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Szpytma MM, Baker RA, Gimpel D, Newland RF, Lance DG, Rice GD, Crouch G, Bennetts JS. Optimal Conduit Diameter Selection in Coronary Bypass Grafting Using Saphenous Vein. Heart Lung Circ 2024; 33:898-907. [PMID: 38458931 DOI: 10.1016/j.hlc.2024.01.035] [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: 05/21/2023] [Revised: 12/27/2023] [Accepted: 01/30/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Predictors of long-term saphenous vein graft (SVG) patency following coronary artery bypass grafting (CABG) include harvesting technique, degree of proximal coronary stenosis, and target vessel diameter and runoff. The objective of this study was to evaluate the association between vein graft diameter and long-term survival. METHODS Patients undergoing primary CABG (2000-2017) at Flinders Medical Centre, Adelaide, Australia, were categorised into three groups according to average SVG diameter (<3.5 mm [small], 3.5-4 mm [medium], >4 mm [large]). Survival data was obtained from the Australian Institute of Health and Welfare National Death Index. To determine the association of SVG diameter with long-term survival we used Kaplan-Meier survival analysis and Cox proportional hazard models adjusted for preoperative variables associated with survival. RESULTS Vein graft diameter was collected in 3,797 patients. Median follow-up time was 7.6 years (interquartile range, 3.9-11.8) with 1,377 deaths. SVG size >4 mm was associated with lower rates of adjusted survival up to 4 years postoperatively (hazard ratio 1.48; 95% confidence interval 1.05-2.1; p=0.026). CONCLUSIONS Vein graft diameter >4mm was found to be associated with lower rates of survival following CABG.
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Affiliation(s)
- Malgorzata Maggie Szpytma
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Robert A Baker
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia; Perfusion and Cardiothoracic Surgery Quality and Outcomes Unit, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia; Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Damian Gimpel
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Richard F Newland
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia; Perfusion and Cardiothoracic Surgery Quality and Outcomes Unit, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia; Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - David G Lance
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Gregory D Rice
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Gareth Crouch
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Jayme S Bennetts
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia; Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
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2
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Mikami T, Dashwood MR, Kawaharada N, Furuhashi M. An Obligatory Role of Perivascular Adipose Tissue in Improved Saphenous Vein Graft Patency in Coronary Artery Bypass Grafting. Circ J 2024; 88:845-852. [PMID: 37914280 DOI: 10.1253/circj.cj-23-0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
The gold standard graft for coronary artery bypass grafting (CABG) is the internal thoracic artery (ITA), and the second recommendation is the radial artery. However, complete revascularization with arterial grafts alone is often difficult, and the saphenous vein (SV) is the most commonly used autologous graft for CABG, because it is easier to use without restriction for the length of the graft. On the other hand, the patency of SV grafts (SVGs) is poor compared with that of arterial grafts. The SVG is conventionally harvested as a distended conduit with surrounding tissue removed, a procedure that may cause vascular damage. A no-touch technique of SVG harvesting has been reported to result in improved long-term patency in CABG comparable to that when using the ITA for grafting. Possible reasons for the excellent long-term patency of no-touch SVGs are the physical support provided by preserved surrounding perivascular adipose tissue, preservation of the vascular wall structure including the vasa vasorum, and production of adipocyte-derived factors. In this review, we discuss recent strategies aimed at improving the performance of SVGs, including no-touch harvesting, minimally invasive harvesting and mechanical support using external stents.
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Affiliation(s)
- Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo Medical University
| | - Michael R Dashwood
- Surgical and Interventional Sciences, Royal Free Hospital Campus, University College London Medical School
| | | | - Masato Furuhashi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
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3
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Pinheiro BB, Dashwood M, Souza DSR. The "No-touch" Harvesting Technique Revives the Position of the Saphenous Vein as an Important Conduit in CABG Surgery: 30-year Anniversary. Braz J Cardiovasc Surg 2021; 36:I-III. [PMID: 34673522 PMCID: PMC8597598 DOI: 10.21470/1678-9741-2021-0959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Bruno Botelho Pinheiro
- Department of Cardiovascular Surgery, Hospital do Coração Anis Rassi, Goiânia, Goiás, Brazil
| | - Michael Dashwood
- Surgical and Interventional Sciences, Royal Free Hospital Campus, University College London Medical School, London, United Kingdom
| | - Domingos S R Souza
- Department of Cardiovascular Surgery, Hospital do Coração Anis Rassi, Goiânia, Goiás, Brazil.,Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Dashwood MR, Loesch A. Endothelin-1, endothelin receptor antagonists, and vein graft occlusion in coronary artery bypass surgery: 20 years on and still no journey from bench to bedside. Can J Physiol Pharmacol 2020; 98:570-578. [PMID: 32343914 DOI: 10.1139/cjpp-2019-0598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The saphenous vein is the most commonly used bypass graft in patients with coronary artery disease. During routine coronary artery bypass, grafting the vascular damage inflicted on the vein is likely to stimulate the release of endothelin-1, a potent endothelium-derived vasoconstrictor that also possesses cell proliferation and inflammatory properties, conditions associated with vein graft failure. In both in vitro and in vivo studies, endothelin receptor antagonists reduce neointimal thickening. The mechanisms underlying these observations are multifactorial and include an effect on cell proliferation and cell/tissue damage. Much of the data supporting the beneficial action of endothelin-1 receptor antagonism at reducing intimal thickening and occlusion in experimental vein grafts were published over 20 years ago. The theme of the recent ET-16 conference in Kobe was "Visiting Old and Learning New". This short review article provides an overview of studies showing the potential of endothelin receptor antagonists to offer an adjuvant therapeutic approach for reducing saphenous vein graft failure and poses the question why this important area of research has not been translated from bench to bedside given the potential benefit for coronary artery bypass patients.
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Affiliation(s)
- Michael R Dashwood
- Surgical and Interventional Sciences, Royal Free Hospital Campus, University College Medical School, London, United Kingdom
| | - Andrzej Loesch
- Centre for Rheumatology, Royal Free Hospital Campus, University College Medical School, London, United Kingdom
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5
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Garoffolo G, Ruiter MS, Piola M, Brioschi M, Thomas AC, Agrifoglio M, Polvani G, Coppadoro L, Zoli S, Saccu C, Spinetti G, Banfi C, Fiore GB, Madeddu P, Soncini M, Pesce M. Coronary artery mechanics induces human saphenous vein remodelling via recruitment of adventitial myofibroblast-like cells mediated by Thrombospondin-1. Am J Cancer Res 2020; 10:2597-2611. [PMID: 32194822 PMCID: PMC7052885 DOI: 10.7150/thno.40595] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/22/2019] [Indexed: 12/27/2022] Open
Abstract
Rationale: Despite the preferred application of arterial conduits, the greater saphenous vein (SV) remains indispensable for coronary bypass grafting (CABG), especially in multi-vessel coronary artery disease (CAD). The objective of the present work was to address the role of mechanical forces in the activation of maladaptive vein bypass remodeling, a process determining progressive occlusion and recurrence of ischemic heart disease. Methods: We employed a custom bioreactor to mimic the coronary shear and wall mechanics in human SV vascular conduits and reproduce experimentally the biomechanical conditions of coronary grafting and analyzed vein remodeling process by histology, histochemistry and immunofluorescence. We also subjected vein-derived cells to cyclic uniaxial mechanical stimulation in culture, followed by phenotypic and molecular characterization using RNA and proteomic methods. We finally validated our results in vitro and using a model of SV carotid interposition in pigs. Results: Exposure to pulsatile flow determined a remodeling process of the vascular wall involving reduction in media thickness. Smooth muscle cells (SMCs) underwent conversion from contractile to synthetic phenotype. A time-dependent increase in proliferating cells expressing mesenchymal (CD44) and early SMC (SM22α) markers, apparently recruited from the SV adventitia, was observed especially in CABG-stimulated vessels. Mechanically stimulated SMCs underwent transition from contractile to synthetic phenotype. MALDI-TOF-based secretome analysis revealed a consistent release of Thrombospondin-1 (TSP-1), a matricellular protein involved in TGF-β-dependent signaling. TSP-1 had a direct chemotactic effect on SV adventitia resident progenitors (SVPs); this effects was inhibited by blocking TSP-1 receptor CD47. The involvement of TSP-1 in adventitial progenitor cells differentiation and graft intima hyperplasia was finally contextualized in the TGF-β-dependent pathway, and validated in a saphenous vein into carotid interposition pig model. Conclusions: Our results provide the evidence of a matricellular mechanism involved in the human vein arterialization process controlled by alterations in tissue mechanics, and open the way to novel potential strategies to block VGD progression based on targeting cell mechanosensing-related effectors.
