Abstract

BackgroundVenous aortocoronary graft arterialization may precede a preterm occlusion in some coronary artery bypass grafting (CABG) patients. The aim of the present study was to identify ultrastructural variations in the saphenous vein wall that may have an impact on the development of venous graft disease in CABG patients.MethodsThe study involved 365 consecutive patients with a mean age of 62.9±9.4 years who underwent isolated CABG. The thickness and area of the whole venous wall, the tunica intima, the tunica media and the adventitia and the number and shape (length, thickness and length/thickness ratio) of the nuclei in the medial smooth muscle cells nuclei in the distal saphenous vein segments were evaluated by ultrastructural studies. Patients were followed up for 41 to 50 months (mean 45.1±5.1). Saphenous vein graft patency was assessed by follow-up coronary angiography. Logistic regression models were used to identify independent risk factors for late graft failure.ResultsIn 71 patients significant lesions in the saphenous vein grafts were observed. The whole venous wall thickness (437.5 µm vs. 405.5 µm), tunica media thickness (257.2 µm vs. 211.5 µm), whole venous wall area (2.23 mm2 vs. 2.02 mm2) and tunica media area (1.09 mm2 vs. 0.93 mm2) were significantly larger for this group of patients than for those without graft disease. In the latter group more elongated smooth muscle cell nuclei (higher length/thickness ratio) were found in the tunica media of the saphenous vein segments. Thickening of the saphenous vein tunica media and chunky smooth muscle cell nuclei were identified as independent risk factors for graft disease development.ConclusionsSaphenous vein tunica media hypertrophy (resulting in wall thickening) and chunky smooth muscle cell nuclei might predict the development of venous graft disease.

Highlights

  • Coronary artery bypass grafting (CABG) is the method of choice for the treatment of patients with advanced coronary artery disease (CAD)

  • Perioperative myocardial infarction was diagnosed in 8 patients. This diagnosis was established according to the latest European Society of Cardiology definition of myocardial infarction related to coronary artery bypass grafting (CABG) [19]

  • Results of the Logistic Regression Models (Table 6) The logistic regression model based on histopathological features showed that a hypertrophic tnuca media and chunky medial smooth muscle cells (SMCs) nuclei were independent risk factors for the development of severe venous graft disease and poor outcome among CABG patients treated with venous aortocoronary bypass grafts

Read more

Summary

Introduction

Coronary artery bypass grafting (CABG) is the method of choice for the treatment of patients with advanced coronary artery disease (CAD). In majority of these patients, this procedure significantly improves prognosis and quality of life [1,2]. The interposition of SV transplants into the arterial system exposes the venous wall to higher wall stretch forces and shear stress. These stresses may result in a series of the biological events within the venous wall that are called ‘‘venous grafts arterialization’’ [9,10]. The aim of the present study was to identify ultrastructural variations in the saphenous vein wall that may have an impact on the development of venous graft disease in CABG patients

Objectives
Methods
Results
Discussion
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call