continuous incision in 48.6%, skip incision in 39.7%, and endoscopic in 12.7%. SSI rates did not differ significantly among the groups (continuous, 4.7%; skip, 4.0%; endoscopic, 3.4%; P = .278). On multivariable analysis, there was no difference in discharge primary patency between the three groups. At 1 year, primary patency rates were 69.5% for continuous, 73.0% for skip, and 58.6% for endoscopic (P < .001). After multivariable analysis, endoscopic vein harvest was independently associated with higher 1-year primary patency loss compared with both continuous (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.05-1.74; P = .020) and skip (HR, 1.53; 95% CI, 1.18-2.00; P = .002). There was no significant difference in 1-year primary patency loss between continuous and skip techniques (HR, 0.88; 95% CI, 0.73-1.05; P = .170). CONCLUSIONS No association between the choice of VHT and the development of SSI after infrainguinal arterial bypass was identified in the Vascular Quality Initiative population. Endoscopic VHT was associated with significantly reduced 1-year primary patency rate compared with both continuous and skip techniques.
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Gamoh S, Kanai T, Tanaka-Totoribe N, Ohkura M, Kuwabara M, Nakamura E, Yokota A, Yamasaki T, Watanabe A, Hayashi M, Fujimoto S, Yamamoto R. Water-soluble jack-knife prawn extract inhibits 5-hydroxytryptamine-induced vasoconstriction and platelet aggregation in humans. Food Funct 2014; 6:444-9. [PMID: 25464143 DOI: 10.1039/c4fo00716f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Coronary artery spasm plays an important role in the pathogenesis of various ischemic heart diseases or serious arrhythmia. The aim of this study is to look for functional foods which have physiologically active substances preventing 5-hydroxytryptamine (5-HT)-related vasospastic diseases including peri- and postoperative ischemic complications of coronary artery bypass grafting (CABG) from ocean resources in Japanese coastal waters. First, we evaluated the effect of water-soluble ocean resource extracts on the response to 5-HT in HEK293 cells which have forcibly expressed cyan fluorescent protein-fused 5-HT2A receptors (5-HT2A-CFP). Among 5 different water-soluble extracts of ocean resources, the crude water-soluble jack-knife prawn extract (WJPE) significantly reduced maximal Ca(2+) influx induced by 0.1 μM 5-HT in a concentration-dependent manner. The Crude WJPE significantly inhibited, in a concentration-dependent manner, 5-HT-induced constriction of human saphenous vein. 5-HT released from activated platelets plays a crucial roles in the constriction of coronary artery. Next the WJPE was purified for applying the experiment of 5-HT-induced human platelet aggregation. The purified WJPE significantly inhibited 5-HT-induced human platelet aggregation also in a concentration-dependent manner. Based on our findings, jack-knife prawn could be one of a functional food with health-promoting benefits for most people with vasospastic diseases including patients who have gone CABG.
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Affiliation(s)
- Shuji Gamoh
- First Department of Pharmacology, Graduate School of Clinical Pharmacy, Kyushu University of Health and Welfare, Nobeoka, Miyazaki 882-8508, Japan.
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Onan B, Yeniterzi M, Onan IS, Ersoy B, Gonca S, Gelenli E, Solakoglu S, Bakir I. Effect of electrocautery on endothelial integrity of the internal thoracic artery: ultrastructural analysis with transmission electron microscopy. Tex Heart Inst J 2014; 41:484-90. [PMID: 25425979 DOI: 10.14503/thij-13-3658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The internal thoracic artery (ITA) is typically harvested from the chest wall by means of conventional electrocautery. We investigated the effects of electrocautery on endothelial-cell and vessel-wall morphology at the ultrastructural level during ITA harvesting. Internal thoracic artery specimens from 20 patients who underwent elective coronary artery bypass grafting were investigated in 2 groups. The ITA grafts were sharply dissected with use of a scalpel and clips in the control group (n=10) and were harvested by means of electrocautery in the study group (n=10). Each sample was evaluated for intimal, elastic-tissue, muscular-layer, and adventitial changes. Free flow was measured intraoperatively. Light microscopic examinations were performed after hematoxylin-eosin and Masson's trichrome staining. Transmission electron microscopy was used to evaluate ultrastructural changes in the endothelial cells and vessel walls of each ITA. In the sharp-dissection group, the endothelial surfaces were lined with normal amounts of original endothelium, endothelial cells were distinctly attached to the basal lamina, cytoplasmic organelles were evident, and intercellular junctional complexes were intact. Conversely, in the electrocautery group, the morphologic integrity of endothelial cells was distorted, with some cell separations and splits, contracted cells, numerous large cytoplasmic vacuoles, and no visible cytoplasmic organelles. The subendothelial layer exhibited disintegration. Free ITA flow was higher in the sharp-dissection group (P=0.04). The integrity of endothelial cells can be better preserved when the ITA is mobilized by means of sharp dissection, rather than solely by electrocautery; we recommend a combined approach.