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Dreifaldt M, Mannion JD, Geijer H, Lidén M, Bodin L, Souza D. The no-touch saphenous vein is an excellent alternative conduit to the radial artery 8 years after coronary artery bypass grafting: A randomized trial. J Thorac Cardiovasc Surg 2019; 161:624-630. [PMID: 31831193 DOI: 10.1016/j.jtcvs.2019.09.177] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/26/2019] [Accepted: 09/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 2004, a prospective randomized trial demonstrated that after 3 years, saphenous veins (SVs) harvested with a no touch (NT) technique had a greater patency than radial grafts for coronary bypass surgery. Here we report the 8-year follow-up data of this trial. METHODS The trial included 108 patients undergoing coronary artery bypass grafting (CABG). Each patient was assigned to receive 1 NT SV and 1 radial artery (RA) graft to either the left or right coronary territory to complement the left internal thoracic artery (LITA). Sequential grafting was common, so overall graft patency as well as the patency of each anastomosis were assessed. RESULTS Angiography was performed in 84 patients (78%) at mean of 97 months postoperatively. Graft patency were high and similar for both NT and RA: 86% for NT versus 79% for RA (P = .22). The patency of coronary anastomoses was significantly higher with the NT SV grafts (91% vs 81%; P = .046). The NT grafts also had excellent patency in coronary arteries with <90% stenosis (93% patency) and in coronary arteries of small diameter (87% patency) or with mild calcification (88% patency). Patency for the LITA was 92%. CONCLUSIONS NT SV grafts have excellent patency similar to that of RA grafts after 8 years. In addition, NT SV grafts can be used in situations that are not ideal for RA grafts.
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Affiliation(s)
- Mats Dreifaldt
- Faculty of Medicine and Health, Department of Cardiothoracic and Vascular Surgery and University Health Care Research Center, Örebro University, Örebro, Sweden
| | - John D Mannion
- Department of Surgery, Bayhealth Medical Center, Dover, Del
| | - Håkan Geijer
- Faculty of Medicine and Health, Department of Radiology, Örebro University, Örebro, Sweden
| | - Mats Lidén
- Faculty of Medicine and Health, Department of Radiology, Örebro University, Örebro, Sweden
| | - Lennart Bodin
- Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Domingos Souza
- Faculty of Medicine and Health, Department of Cardiothoracic and Vascular Surgery and University Health Care Research Center, Örebro University, Örebro, Sweden.
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Loesch A, Pinheiro BB, Dashwood MR. Why Use the Radial Artery? The Saphenous Vein is the Second Graft of Choice for CABG in Brazil. Braz J Cardiovasc Surg 2019; 34:480-483. [PMID: 31454203 PMCID: PMC6713382 DOI: 10.21470/1678-9741-2019-0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The saphenous vein (SV) is the most commonly used conduit for coronary artery bypass surgery (CABG) and the second conduit of choice in Brazil and many other countries. The radial artery (RA) is suggested, by some, to be superior to SV grafts, although its use in the USA declined over a 10 year period. The patency of SV grafts (SVG) is improved when the vein is harvested with minimal trauma using the no-touch (NT) technique. This improved performance is due to the preservation of the outer pedicle surrounding the SV and reduction in vascular damage that occurs when using conventional techniques (CT) of harvesting. While the patency of NT SVGs has been shown superior to the RA at 36 months in one study, data from the RADIAL trial suggests the RA to be the superior conduit. When additional data using NT SVG is included in this trial the difference in risk of graft occlusion between the RA and SV grafts dissipates with there no longer being a significant difference in patency between conduits. The importance of preserving SV structure and the impact of NT harvesting on conduit choice for CABG patients are discussed in this short review.
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Affiliation(s)
- Andrzej Loesch
- University College London Medical School Centre for Rheumatology London United Kingdom Centre for Rheumatology, University College London Medical School, London, United Kingdom
| | - Bruno Botelho Pinheiro
- Hospital do Coração Anis Rassi Department of Cardiovascular Surgery Goiânia GO Brazil Department of Cardiovascular Surgery, Hospital do Coração Anis Rassi, Goiânia, GO, Brazil
| | - Michael Richard Dashwood
- University College London Medical School Surgical and Interventional Sciences London United Kingdom Surgical and Interventional Sciences, University College London Medical School, London, United Kingdom
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8
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Harky A, MacCarthy‐Ofosu B, Grafton‐Clarke C, Pousios D, Muir AD. Long saphenous vein harvesting techniques and their effect on graft patency. J Card Surg 2019; 34:821-828. [DOI: 10.1111/jocs.14153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Amer Harky
- Department of Cardiothoracic SurgeryLiverpool Heart and ChestLiverpool UK
| | | | | | - Dimitrios Pousios
- Department of Cardiothoracic SurgeryLiverpool Heart and ChestLiverpool UK
| | - Andrew D. Muir
- Department of Cardiothoracic SurgeryLiverpool Heart and ChestLiverpool UK
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9
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Herrmann FEM, Lamm P, Wellmann P, Milz S, Hagl C, Juchem G. Autologous endothelialized vein allografts in coronary artery bypass surgery - Long term results. Biomaterials 2019; 212:87-97. [PMID: 31108275 DOI: 10.1016/j.biomaterials.2019.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 04/20/2019] [Accepted: 05/10/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Lack of autologous graft material restricts the ability to treat patients requiring coronary artery bypass surgery (CABG). An off the shelf tissue engineered small diameter vascular graft is the holy grail of cardiovascular surgery. METHODS Allograft saphenous veins were harvested from organ donors, cryopreserved, deendothelialized and then seeded with autologous endothelial cells prior to implantation during coronary artery bypass surgery. All patients treated were followed-up until death and angiographic results were collected. Grafts were explanted during autopsy and immunohistochemistry was performed. RESULTS Twelve patients received 15 engineered grafts. Mean patient survival was 9.1 ± 1.8 years. Six month graft patency was 80 (95% CI: 59-100) and 9 month graft patency was 50 (95% CI: 27-93) - graft patency detected up to 32 months after surgery. Immunohistochemistry in grafts explanted showed a presence of CD31 and CD68 positive cells in the luminal region of the vessel walls and layers of Collagen Type I in the abluminal vessel walls. CONCLUSIONS Our small diameter tissue engineered vascular graft shows openness up to 32 months after implantation. Immunohistochemistry suggests that monocyte activation may lead to vessel remodeling with thickening of the vessel wall. Research should concentrate on a manipulation of remodeling processes.
