Localization of tissue plasminogen activator in relation to morphologic changes in human saphenous veins used as coronary artery bypass autografts.

Abstract

Employing the histochemical fibrin slide technique, we studied the localization of fibrinolytically active sites in relation to morphologic changes in saphenous veins used as coronary artery bypass autografts. Of veins from 100 patients undergoing surgery for coronary heart disease, 63 samples revealed well-demarcated intimal fibrinolytic activity. Distinct foci of lysis were present in the media and adventitia of all vein samples corresponding to the distribution of the vasa vasorum. Graft specimens obtained by autopsy from 13 patients surviving from 30 minutes to 13 days revealed considerable intimal damage with loss of fibrinolytic activity. Medial fibrinolytic activity disappeared early concomitant with disorganization of the medial muscle fibers, followed by necrosis, atrophy and fibrous transformation of the muscular structures. Adventitial activity disappeared later. One reoperation sample obtained after 8 weeks in situ showed moderate proliferative intimal fibrosis without an apparent neo-intima and without fibrinolytic activity, and one section showed evidence of valve cusp fibrosis, while most of the media had been replaced by fibrous tissue. Numerous foci of "medial" -adventitial fibrinolytic activity indicated presence of vascular structures in the venous wall. The fibrin slide technique is a convenient tool for studying the process of revascularization.