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Krishnamoorthy B, Critchley WR, Bhinda P, Crockett J, John A, Bridgewater BJ, Waterworth PD, Fildes J, Yonan N. Does the introduction of a comprehensive structured training programme for endoscopic vein harvesting improve conduit quality? A multicentre pilot study. Interact Cardiovasc Thorac Surg 2014; 20:186-93. [DOI: 10.1093/icvts/ivu354] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tseng CN, Karlöf E, Chang YT, Lengquist M, Rotzius P, Berggren PO, Hedin U, Eriksson EE. Contribution of endothelial injury and inflammation in early phase to vein graft failure: the causal factors impact on the development of intimal hyperplasia in murine models. PLoS One 2014; 9:e98904. [PMID: 24887332 PMCID: PMC4041877 DOI: 10.1371/journal.pone.0098904] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/08/2014] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Autologous veins are preferred conduits in by-pass surgery. However, long-term results are hampered by limited patency due to intimal hyperplasia. Although mechanisms involved in development of intimal hyperplasia have been established, the role of inflammatory processes is still unclear. Here, we studied leukocyte recruitment and intimal hyperplasia in inferior vena cava grafts transferred to abdominal aorta in mice. METHODS AND RESULTS Several microscopic techniques were used to study endothelium denudation and regeneration and leukocyte recruitment on endothelium. Scanning electron microscopy demonstrated denudation of vein graft endothelium 7 days post-transfer and complete endothelial regeneration by 28 days. Examination of vein grafts transferred to mice transgenic for green fluorescent protein under Tie2 promoter in endothelial cells showed regeneration of graft endothelium from the adjacent aorta. Intravital microscopy revealed recruitment of leukocytes in vein grafts at 7 days in wild type mice, which had tapered off by 28 days. At 28 and 63 days there was significant development of intimal hyperplasia. In contrast; no injury, leukocyte recruitment nor intimal hyperplasia occurred in arterial grafts. Leukocyte recruitment was reduced in vein grafts in mice deficient in E- and P-selectin. In parallel, intimal hyperplasia was reduced in vein grafts in mice deficient in E- and P-selectin and in wild type mice receiving P-selectin/E-selectin function-blocking antibodies. CONCLUSION The results show that early phase endothelial injury and inflammation are crucial processes in intimal hyperplasia in murine vein grafts. The data implicate endothelial selectins as targets for intervention of vein graft disease.
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Affiliation(s)
- Chi-Nan Tseng
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Eva Karlöf
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ya-Ting Chang
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mariette Lengquist
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Pierre Rotzius
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Per-Olof Berggren
- The Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Hedin
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Einar E. Eriksson
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Sur S, Sugimoto JT, Agrawal DK. Coronary artery bypass graft: why is the saphenous vein prone to intimal hyperplasia? Can J Physiol Pharmacol 2014; 92:531-45. [PMID: 24933515 DOI: 10.1139/cjpp-2013-0445] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Proliferation and migration of smooth muscle cells and the resultant intimal hyperplasia cause coronary artery bypass graft failure. Both internal mammary artery and saphenous vein are the most commonly used bypass conduits. Although an internal mammary artery graft is immune to restenosis, a saphenous vein graft is prone to develop restenosis. We found significantly higher activity of phosphatase and tensin homolog (PTEN) in the smooth muscle cells of the internal mammary artery than in the saphenous vein. In this article, we critically review the pathophysiology of vein-graft failure with detailed discussion of the involvement of various factors, including PTEN, matrix metalloproteinases, and tissue inhibitor of metalloproteinases, in uncontrolled proliferation and migration of smooth muscle cells towards the lumen, and invasion of the graft conduit. We identified potential target sites that could be useful in preventing and (or) reversing unwanted consequences following coronary artery bypass graft using saphenous vein.