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Affiliation(s)
| | - Peter Lamm
- Department of Cardiac Surgery, Chirurgisches Klinikum Muenchen Sued, Munich, Germany
| | - Petra Wellmann
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Stefan Milz
- Department of Anatomy, Ludwig Maximilian University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
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10
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Yasuda S, Goda M, Shibuya T, Uchida K, Suzuki S, Noishiki Y, Yokoyama U, Ishikawa Y, Masuda M. An appropriately sized soft polyester external stent prevents enlargement and neointimal hyperplasia of a saphenous vein graft in a canine model. Artif Organs 2019; 43:577-583. [DOI: 10.1111/aor.13399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/06/2018] [Accepted: 11/20/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Shota Yasuda
- Department of Surgery Yokohama City University Yokohama Japan
| | - Motohiko Goda
- Department of Surgery Yokohama City University Yokohama Japan
| | - Taisuke Shibuya
- Department of Surgery Yokohama City University Yokohama Japan
| | - Keiji Uchida
- Cardiovascular Center Yokohama City University Medical Center Yokohama Japan
| | - Shinichi Suzuki
- Department of Surgery Yokohama City University Yokohama Japan
| | - Yasuharu Noishiki
- Department of Neurological Anatomy Yokohama City University Yokohama Japan
| | - Utako Yokoyama
- Cardiovascular Research Institute Yokohama City University Yokohama Japan
| | - Yoshihiro Ishikawa
- Cardiovascular Research Institute Yokohama City University Yokohama Japan
| | - Munetaka Masuda
- Department of Surgery Yokohama City University Yokohama Japan
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11
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Does No-Touch Technique Better than Conventional or Intermediate Saphenous Vein Harvest Techniques for Coronary Artery Bypass Graft Surgery: a Systematic Review and Meta-analysis. J Cardiovasc Transl Res 2018; 11:483-494. [DOI: 10.1007/s12265-018-9832-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
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12
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Loesch A, Dashwood MR. Vasa vasorum inside out/outside in communication: a potential role in the patency of saphenous vein coronary artery bypass grafts. J Cell Commun Signal 2018; 12:631-643. [PMID: 30078142 PMCID: PMC6235771 DOI: 10.1007/s12079-018-0483-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 07/30/2018] [Indexed: 01/08/2023] Open
Abstract
The saphenous vein (SV) is the most commonly used conduit for revascularization in patients undergoing coronary artery bypass surgery (CABG). The patency rate of this vessel is inferior to the internal thoracic artery (ITA). In the majority of CABG procedures the ITA is removed with its outer pedicle intact whereas the (human) SV (hSV) is harvested with pedicle removed. The vasa vasorum, a microvessel network providing the adventitia and media with oxygen and nutrients, is more pronounced and penetrates deeper towards the lumen in veins than in arteries. When prepared in conventional CABG the vascular trauma caused when removing the hSV pedicle damages the vasa vasorum, a situation affecting transmural flow potentially impacting on graft performance. In patients, where the hSV is harvested with pedicle intact, the vasa vasorum is preserved and transmural blood flow restored at graft insertion and completion of CABG. By maintaining blood supply to the hSV wall, apart from oxygen and nutrients, the vasa vasorum may also transport factors potentially beneficial to graft performance. Studies, using either corrosion casts or India ink, have shown the course of vasa vasorum in animal SV as well as in hSV. In addition, there is some evidence that vasa vasorum of hSV terminate in the vessel lumen based on ex vivo perfusion, histological and ultrastructural studies. This review describes the preparation of the hSV as a bypass conduit in CABG and its performance compared with the ITA as well as how and why its patency might be improved by harvesting with minimal trauma in a way that preserves an intact vasa vasorum.
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Affiliation(s)
- Andrzej Loesch
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Michael R Dashwood
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
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13
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Kopjar T, Ivankovic S, Lima ML, Pinheiro BB, Dashwood MR. Endoscopic or No-Touch Vein Harvesting for CABG: What is Best for the Patient? Braz J Cardiovasc Surg 2017; 31:461-464. [PMID: 28076625 PMCID: PMC5407140 DOI: 10.5935/1678-9741.20160091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/17/2016] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tomislav Kopjar
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Stjepan Ivankovic
- Department of Cardiovascular Surgery, Meridional Hospital, Vitoria, ES, Brazil
| | - Melchior Luiz Lima
- Department of Cardiovascular Surgery, Clinicord, Anis Rassi Hospital, Goiania, GO, Brazil
| | - Bruno Botelho Pinheiro
- Surgical and Interventional Sciences, Royal Free Hospital Campus, University College Medical School, London, United Kingdom
| | - Michael Richard Dashwood
- Surgical and Interventional Sciences, Royal Free Hospital Campus, University College Medical School, London, United Kingdom
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14
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Loesch A, Dashwood MR. Nerve-perivascular fat communication as a potential influence on the performance of blood vessels used as coronary artery bypass grafts. J Cell Commun Signal 2017; 12:181-191. [PMID: 28601937 PMCID: PMC5842173 DOI: 10.1007/s12079-017-0393-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/09/2017] [Indexed: 12/14/2022] Open
Abstract
Perivascular fat, the cushion of adipose tissue surrounding blood vessels, possesses dilator, anti-contractile and constrictor actions. The majority of these effects have been demonstrated in vitro and may depend on the vessel and/or the experimental method or species used. In general, the relaxant effect of perivascular adipose tissue is local and may be either endothelium-dependent or endothelium-independent. However, nerve stimulation studies show that, in general, perivascular adipose tissue (PVAT) has an anti-contractile vascular effect likely to involve an action of the autonomic vascular nerves. Apart from a direct effect of perivascular fat-derived factors on bypass conduits, an interaction with a number of neurotransmitters and other agents may play an important role in graft performance. Although the vascular effects of PVAT are now well-established there is a lack of information regarding the role and/or involvement of peripheral nerves including autonomic nerves. For example, are perivascular adipocytes innervated and does PVAT affect neuronal control of vessels used as grafts? To date there is a paucity of electrophysiological studies into nerve-perivascular fat control. This review provides an overview of the vascular actions of PVAT, focussing on its potential relevance on blood vessels used as bypass grafts. In particular, the anatomical relationship between the perivascular nerves and fat are considered and the role of the perivascular-nerve/fat axis in the performance of bypass grafts is also discussed.
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Affiliation(s)
- Andrzej Loesch
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London Medical School, Royal Free Campus, Rowland Hill Street, NW3 2PF, London, UK.
| | - Michael R Dashwood
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London Medical School, Royal Free Campus, Rowland Hill Street, NW3 2PF, London, UK
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15
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Fernández-Alfonso MS, Gil-Ortega M, Aranguez I, Souza D, Dreifaldt M, Somoza B, Dashwood MR. Role of PVAT in coronary atherosclerosis and vein graft patency: friend or foe? Br J Pharmacol 2017; 174:3561-3572. [PMID: 28150299 DOI: 10.1111/bph.13734] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/02/2017] [Accepted: 01/19/2017] [Indexed: 01/18/2023] Open
Abstract
Perivascular adipose tissue (PVAT) releases numerous factors and adipokines with paracrine effects on both vascular structure and function. These effects are variable as they depend on regional differences in PVAT among blood vessels and vary with changes in adiposity. There is considerable evidence demonstrating an association between coronary PVAT and the development and progression of coronary artery disease, which is associated with inflammation, oxidative stress, angiogenesis, vascular remodelling and blood clotting. However, PVAT also has a protective role in vascular grafts, especially the no-touch saphenous vein, in patients undergoing coronary artery bypass. This beneficial influence of PVAT involves factors such as adipocyte-derived relaxing factor, nitric oxide (NO), leptin, adiponectin, prostanoids, hydrogen sulphide and neurotransmitters, as well as mechanical protection. This article aims to highlight and compare the dual role of PVAT in the development and progression of coronary atherosclerosis, as well as in increased graft patency. Different deleterious and protective mechanisms of PVAT are also discussed and the inside-outside signalling paradigm of atherosclerosis development re-evaluated. The bidirectional communication between the arterial and venous wall and their surrounding PVAT, where signals originating from the vascular wall or lumen can affect PVAT phenotype, has been shown to be very complex. Moreover, signals from PVAT also influence the structure and function of the vascular wall in a paracrine manner. LINKED ARTICLES This article is part of a themed section on Molecular Mechanisms Regulating Perivascular Adipose Tissue - Potential Pharmacological Targets? To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.20/issuetoc.
