Abstract
BackgroundAccelerated atherosclerosis is the main cause of late aortocoronary vein graft failure. We aimed to develop a large animal model for the study of pathogenesis and treatment of vein graft atherosclerosis.MethodsAn autologous reversed jugular vein graft was inserted end-to-end into the transected common carotid artery of ten hypercholesteroemic minipigs. The vein grafts were investigated 12-14 weeks later with ultrasound and angiograpy in vivo and microscopy post mortem.ResultsOne minipig died during follow up (patent vein graft at autopsy), and one vein graft thrombosed early. In the remaining eight patent vein grafts, the mean (standard deviation) intima-media thickness was 712 μm (276 μm) versus 204 μm (74 μm) in the contralateral control internal jugular veins (P < .01). Advanced atherosclerotic plaques were found in three of four oversized vein grafts (diameter of graft > diameter of artery). No plaques were found in four non-oversized vein grafts (P < .05).ConclusionsOur model of jugular vein graft in the common carotid artery of hypercholesterolemic minipigs displayed the components of human vein graft disease, i.e. thrombosis, intimal hyperplasia, and atherosclerosis. Advanced atherosclerosis, the main cause of late failure of human aortocoronary vein grafts was only seen in oversized grafts. This finding suggests that oversized vein grafts may have detrimental effects on patient outcome.
Highlights
Accelerated atherosclerosis is the main cause of late aortocoronary vein graft failure
Aortocoronary vein graft atherosclerosis and late graft failure is more common in patients with higher plasma cholesterol levels [13,14], and plasma cholesterol lowering decreases the risk of late aortocoronary vein graft failure in patients [15,16]
We present a human-like model of vein graft disease including advanced atherosclerosis in hypercholesterolemic minipigs
Summary
Accelerated atherosclerosis is the main cause of late aortocoronary vein graft failure. We aimed to develop a large animal model for the study of pathogenesis and treatment of vein graft atherosclerosis. Aortocoronary vein graft disease can be divided into three discrete, but pathophysiologically linked, processes: thrombosis, intimal hyperplasia, and atherosclerosis [1]. That do not occlude early, develop intimal hyperplasia which rarely causes significant stenosis in itself. Late aortocoronary vein graft failure is most often caused by rupture of an atherosclerotic plaque in the graft leading to thrombotic occlusion [2]. The risk factors for Rupture of a lipid-rich atherosclerotic plaque with thrombosis leading to late graft failure remains a substantial clinical problem [1], so we aimed at developing a new animal model in which vein graft atherosclerosis, the primary cause of late vein graft failure, can be studied
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