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Affiliation(s)
- Swastika Sur
- a Department of Biomedical Science, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
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Temizkan V, Ugur M, Arslan G, Alp I, Yedekci E, Ucak A, Yilmaz AT. Comparison of conventional technique and ultrasonographic mapping in saphenous vein harvesting. Heart Surg Forum 2013; 16:E248-51. [PMID: 24217237 DOI: 10.1532/hsf98.2013134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Saphenous vein mapping provides accurate identification of the graft diameter, location of the harvest side, and quality of graft and also led to a selective leg skin incision. In this article, we aimed to compare patients who underwent coronary artery bypass graft (CABG) surgery with or without vein mapping. METHODS Patients who underwent CABG surgery with saphenous vein grafts (SVG) between January 2005 and January 2010 in our service were analyzed retrospectively. One hundred seventy-eight 178 SVGs were harvested with classical methods (Group A), and 136 SVGs were harvested after Doppler ultrasonography (USG) mapping (Group B). RESULTS In Group A, 6.7% of patients needed additional incisions for graft harvesting than planned before CABG surgery due to unsuitable vein grafts. In Group B, SVGs were harvested from left lower extremity in 16 patients, and the saphenous vein was not suitable for grafting in 1 patient due to Doppler examination. In the postoperative period, complications at the incision site were reduced in Group B. CONCLUSION Preoperative vein mapping for harvesting SVGs is an effective method in reducing wound site complications, hospital stay, and hospital costs and in increasing patient comfort and satisfaction.
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Affiliation(s)
- Veysel Temizkan
- Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
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Sen O, Gonca S, Solakoglu S, Dalcik H, Dalcik C, Ozkara A. Comparison of Conventional and No-Touch Techniques in Harvesting Saphenous Vein for Coronary Artery Bypass Grafting in View of Endothelial Damage. Heart Surg Forum 2013; 16:E177-83. [DOI: 10.1532/hsf98.20131006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<p><b>Background:</b> Optimization of saphenous vein patency for myocardial revascularization.</p><p><b>Objective:</b> The goal of this study was to present the no-touch technique of saphenous vein preparation. This technique consists of harvesting the vein with a pedicle of surrounding tissue, which protects the vein from distension pressure.</p><p><b>Methods:</b> We performed a prospective, randomized study that compared 2 techniques for harvesting saphenous vein-conventional and no-touchin 40 patients undergoing coronary artery bypass grafting. We carried out a morphologic study of the endothelium with the aid of light and transmission electron microscopy and an immunohistochemical assessment to identify adenosine, inducible nitric oxide synthase (iNOS), and vascular endothelial growth factor (VEGF) in the vein wall.</p><p><b>Results:</b> The integrity of endothelial cell and all vascular layers was maintained better with the no-touch technique than with the conventional procedure. The immunohistochemical assessment revealed that adenosine receptor, iNOS, and VEGF immunoexpression levels were normal or lower in the no-touch group than in the conventional-harvest group, as shown by the staining densities in all layers of the vein wall.</p><p><b>Conclusion:</b> Endothelial integrity and adenosine, iNOS, and VEGF immunoreactivities were better preserved when the no-touch technique was used for vein graft harvesting. The mechanical protection provided by the cushion of surrounding tissue in the no-touch group and the vasorelaxation and thromboresistant activities of nitric oxide may be responsible for the reduction in vasospasms and the improved patency rate.</p>
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Harskamp RE, Lopes RD, Baisden CE, de Winter RJ, Alexander JH. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Ann Surg 2013; 257:824-33. [PMID: 23574989 DOI: 10.1097/sla.0b013e318288c38d] [Citation(s) in RCA: 237] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To review our current understanding of the epidemiology and pathogenesis of vein graft failure (VGF), give an overview of current preventive and interventional measures, and explore strategies that may improve vein graft patency. BACKGROUND VGF and progression of native coronary artery disease limit the long-term efficacy of coronary artery bypass graft surgery. METHODS We reviewed the published literature on the pathophysiology, prevention, and/or treatment of VGF by searching the MEDLINE (January 1, 1966-January 1, 2012), EMBASE (January 1, 1980-January 1, 2012), and Cochrane (January 1, 1995-January 1, 2012) databases. In addition, we reviewed references from the selected articles for studies not identified in the initial search. Basic science and clinical studies were included; non-English language publications were excluded. RESULTS Acute thrombosis, neointimal hyperplasia, and accelerated atherosclerosis are the 3 mechanisms that lead to VGF. Preventive measures include matching and quality assessment of conduit and target vessel, lipid-lowering drugs, antithrombotic therapy, and cessation of smoking. Treatment of VGF includes medical therapy, percutaneous intervention, and redo coronary artery bypass graft surgery. In patients undergoing graft intervention, the use of drug-eluting stents, antiplatelet agents, and embolic protection devices may improve clinical outcomes. CONCLUSIONS Despite advances in management, VGF remains one of the leading causes of poor in-hospital and long-term outcomes after coronary artery bypass graft surgery. New developments in VGF prevention such as gene therapy, external graft support, fully tissue-engineered grafts, hybrid grafts, and synthetic conduits are promising but unproven. Future efforts to reduce VGF require a multidisciplinary approach with a primary focus on prevention.