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Affiliation(s)
- M S Fernández-Alfonso
- Instituto Pluridisciplinar and Facultad de Farmacia, Universidad Complutense, Madrid, Spain
| | - M Gil-Ortega
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad CEU-San Pablo, Madrid, Spain
| | - I Aranguez
- Instituto Pluridisciplinar and Facultad de Farmacia, Universidad Complutense, Madrid, Spain
| | - D Souza
- Department of Cardiothoracic and Vascular Surgery and University Health Care Research Center, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - M Dreifaldt
- Department of Cardiothoracic and Vascular Surgery and University Health Care Research Center, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - B Somoza
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad CEU-San Pablo, Madrid, Spain
| | - M R Dashwood
- Royal Free Hospital Campus, University College Medical School, London, UK
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Full Mimicking of Coronary Hemodynamics for Ex-Vivo Stimulation of Human Saphenous Veins. Ann Biomed Eng 2016; 45:884-897. [PMID: 27752921 DOI: 10.1007/s10439-016-1747-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/05/2016] [Indexed: 01/25/2023]
Abstract
After coronary artery bypass grafting, structural modifications of the saphenous vein wall lead to lumen narrowing in response to the altered hemodynamic conditions. Here we present the design of a novel ex vivo culture system conceived for mimicking central coronary artery hemodynamics, and we report the results of biomechanical stimulation experiments using human saphenous vein samples. The novel pulsatile system used an aortic-like pressure for forcing a time-dependent coronary-like resistance to obtain the corresponding coronary-like flow rate. The obtained pulsatile pressures and flow rates (diastolic/systolic: 80/120 mmHg and 200/100 mL/min, respectively) showed a reliable mimicking of the complex coronary hemodynamic environment. Saphenous vein segments from patients undergoing coronary artery bypass grafting (n = 12) were subjected to stimulation in our bioreactor with coronary pulsatile pressure/flow patterns or with venous-like perfusion. After 7-day stimulation, SVs were fixed and stained for morphometric evaluation and immunofluorescence. Results were compared with untreated segments of the same veins. Morphometric and immunofluorescence analysis revealed that 7 days of pulsatile stimulation: (i) did not affect integrity of the vessel wall and lumen perimeter, (ii) significantly decreased both intima and media thickness, (iii) led to partial endothelial denudation, and (iv) induced apoptosis in the vessel wall. These data are consistent with the early vessel remodeling events involved in venous bypass adaptation to arterial flow/pressure patterns. The pulsatile system proved to be a suitable device to identify ex vivo mechanical cues leading to graft adaptation.
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Papakonstantinou NA, Baikoussis NG, Goudevenos J, Papadopoulos G, Apostolakis E. Novel no touch technique of saphenous vein harvesting: Is great graft patency rate provided? Ann Card Anaesth 2016; 19:481-8. [PMID: 27397453 PMCID: PMC4971977 DOI: 10.4103/0971-9784.185537] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/25/2016] [Indexed: 11/09/2022] Open
Abstract
Coronary artery bypass grafting surgery effectively relieves signs and symptoms of myocardial ischemia. The left internal thoracic artery (LITA) graft is the gold standard having 90-95% patency rate at 10 years, whereas only 50% of saphenous vein (SV) grafts are patent at 10 years. However, there is a novel "no touch" technique in order to harvest an SV complete with its cushion of surrounding tissue, thus maintaining its endothelium-intact. Significantly superior short- and long-term graft patency rates comparable to LITA grafts can be achieved. Consequently, the SV may be revived as an important conduit in coronary artery bypass surgery.
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Affiliation(s)
- Nikolaos A. Papakonstantinou
- Department of Cardiothoracic Surgery, University Hospital of Ioannina, School of Medicine, 45500 Ioannina, Greece
- Department of Cardiothoracic Surgery, General Hospital of Athens “Evangelismos”, Athens, Greece
| | - Nikolaos G. Baikoussis
- Department of Cardiothoracic Surgery, General Hospital of Athens “Evangelismos”, Athens, Greece
| | - John Goudevenos
- Department of Cardiology, University Hospital of Ioannina, School of Medicine, 45500 Ioannina, Greece
| | - George Papadopoulos
- Department of Anesthesiology, University Hospital of Ioannina, School of Medicine, 45500 Ioannina, Greece
| | - Efstratios Apostolakis
- Department of Cardiothoracic Surgery, University Hospital of Ioannina, School of Medicine, 45500 Ioannina, Greece
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18
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Rivera J, van der Graaf GB, Escudero JR, Bellmunt S, van de Vosse F. A computational fluid dynamics study on hemodynamics for different locations of the distal anastomosis of a bypass nearby a collateral vessel in the femoropopliteal area. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:1263-1277. [PMID: 24916477 DOI: 10.1002/cnm.2656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 05/23/2014] [Accepted: 05/27/2014] [Indexed: 06/03/2023]
Abstract
Revascularization of the femoropopliteal sector is often performed by the placement of a bypass. In this paper, we have studied the effects of hemodynamics on patency of the bypass for different positions of the distal anastomosis close to a collateral artery. Computational fluid dynamics (CFD) are used for this study. The cardiac cycle-averaged wall shear stress (WSS) and oscillation index (OSI) have been analyzed. Low WSS and high OSI may increase the risk of intimal hyperplasia (IH), which may reduce bypass patency. From the CFD simulations, spots of low WSS and high OSI are found within and near the entrance of the collateral artery, near the suture line, at the floor, toe, and heel. We regarded flow ratios of 20:80 and of 35:65. It is found that for the high flow ratio anastomosis located proximal to the collateral artery is clearly more advantageous. However for the low flow ratio anastomosis located distal to the collateral artery seems to be slightly more advantageous, the results are less conclusive. One of the studied flow geometries has been validated by in vitro experiments using a time resolved particle image velocimetry technique. Velocity fields from these experiments are in good agreement with the CFD results.
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Affiliation(s)
- J Rivera
- Departament de Resistència de Materials i Estructures a l'Enginyeria, Universitat Politècnica de Catalunya, Avda. Bases de Manresa 61-73, 08242 Manresa, Spain
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19
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Hashmi SF, Krishnamoorthy B, Critchley WR, Walker P, Bishop PW, Venkateswaran RV, Fildes JE, Yonan N. Histological and immunohistochemical evaluation of human saphenous vein harvested by endoscopic and open conventional methods. Interact Cardiovasc Thorac Surg 2014; 20:178-85. [DOI: 10.1093/icvts/ivu359] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Al-Aqeedi RF, Al Suwaidi J. Outcomes of patients with prior coronary artery bypass graft who present with acute coronary syndrome. Expert Rev Cardiovasc Ther 2014; 12:715-32. [PMID: 24754442 DOI: 10.1586/14779072.2014.910116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Generally, patients with prior coronary artery bypass graft (CABG) are often under-represented in acute coronary syndrome (ACS) clinical trials. Nevertheless, there is growing global attention concerning their short- and long-term prognosis. Some reports suggest prior CABG as an independent risk factor for increased mortality, while others report an equal or a more favorable prognosis despite their adverse baseline clinical characteristics. The reasons for this 'risk-mortality paradox' need to be further evaluated. More recent reports showed a significant reduction in in-hospital morbidity and mortality over a 20-year period of follow up that may be attributed to the improvement in surgical CABG techniques and increased use of evidence-based therapies over the past two decades. In the current review we discuss the available literature regarding outcomes of prior CABG patients who are presenting with ACS.
