Abstract
While the pathophysiology and clinical significance of arterial calcifications have been studied extensively, minimal focus has been placed on venous calcification deposition. In this study, we evaluated the association between calcium deposition in human saphenous vein (HSV), endothelial function, and patient demographic risk factors. Fifty-four HSV segments were collected at the time of coronary artery bypass graft (CABG) surgery. The presence or absence of calcium deposits was visualized using the Von Kossa staining method. Endothelial function was determined by measuring muscle tissue contraction with phenylephrine and relaxation with carbachol in a muscle bath. Additional segments of vein underwent histologic evaluation for preexisting intimal thickness and extracellular matrix (ECM) deposition. Patient demographics data were obtained through our institution’s electronic medical record, with patient consent. Calcium was present in 16 of 54 samples (29.6%). Veins with calcium deposits had significantly greater intimal-to-medial thickness ratios (p = 0.0058) and increased extracellular collagen deposition (p = 0.0077). Endothelial relaxation was significantly compromised in calcified veins vs. those without calcium (p = 0.0011). Significant patient risk factors included age (p = 0.001) and preoperative serum creatinine (p = 0.017). Calcified veins can be characterized as having endothelial dysfunction with increased basal intimal thickness and increased ECM deposition. Patient risk factors for calcium deposits in veins were similar to those for arteries, namely, advanced age and kidney disease. Further studies are needed to determine the effect of preexisting vein calcification on short- and long-term graft patency.
Highlights
Saphenous vein is the most commonly used bypass conduit for coronary artery and peripheral arterial bypass surgery
Recent large prospective studies have indicated that graft failure rates remain high [39% of lower extremity bypass grafts and 45% of coronary artery bypass grafts (CABGs)
Calcification Associated with Endothelial Dysfunction will fail within 12–18 months, Project of Ex vivo Vein Graft Engineering via Transfection (PREVENT) III and PREVENT IV trials, respectively] [1, 2]
Summary
Saphenous vein is the most commonly used bypass conduit for coronary artery and peripheral arterial bypass surgery. Calcification Associated with Endothelial Dysfunction will fail within 12–18 months, Project of Ex vivo Vein Graft Engineering via Transfection (PREVENT) III and PREVENT IV trials, respectively] [1, 2]. Preexisting disease in the saphenous vein has been implicated as a contributing factor to the development of IH and graft failure. The most frequently encountered lesion found on pre-bypass vein histology is intimal thickening [4]. Our lab has previously published an association between preexisting intimal thickness and endothelial dysfunction [5]. Marin et al reported more frequent peripheral bypass graft failure with use of thicker-walled saphenous vein [6]. Additional characteristics in morphology may contribute to the baseline quality of a saphenous vein graft
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