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Affiliation(s)
- Ralf E Harskamp
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA
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44
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Deppe AC, Liakopoulos OJ, Choi YH, Slottosch I, Kuhn EW, Scherner M, Stange S, Wahlers T. Endoscopic vein harvesting for coronary artery bypass grafting: a systematic review with meta-analysis of 27,789 patients. J Surg Res 2013; 180:114-24. [DOI: 10.1016/j.jss.2012.11.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/15/2012] [Accepted: 11/08/2012] [Indexed: 12/13/2022]
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45
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Osgood MJ, Flynn CR, Komalavilas P, Brophy C. Cell-permeant peptide inhibitors of vasospasm and intimal hyperplasia. Vascular 2012; 21:46-53. [PMID: 23104826 DOI: 10.1258/vasc.2011.201203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Outcomes from vein graft bypass are limited by graft failure, leading causes of which include intimal hyperplasia and vasospasm. Intimal hyperplasia remains the most common cause of graft failure, but no therapeutic modalities have been shown to prevent intimal hyperplasia in humans. The small heat shock proteins are a class of naturally occurring proteins in vascular smooth muscle. These proteins have an integral role in maintenance of vascular tone and in cellular defense against various stressors. Transduction domains have enabled intracellular therapeutic delivery of peptide analogs of heat shock proteins, as well as peptide inhibitors of the kinases that phosphorylate these proteins. These cell-permeant peptides have been shown to prevent vasospasm and intimal hyperplasia in vitro. Since vascular bypass using vein grafts is analogous to autologous organ transplantation, ex vivo treatment of the vein graft with cell-permeant peptide inhibitors of vasospasm and intimal hyperplasia prior to implantation provides a unique opportunity for targeted treatment of the graft to improve patency.
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Affiliation(s)
- Michael J Osgood
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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46
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Barner HB, Farkas EA. Conduits for coronary bypass: vein grafts. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 45:275-86. [PMID: 23130300 PMCID: PMC3487010 DOI: 10.5090/kjtcs.2012.45.5.275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 08/16/2012] [Accepted: 08/17/2012] [Indexed: 11/23/2022]
Abstract
The saphenous vein has been the principal conduit for coronary bypass grafting from the beginning, circa 1970. This report briefly traces this history and concomitantly presents one surgeons experience and personal views on use of the vein graft. As such it is not exhaustive but meant to be practical with a modest number of references. The focus is that of providing guidance and perspective which may be at variance with that of others and recognizing that there may be many ways to accomplish the task at hand. Hopefully the surgeon in training/early career may find this instructive on the journey to surgical maturity.