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21
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Piola M, Prandi F, Bono N, Soncini M, Penza E, Agrifoglio M, Polvani G, Pesce M, Fiore GB. A compact and automated ex vivo vessel culture system for the pulsatile pressure conditioning of human saphenous veins. J Tissue Eng Regen Med 2013; 10:E204-15. [PMID: 23897837 DOI: 10.1002/term.1798] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/29/2013] [Accepted: 07/08/2013] [Indexed: 11/05/2022]
Abstract
Saphenous vein (SV) graft disease represents an unresolved problem in coronary artery bypass grafting (CABG). After CABG, a progressive remodelling of the SV wall occurs, possibly leading to occlusion of the lumen, a process termed 'intima hyperplasia' (IH). The investigation of cellular and molecular aspects of IH progression is a primary end-point toward the generation of occlusion-free vessels that may be used as 'life-long' grafts. While animal transplantation models have clarified some of the remodelling factors, the pathology of human SV is far from being understood. This is also due to the lack of devices able to reproduce the altered mechanical load encountered by the SV after CABG. This article describes the design of a novel ex vivo vein culture system (EVCS) capable of replicating the altered pressure pattern experienced by SV after CABG, and reports the results of a preliminary biomechanical conditioning experimental campaign on SV segments. The EVCS applied a CAGB-like pressure (80-120 mmHg) or a venous-like perfusion (3 ml/min, 5 mmHg) conditioning to the SVs, keeping the segments viable in a sterile environment during 7 day culture experiments. After CABG-like pressure conditioning, SVs exhibited a decay of the wall thickness, an enlargement of the luminal perimeter, a rearrangement of the muscle fibres and partial denudation of the endothelium. Considering these preliminary results, the EVCS is a suitable system to study the mechanical attributes of SV graft disease, and its use, combined with a well-designed biological protocol, may be of help in elucidating the cellular and molecular mechanisms involved in SV graft disease.
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Affiliation(s)
- Marco Piola
- Politecnico di Milano, Dipartimento di Elettronica, Informazione e Bioingegneria, Milan, Italy
| | - Francesca Prandi
- Laboratorio di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Nina Bono
- Politecnico di Milano, Dipartimento di Elettronica, Informazione e Bioingegneria, Milan, Italy
| | - Monica Soncini
- Politecnico di Milano, Dipartimento di Elettronica, Informazione e Bioingegneria, Milan, Italy
| | - Eleonora Penza
- II Divisione di Cardiochirurgia, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Marco Agrifoglio
- Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milan, Italy
| | - Gianluca Polvani
- Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milan, Italy
| | - Maurizio Pesce
- Laboratorio di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino-IRCCS, Milan, Italy
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22
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Yazdani SK, Otsuka F, Nakano M, Ladich E, Virmani R. Pathology of Saphenous Vein Grafts. Interv Cardiol Clin 2013; 2:241-249. [PMID: 28582132 DOI: 10.1016/j.iccl.2012.11.002] [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: 06/07/2023]
Abstract
Saphenous vein grafts (SVGs) are the most used conduits in coronary artery bypass graft (CABG) surgery; however, they are susceptible to accelerated atherosclerosis. Clinical studies have shown 10-year patency rates of SVG can be as low as 50% to 60%. This article highlights changes that are observed following CABG surgery using SVG, including intimal thickening to the development of atherosclerotic changes, and how these changes in vein graft are different from those observed in native atherosclerosis. It also discusses the role of risk factors that contribute to acceleration of SVG atherosclerosis.
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Affiliation(s)
- Saami K Yazdani
- Department of Cardiovascular Pathology, CVPath Institute, Inc. 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Fumiyuki Otsuka
- Department of Cardiovascular Pathology, CVPath Institute, Inc. 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Masataka Nakano
- Department of Cardiovascular Pathology, CVPath Institute, Inc. 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Elena Ladich
- Department of Cardiovascular Pathology, CVPath Institute, Inc. 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Renu Virmani
- Department of Cardiovascular Pathology, CVPath Institute, Inc. 19 Firstfield Road, Gaithersburg, MD 20878, USA.
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Movahed MR, Ramaraj R, Khoynezhad A, Hashemzadeh M, Hashemzadeh M. Declining in-hospital mortality in patients undergoing coronary bypass surgery in the United States irrespective of presence of type 2 diabetes or congestive heart failure. Clin Cardiol 2012; 35:297-300. [PMID: 22362298 DOI: 10.1002/clc.21970] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Significant advances in surgical techniques and postsurgical care have been made in the last 10 years. The goal of this study was to evaluate any decline in the age-adjusted in-hospital mortality rate of patients undergoing coronary artery bypass grafting (CABG) using a national database from 1989 to 2004 in the United States. HYPOTHESIS Reduction in CABG related mortality in recent years. METHODS Using the Nationwide Inpatient Sample (NIS) database, we obtained specific ICD-9-CM codes forCABG to compile the data. To exclude nonatherosclerotic cause of coronary disease, we studied only patients older than 40 years. We calculated total and age-adjusted mortality rate per 100,000 for this period. RESULTS The NIS database contained 1 145 285 patients who had CABG performed from 1988 to 2004. The mean age for these patients was 71.05 ± 9.20 years. From 1989, the age-adjusted rate for all CABG-related mortality has been decreasing steadily and reached the lowest level in 2004: 300.3 per 100 000 in 1989, (95%confidence interval [CI], 20.4-575.9) and 104.69 per 100 000 (95% CI, 22.6-186.7) in 2004. Total death also declined from 5.5% to 3.06%. This decline occurred irrespective of comorbidities such as congestive heart failure, diabetes, or acute myocardial infarction, albeit increasing the number of CABG procedures performed in high-risk patients. CONCLUSIONS The age-adjusted in-hospital mortality rate from CABG has been declining steadily and reached its lowest level in 2004, irrespective of comorbidities. This decline most likely reflects advances in surgical techniques and the use of evidence-based medicine in patients undergoing CABG.
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Affiliation(s)
- Mohammad Reza Movahed
- Department of Medicine, Division of Cardiology, The Southern Arizona VA Health Care System, University of Arizona College of Medicine, 3601 South Sixth Avenue, Tucson, AZ 85723, USA.
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Dashwood MR, Tsui JC. 'No-touch' saphenous vein harvesting improves graft performance in patients undergoing coronary artery bypass surgery: a journey from bedside to bench. Vascul Pharmacol 2012; 58:240-50. [PMID: 22967905 DOI: 10.1016/j.vph.2012.07.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 07/14/2012] [Accepted: 07/31/2012] [Indexed: 11/19/2022]
Abstract
The saphenous vein is the most commonly used conduit in patients undergoing coronary artery bypass surgery yet its patency is inferior to the internal thoracic artery. Vascular damage inflicted to the vein when using conventional harvesting techniques affects its structure. Endothelial denudation is associated with early vein graft failure while damage of the outermost vessel layers has adverse long-term effects on graft performance. While many in vitro and in vivo experimental studies aimed at improving vein graft patency have been performed to date no significant 'bench to bedside' advances have been made. Among experimental strategies employed is the use of pharmacological agents, gene targeting and external stents. A 'no-touch' technique, where the saphenous vein is removed with minimal trauma and normal architecture preserved, produces a superior graft with long term patency comparable to the internal thoracic artery. Interestingly, many experimental studies are aimed at repairing or replacing those regions of the saphenous vein damaged when harvesting conventionally. 'No-touch' harvesting is superior in coronary artery bypass patients with long-term data published 5years ago. Here we describe a 'bedside to bench' situation where the mechanisms underlying the improved performance of 'no touch' saphenous vein grafts in patients have been studied in the laboratory.
