Early adaptation of human lower extremity vein grafts: wall stiffness changes accompany geometric remodeling

Abstract

Objective To quantitatively describe the temporal changes in elastic properties and wall dimensions in lower-extremity vein grafts after implantation. Design of study This is a prospective study of patients (N = 38) undergoing lower extremity bypass grafts (N = 41) with autologous veins. Pulse wave velocity (PWV), luminal diameter, and wall thickness measurements were obtained by duplex ultrasound scan intraoperatively and at 1, 3, and 6 months postoperatively for assessment of graft dimensions and wall stiffness. Results Lower extremity vein grafts showed an increase in PWV (from 16 ± 1 to 21 ± 3 cm/s; mean ± SEM; P = .08), reflecting an increase in wall stiffness (from 1.2 ± 0.2 to 2.5 ± 0.7 × 10 6 dynes/cm; P = .02) and wall thickness (from 0.47 ± 0.03 to 0.61 ± 0.004 mm; P = .04) over the first 6 months after implantation. Changes in lumen diameter were positively correlated with changes in external graft diameter ( P < .01) and negatively correlated with initial lumen diameter ( P < .01) but not with changes in the wall thickness. Conclusions These results suggest complex remodeling of vein grafts during the first several months after implantation, with increased wall thickness occurring independent of variable changes in lumen diameter. Simultaneously, a marked increase in wall stiffness over this interval suggests a likely role for collagen deposition.