Abstract
IntroductionAngiographically visible plaques in patent vein grafts are usually detected years after surgery. Our aim was to examine early plaque formation in vein grafts.MethodsBypass angiography and intravascular ultrasonography (IVUS) examination were performed on 77 aortocoronary saphenous vein grafts (SVGs) implanted in 36 patients during the first 2 years after CABG. In each graft, a good quality 25 mm ultrasound image was analyzed. We measured: plaque area, lumen area, external elastic membrane (EEM) area, graft area and wall area. For the comparative assessment of SVGs, the index plaque area/EEM area was calculated. Data were analyzed for the following 4 time periods: I – 0-4 months (22 grafts), II – 5-8 months (23 grafts), III – 9-12 months (19 grafts) and IV – 13-16 months (13 grafts) after CABG. Student’s t and Fisher-Snedecor tests were used for the purpose of statistical analysis in this retrospective study.ResultsIn period I, plaque formation (neointimal) was observed in 10 grafts (45%), with a mean plaque area of 1.59 mm., in 6 grafts (26%) in period II, with a mean plaque area of 1.03 mm. and in 15 grafts (71%) in period III, with a mean plaque area of 1.41 mm., and in all (100%) grafts in period IV, with mean plaque area of 2,3 mm.. Average index plaque area/EEM area in periods I, II, III and IV were 0.12, 0.08, 0.13 and 0.22. We have showed a significant plaque increase between periods II and IV(P=0.038).ConclusionIVUS showed plaque in about 40% of venous grafts during the first year after CABG. Between 13-16 months plaque was visible in all studied grafts.
Highlights
Visible plaques in patent vein grafts are usually detected years after surgery
It is estimated that ten years after surgery, only 60% of implanted aortocoronary venous bypasses remain patent and only 50% of patent bypasses are free of atheromatous formations[7,8]
The aim of the study was to analyze the formation of neointima in venous grafts in the first 1.5 years after the surgical procedure using intravascular ultrasonography (IVUS)
Summary
Visible plaques in patent vein grafts are usually detected years after surgery. Because it is not always possible to achieve complete revascularization through only arterial grafts, the use of saphenous vein grafts (SVGs) is still common worldwide. The correct identification of the neointimal formation in venous grafts may help in the decision-making regarding the intensification of lipid-lowering therapy, the use of antiplatelet drugs or even gene therapy in the future. The aim of these therapies is to slow or preferably reverse the progression of plaque formation within grafted veins. It is estimated that ten years after surgery, only 60% of implanted aortocoronary venous bypasses remain patent and only 50% of patent bypasses are free of atheromatous formations[7,8].
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