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Affiliation(s)
- Michael R Dashwood
- Department of Clinical Biochemistry, Royal Free and University College Medical School, Pond Street, London NW3 2QG, United Kingdom.
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25
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Dreifaldt M, Souza D, Bodin L, Shi-Wen X, Dooley A, Muddle J, Loesch A, Dashwood MR. The vasa vasorum and associated endothelial nitric oxide synthase is more important for saphenous vein than arterial bypass grafts. Angiology 2012; 64:293-9. [PMID: 22569406 DOI: 10.1177/0003319712443729] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
No-touch (NT) saphenous vein (SV) grafts are superior to SVs harvested by the conventional technique (CT), with a patency comparable with the internal thoracic artery (ITA). Preservation of the vasa vasorum is implicated in the success of NT harvesting. We compared the vasa vasorum and endothelial nitric oxide synthase (eNOS) in NT SV with ITA and radial artery (RA) grafts. Skeletonized SV (SSV) was also analyzed. The NT SV had a higher number and larger vasa vasorum compared with ITA (P = .0001) and RA (P = .0004) that correlated with eNOS protein. Activity of eNOS in SSV grafts was significantly lower than NT SV grafts (P = 004). Since a high proportion of the vasa vasorum are removed in SSV using the CT, we suggest that preservation of the vasa vasorum and eNOS-derived NO contributes to the high patency for NT as compared with SSV grafts.
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Affiliation(s)
- Mats Dreifaldt
- Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Sweden
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26
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Prolonged indwelling time of temporary vascular shunts is associated with increased endothelial injury in the porcine mesenteric artery. ACTA ACUST UNITED AC 2011; 70:1464-70. [PMID: 21817984 DOI: 10.1097/ta.0b013e31820c9b4e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Temporary intravascular shunts (TIVS) have been used as a damage control surgery (DCS) adjuncts in superior mesenteric artery (SMA) injuries, both experimentally and clinically. However, no study to date has evaluated the relationship between shunt indwelling time and resultant endothelial cell (EC) injury. We hypothesized that prolonged use of TIVS in SMA injuries would jeopardize EC integrity. METHOD After laparotomy, the SMA was clamped and transected while pigs were hemorrhaged to 40 mm Hg for 30 minutes. A TIVS was inserted between transected ends of the SMA without systemic anticoagulation. Totally, 24 animals were resuscitated and randomized to different shunt indwelling time groups: A, 3 hours; B, 6 hours; C, 9 hours; and D, 12 hours. Patency of shunts was monitored and recorded. Continuous wave Doppler was used as a determinant of adequacy of flow through the shunts. Transmural SMA biopsies from areas of TIVS placement were examined with electron microscopy for histopathologic injury after staining with hematoxylin and eosin and immunofluorescence using a validated histopathologic injury score (minimum-maximum score: 0-4). RESULTS Severity of endothelial injury was observed to be directly related to shunt indwell time. SMA transmural biopsies harvested from group D animals showed the most profound injury, demonstrating extensive EC denudations and marked intimal rupture (injury grade, 3.4 ± 0.2). Sections from group A animals revealed the mildest EC injury (1.3 ± 0.3 vs. group D p < 0.01). No significant difference was detected between group A and B. EC injury grade in group C (2.7 ± 0.6) was higher than that in group B (1.8 ± 0.6) but did not reach statistical significance (p = 0.58). CONCLUSION When possible, vascular reconstruction following use of shunts should include an interposition graft after debridement of the arterial edges having interfaced with the shunt. Finally, to minimize intimal injury to the native vessel, this model suggests that indwell times of shunts should be <9 hours.
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27
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Comparison of Clipping Versus Ligation of Side-Branches During Saphenous Vein Graft Harvesting: Which Method Is Superior? Ann Vasc Surg 2011; 25:669-74. [DOI: 10.1016/j.avsg.2010.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/21/2010] [Accepted: 11/22/2010] [Indexed: 11/21/2022]
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Dreifaldt M, Souza DSR, Loesch A, Muddle JR, Karlsson MG, Filbey D, Bodin L, Norgren L, Dashwood MR. The "no-touch" harvesting technique for vein grafts in coronary artery bypass surgery preserves an intact vasa vasorum. J Thorac Cardiovasc Surg 2010; 141:145-50. [PMID: 20381817 DOI: 10.1016/j.jtcvs.2010.02.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 12/15/2009] [Accepted: 02/01/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Our objective was to evaluate the impact of vein graft harvesting technique on structure and function of vasa vasorum. METHODS Paired segments of great saphenous veins harvested either with conventional harvesting technique or no-touch technique were obtained from 9 consecutive patients undergoing coronary artery bypass grafting. Quantitative measurements, using immunohistochemistry and morphometry, were performed. Ultrastructural analyses of vasa vasorum were performed with electron microscopy. Video footage of superficial vasa vasorum in an implanted saphenous vein graft harvested with the no-touch technique was captured during a coronary bypass operation and is presented for online viewing. RESULTS The total area of vasa vasorum in vein grafts harvested with the conventional technique was significantly reduced both in the media (P = .007) and in the adventitia (P = .014) compared with vein grafts harvested with the no-touch technique. Ultrastructural findings indicated that the no-touch technique preserved an intact vasa vasorum whereas the conventional technique did not. Video footage showed retrograde flow in the vasa vasorum in vein graft harvested with the no-touch technique. CONCLUSIONS These findings show that the no-touch technique for saphenous vein graft harvesting for coronary bypass grafting preserves an intact vasa vasorum. This could represent one of the mechanisms underlying the improved patency of saphenous vein grafts harvested with this technique.
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Affiliation(s)
- Mats Dreifaldt
- Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden.
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29
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Abstract
The saphenous vein is the most commonly used graft for revascularization procedures in patients with coronary artery disease and critical limb ischaemia. However, the patency rate of this vessel is poor, with a high proportion of patients requiring further surgery. Early graft occlusion is caused by vasoconstriction or thrombus formation, with later stages of graft failure being due to neointimal formation or atherosclerosis. Apart from its potent constrictor action, endothelin-1 is also a potent proliferative and proinflammatory peptide that is implicated in a number of vascular diseases. The surgical trauma caused during preparation of the saphenous vein as a bypass graft stimulates the release of a number of factors affecting vascular reactivity and structure, including endothelin-1. Endothelin-1 not only constricts animal and human isolated saphenous vein segments but also causes vascular smooth muscle proliferation and neointimal thickening in vitro, actions that are mediated via endothelin (A and B) receptors. Experimentally, the effects of subtype-selective and dual receptor antagonists have been shown to inhibit endothelin-1-mediated constriction and cell proliferation of the saphenous vein. In this review, data supporting a role of endothelin-1 in vein graft occlusion are presented, and the therapeutic potential of endothelin receptor antagonists in improving graft performance is discussed.
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Affiliation(s)
- M R Dashwood
- Royal Free and University College Medical School, London, UK.