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Affiliation(s)
- Hendrick B Barner
- Division of Cardiothoracic Surgery, St. Louis University Hospital, USA
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Abstract
Autologous saphenous vein is commonly used as a conduit to bypass atherosclerotic lesions in coronary and femoral arteries. Despite the wide use of arterial conduits, which are less susceptible to complications and failure, as alternative conduits, the saphenous vein will continue to be used in coronary artery bypass grafting until acceptable alternative approaches are evaluated. Hence, preservation of vein graft patency is essential for the long-term success. Gene therapy is attractive in this setting as an ex-vivo technology to genetically manipulate the conduit before grafting. The use of safe and efficient vectors for delivery is a necessity as well as a strategy to improve patency in the long term. Here, we review the current clinical practice, the pathogenesis of bypass graft failure and adenovirus-mediated gene therapy strategies designed to improve late vein graft failure by modulation of smooth muscle cells in the vein wall.
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48
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Shukla N, Jeremy JY. Pathophysiology of saphenous vein graft failure: a brief overview of interventions. Curr Opin Pharmacol 2012; 12:114-20. [PMID: 22321569 DOI: 10.1016/j.coph.2012.01.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 01/05/2012] [Accepted: 01/06/2012] [Indexed: 12/01/2022]
Abstract
Coronary artery bypass graft surgery (CABG) is widely used for the treatment of atheromatous stenosis of coronary arteries. However, as many as 50% of grafts fail within 10 years after CABG due to neointima (NI) formation, a process involving the proliferation of vascular smooth muscle cells (VSMCs) and superimposed atherogenesis. To date no therapeutic intervention has proved successful in treating late vein graft failure. However, several diverse approaches aimed at preventing neointimal formation have been devised which have yielded promising results. In this review, therefore, we will summarise the pathophysiology of vein graft disease and then briefly consider interventional approaches to prevent late vein graft failure which include surgical technique, conventional pharmacology, external sheaths, cytostatic drugs and gene transfer.
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Affiliation(s)
- Nilima Shukla
- Bristol Heart Institute, The University of Bristol, UK.
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49
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Khaleel MS, Dorheim TA, Duryee MJ, Durbin HE, Bussey WD, Garvin RP, Klassen LW, Thiele GM, Anderson DR. High-Pressure Distention of the Saphenous Vein During Preparation Results in Increased Markers of Inflammation: A Potential Mechanism for Graft Failure. Ann Thorac Surg 2012; 93:552-8. [DOI: 10.1016/j.athoracsur.2011.10.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 10/13/2011] [Accepted: 10/14/2011] [Indexed: 10/14/2022]
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50
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Kanai T, Kuwabara M, Tanaka-Totoribe N, Nakamura E, Matsuo Y, Gamoh S, Suzuki A, Asada Y, Hisa H, Yamamoto R. Insulin induces internalization of the plasma membrane 5-hydroxytryptamine2A (5-HT2A) receptor in the isolated human endothelium-denuded saphenous vein via the phosphatidylinositol 3-kinase pathway. J Pharmacol Sci 2012; 118:178-85. [PMID: 22293289 DOI: 10.1254/jphs.11172fp] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
The aim of this study was to investigate the relaxant effect of insulin on the 5-hydroxytryptamine (5-HT)-induced constriction of the human endothelium-denuded saphenous vein (SV) and its signal transduction pathway. During the 5-HT-induced sustained constriction of vessels, insulin induced vasorelaxation in a concentration-dependent manner. This insulin-induced vasorelaxation was partially attenuated by L-NAME, a nitric oxide synthase (NOS) inhibitor, and was abolished by wortmannin, a phosphatidylinositol 3-kinase (PI3-K) inhibitor. Insulin increased the Ser(473) phosphorylation of Akt. Endothelial NOS and inducible NOS protein expressions were observed in SV smooth muscle when insulin induced relaxation of SV vessels preconstricted with 5-HT. Although insulin did not affect the total protein level of 5-HT(2A) receptors, it decreased the particulate protein level and reciprocally increased the soluble protein level of 5-HT(2A) receptors in a concentration-dependent manner. These results demonstrate that insulin can induce the internalization of 5-HT(2A) receptors from the plasma membrane to the cytoplasm. The insulin-induced internalization of 5-HT(2A) receptors was abolished by wortmannin but was not affected by L-NAME. These results suggest that the relaxant effect of insulin on 5-HT-induced vasoconstriction is mediated in part by the internalization of plasma membrane 5-HT(2A) receptors and the production of nitric oxide via the PI3-K/Akt pathway.
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Affiliation(s)
- Tasuku Kanai
- First Department of Pharmacology, School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, Japan
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