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30
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Dashwood MR, Savage K, Tsui JCS, Dooley A, Shaw SG, Fernández Alfonso MS, Bodin L, Souza DSR. Retaining perivascular tissue of human saphenous vein grafts protects against surgical and distension-induced damage and preserves endothelial nitric oxide synthase and nitric oxide synthase activity. J Thorac Cardiovasc Surg 2009; 138:334-40. [PMID: 19619776 DOI: 10.1016/j.jtcvs.2008.11.060] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 10/29/2008] [Accepted: 11/19/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Conventional harvesting of saphenous vein used for coronary artery bypass surgery induces a vasospasm that is overcome by high-pressure distension. Saphenous vein harvested with its cushion of perivascular tissue by a "no touch" technique does not undergo vasospasm and distension is not required, leading to an improved graft patency. The aim of this study is to investigate the effect of surgical damage and high-pressure distension on endothelial integrity and endothelial nitric oxide synthase expression and activity in saphenous vein harvested with and without perivascular tissue. METHODS Saphenous veins from patients (n = 26) undergoing coronary artery bypass surgery were prepared with and without perivascular tissue. We analyzed the effect of 300 mm Hg distension on morphology and endothelial nitric oxide synthase/nitric oxide synthase activity using a combination of immunohistochemistry, Western blot analysis, reverse transcriptase polymerase chain reaction, and enzyme assay in distended (with and without perivascular tissue) compared with nondistended (with and without perivascular tissue) segments. RESULTS Distension induced substantial damage to the luminal endothelium (assessed by CD31 staining) and vessel wall. Endothelial nitric oxide synthase expression and activity were significantly reduced by high-pressure distension and removal of, or damage to, perivascular tissue. The effect of distension was significantly less for those with perivascular tissue than for those without perivascular tissue in most cases. CONCLUSION The success of the saphenous vein used as a bypass graft is affected by surgical trauma and distension. Veins removed with minimal damage exhibit increased patency rates. We show that retention of perivascular tissue on saphenous vein prepared for coronary artery bypass surgery by the "no touch" technique protects against distension-induced damage, preserves vessel morphology, and maintains endothelial nitric oxide synthase/nitric oxide synthase activity.
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Affiliation(s)
- Michael R Dashwood
- Department of Clinical Biochemistry, Royal Free and University College Medical School, Royal Free Campus, Pond Street, London, United Kingdom.
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31
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Reisinger U, Schwaiger S, Zeller I, Messner B, Stigler R, Wiedemann D, Mayr T, Seger C, Schachner T, Dirsch VM, Vollmar AM, Bonatti JO, Stuppner H, Laufer G, Bernhard D. Leoligin, the major lignan from Edelweiss, inhibits intimal hyperplasia of venous bypass grafts. Cardiovasc Res 2009; 82:542-9. [PMID: 19228707 PMCID: PMC2682615 DOI: 10.1093/cvr/cvp059] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aims Despite the lower patency of venous compared with arterial coronary artery bypass grafts, ∼50% of grafts used are saphenous vein conduits because of their easier accessibility. In a search for ways to increase venous graft patency, we applied the results of a previous pharmacological study screening for non-toxic compounds that inhibit intimal hyperplasia of saphenous vein conduits in organ cultures. Here we analyse the effects and mechanism of action of leoligin [(2S,3R,4R)-4-(3,4-dimethoxybenzyl)-2-(3,4-dimethoxyphenyl)tetrahydrofuran-3-yl]methyl (2Z)-2-methylbut-2-enoat, the major lignan from Edelweiss (Leontopodium alpinum Cass.). Methods and results We found that leoligin potently inhibits vascular smooth muscle cell (SMC) proliferation by inducing cell cycle arrest in the G1-phase. Leoligin induced cell death neither in SMCs nor, more importantly, in endothelial cells. In a human saphenous vein organ culture model for graft disease, leoligin potently inhibited intimal hyperplasia, and even reversed graft disease in pre-damaged vessels. Furthermore, in an in vivo mouse model for venous bypass graft disease, leoligin potently inhibited intimal hyperplasia. Conclusion Our data suggest that leoligin might represent a novel non-toxic, non-thrombogenic, endothelial integrity preserving candidate drug for the treatment of vein graft disease.
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Affiliation(s)
- Ute Reisinger
- Cardiac Surgery Research Laboratory, Department of Cardiac Surgery, Innsbruck Medical University, Innrain 66, A-6020 Innsbruck, Austria
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Hassantash SA, Bikdeli B, Kalantarian S, Sadeghian M, Afshar H. Pathophysiology of aortocoronary saphenous vein bypass graft disease. Asian Cardiovasc Thorac Ann 2008; 16:331-6. [PMID: 18670032 DOI: 10.1177/021849230801600418] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aortocoronary saphenous vein bypass grafting relieves anginal pain in patients with coronary artery disease. However, its effectiveness is limited due to graft failure; the 10-year patency rate is 50%-60%. Early, 1-year and late graft failure may be due to thrombosis, fibrointimal hyperplasia and atherosclerosis, respectively. There is general agreement that vein graft atherosclerosis differs from arterial lesions in terms of temporal and histological changes. Vein graft atherosclerosis is more rapid, with diffuse concentric changes and a less noticeable fibrous cap, making venous plaques more vulnerable to rupture and subsequent thrombus formation. Despite progress in understanding the pathophysiology, some aspects of vein graft atherosclerosis need to be clarified. This review focuses on the pathophysiologic aspects of this widespread, costly and disabling disease, with emphasis on late graft occlusion and distinctions between arterial and venous atherosclerosis in terms of histology, pathophysiology and risk factors.
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Affiliation(s)
- Seyed-Ahmad Hassantash
- Department of Cardiovascular Surgery, Modarres Medical Center, Shaheed Beheshti University of Medical Sciences, Saadat-Abad, Tehran, Iran.
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Dashwood MR, Dooley A, Shi-Wen X, Abraham DJ, Souza DSR. Does periadventitial fat-derived nitric oxide play a role in improved saphenous vein graft patency in patients undergoing coronary artery bypass surgery? J Vasc Res 2007; 44:175-81. [PMID: 17308436 DOI: 10.1159/000099833] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 12/02/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The saphenous vein is commonly used for coronary artery bypass surgery but its patency is poor. Vascular damage occurs during conventional surgery. However, patency improves when the graft is harvested with minimal surgical trauma, partly due to preservation of vascular endothelial nitric oxide synthase (eNOS) and tissue sources of nitric oxide (NO), a factor possessing both dilatory and anti-proliferative properties. Apart from these grafts exhibiting an intact luminal endothelium they are harvested complete with a surrounding cushion of tissue, much of which is fat. METHODS Immunostaining for eNOS was performed on vein graft sections and reverse-transcriptase polymerase chain reaction and Western blotting were used to identify eNOS mRNA and protein. NO synthase activity was measured using the citrulline assay. RESULTS Immunohistochemistry identified eNOS staining of vein graft segments, including dense staining of the cushion of perivascular fat and associated structures surrounding the vein. eNOS protein was confirmed in both the vein and surrounding fat by Western blot analysis. Using the citrulline assay, the perivascular fat and underlying vein possessed comparable NO synthase activity. CONCLUSIONS Our observations suggest that perivascular fat-derived NO plays a beneficial role in saphenous veins harvested atraumatically and used as grafts in patients undergoing coronary artery bypass surgery.
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Affiliation(s)
- Michael R Dashwood
- Department of Clinical Biochemistry, Royal Free and University College Medical School, London, UK.
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34
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Dashwood MR, Loesch A. Surgical damage of the saphenous vein and graft patency. J Thorac Cardiovasc Surg 2007; 133:274-5. [PMID: 17198836 DOI: 10.1016/j.jtcvs.2006.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Accepted: 09/28/2006] [Indexed: 11/20/2022]
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35
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Dashwood MR, Savage K, Dooley A, Shi-Wen X, Abraham DJ, Souza DSR. Effect of vein graft harvesting on endothelial nitric oxide synthase and nitric oxide production. Ann Thorac Surg 2006; 80:939-44. [PMID: 16122459 DOI: 10.1016/j.athoracsur.2005.03.042] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 03/03/2005] [Accepted: 03/08/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although the saphenous vein is the most commonly used conduit for coronary artery bypass surgery occlusion rates are high, with more than 50% grafts failing within 10 years. Nitric oxide, a potent vasodilator, also inhibits platelet aggregation, thrombus formation and vascular smooth muscle cell proliferation, is implicated in various vascular pathologies, including graft failure. METHODS Saphenous veins were obtained from patients undergoing bypass surgery harvested by conventional methods and with minimal handling, using a "no-touch" technique. Tissue distribution and protein expression of endothelial nitric oxide synthase was compared using immunohistochemistry and Western blot analysis. Nitric oxide generation was assessed using the citrulline assay. RESULTS There was injury to conventional compared with no-touch vein segments, in particular to the lumenal endothelium and tunica adventitia. This injury was accompanied by an absence of endothelial nitric oxide synthase immunostaining at regions of endothelial denudation and damaged adventitial layer of conventional veins and a significant reduction (p < 0.05) in endothelial nitric oxide synthase protein expression. Furthermore, nitric oxide release from conventional tissue extracts was significantly (p < 0.05) lower than no-touch vein segments. CONCLUSIONS Our results show that there is a reduction in endothelial nitric oxide synthase and nitric oxide release in saphenous veins harvested by conventional surgical methods compared with those prepared atraumatically. These observations may influence graft performance.
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Affiliation(s)
- Michael R Dashwood
- Department of Clinical Biochemistry, Royal Free and University College Medical School, Pond Street, London, United Kingdom.
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36
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Eriksson EE, Karlof E, Lundmark K, Rotzius P, Hedin U, Xie X. Powerful Inflammatory Properties of Large Vein Endothelium In Vivo. Arterioscler Thromb Vasc Biol 2005; 25:723-8. [PMID: 15681299 DOI: 10.1161/01.atv.0000157578.51417.6f] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Inflammatory responses of large vein endothelium are of importance in pathological processes such as venous thrombosis, chronic venous congestion, and vein graft atherosclerosis. However, the inflammatory properties of large vein endothelium are unclear. METHODS AND RESULTS In this study, we used several microscopy techniques to investigate the inflammatory properties of large vein endothelium in vivo. We show that the endothelium in the mouse inferior vena cava (IVC) possesses powerful inflammatory properties that are distinct from the less inflammatory reactive aortic endothelium and virtually identical to endothelial responses in postcapillary venules. Inflammatory stimulation with tumor necrosis factor-alpha induced strong expression of cell adhesion molecules (CAMs) in the IVC. These CAMs promoted recruitment of leukocytes, platelets, and erythrocytes to the vein wall. The inflammatory responses altered endothelial structure and increased endothelial permeability in the IVC. Accumulation of blood cells and endothelial damage were markedly reduced in mice deficient in the endothelial leukocyte recruitment molecules E-selectin and P-selectin, indicating a central role for these molecules in driving structural and functional changes of IVC endothelium. CONCLUSIONS These findings provide the first comprehensive demonstration of the inflammatory capacity of large vein endothelium and emphasize the actions of endothelial cells as targets in large vein disease.
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Affiliation(s)
- Einar E Eriksson
- Department of Physiology and Pharmacology, Karolinska Institutet S-171 77 Stockholm, Sweden.
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Cabrera Fischer EI, Bia Santana D, Cassanello GL, Zócalo Y, Crawford EV, Casas RF, Armentano RL. Reduced Elastic Mismatch Achieved by Interposing Vein Cuff in Expanded Polytetrafluoroethylene Femoral Bypass Decreases Intimal Hyperplasia. Artif Organs 2005; 29:122-30. [PMID: 15670281 DOI: 10.1111/j.1525-1594.2005.29023.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Wall shear stress, arterial wall elasticity, and intimal hyperplasia are related. The aim of this study was to investigate the in vitro mechanical properties of ovine femoral arteries, jugular veins, and expanded polytetrafluoroethylene conduits, and to evaluate postoperative intimal hyperplasia. METHODS Arterial, venous, and ePTFE mechanical properties were studied in a circulating loop at isobaric systemic pressures. Histological studies of intimal hyperplasia in ePTFE-bypassed femoral arteries with and without Miller cuffs were performed at the 40th and 120th day. RESULTS The incremental elastic modulus of veins was significantly higher than that of femoral arteries (P < 0.05), but significantly lower than that of ePTFE graft conduits (P < 0.05). Intimal hyperplasia was significantly less in Miller-cuff-bypassed arteries both at the 40th and 120th day (P < 0.01). CONCLUSIONS The Miller cuff acts as a mechanical adapter enhancing wall shear stress and the elastic matching between ePTFE and the native artery, resulting in an early decrease of intimal hyperplasia.
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Dashwood MR, Anand R, Loesch A, Souza DSR. Hypothesis: a potential role for the vasa vasorum in the maintenance of vein graft patency. Angiology 2004; 55:385-95. [PMID: 15258684 DOI: 10.1177/000331970405500405] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Autologous saphenous vein is the most commonly used conduit for coronary artery bypass surgery with more than 50% grafts occluding within 10 years. In conventional preparation the vein undergoes considerable surgical trauma with damage to the outer layers during harvesting. Within these regions are situated the vasa vasorum and small vessels providing oxygen and nutrients to the vessel wall. Certain vasa vasorum terminate in the vessel lumen where it is suggested that they have a physiological role. Preservation of the vasa vasorum of saphenous veins used as bypass conduits may play an important role in the maintenance of graft patency.
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Affiliation(s)
- Michael R Dashwood
- Department of Clinical Biochemistry, Royal Free and University College Medical School, London, United Kingdom.
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Prager M, Türel Z, Speidl WS, Zorn G, Kaun C, Niessner A, Heinze G, Huk I, Maurer G, Huber K, Wojta J. Chlamydia pneumoniae in carotid artery atherosclerosis: a comparison of its presence in atherosclerotic plaque, healthy vessels, and circulating leukocytes from the same individuals. Stroke 2002; 33:2756-61. [PMID: 12468766 DOI: 10.1161/01.str.0000039322.66575.77] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE There is growing clinical and experimental evidence that infections with Chlamydia pneumoniae might contribute to the development and progression of atherosclerosis. However, studies detecting the pathogen in atherosclerotic lesions examined either only atherosclerotic vessels or control vessels without atherosclerosis obtained from a different group of individuals. We analyzed atherosclerotic plaques of the carotid artery, samples of apparently healthy greater saphenous veins, and circulating leukocytes from the same individual patients for the presence of C pneumoniae. METHODS From each of 46 patients undergoing carotid endarterectomy for symptomatic carotid artery stenosis, these samples were analyzed by nested polymerase chain reaction for C pneumoniae-specific DNA. Furthermore, we determined IgA and IgG titers specific for the pathogen and plasma levels of C-reactive protein in these patients. RESULTS C pneumoniae DNA was detected in 86.9% of the leukocytes and in 82.6% of the atherosclerotic plaques but in only 6.5% of the saphenous veins. In 85% of patients who also had leukocytes positive for C pneumoniae, the atherosclerotic plaques were positive and the saphenous veins were negative. The presence of C pneumoniae-specific DNA in leukocytes significantly coincided with the presence of the respective DNA in the plaques of the carotid arteries (P=0.0002). No association between the presence of C pneumoniae and specific IgA or IgG levels was seen. C-reactive protein levels were significantly higher in patients with chlamydia-positive atherosclerotic plaques and with positive leukocytes than in patients with negative plaques of the carotid arteries or negative leukocytes, respectively (P<0.01, P<0.05). CONCLUSIONS Our observation of >80% incidence of C pneumoniae in atherosclerotic plaques of the carotid artery does not prove causality between an infection with the pathogen and the development of atherosclerosis. It must be emphasized, however, that >90% of apparently healthy saphenous veins were negative for C pneumoniae. Given the structural and functional differences between veins and arteries, careful interpretation of our results regarding a possible causative role of C pneumoniae seems warranted.
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Affiliation(s)
- Manfred Prager
- Department of Vascular Surgery, University of Vienna, Vienna, Austria
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