Autogenous Jugular Vein Research Articles

Bletilla striata Polysaccharide Prevents Restenosis of Vein Graft Through Inhibiting Cell Proliferation in Rat Model

Coronary artery bypass grafting (CABG) is still the most effective method for the treatment of coronary heart disease at present. However, the restenosis of vein grafts following surgery is an important complication of CABG. In this study, Bletilla striata polysaccharide (BSP), which has anti-inflammatory and antiproliferative properties, was used to prevent or delay the proliferation of venous bridge endothelial cells in a rat model. We transplanted the autogenous jugular vein to the rat carotid artery, and wrapped it with BSP. We carried out experiments in 4 groups (with 24 rats in each group): a high-BSP dose group (the HBG group, 10 mg), a low-BSP dose group (the LBG group, 3 mg), a pluronic gel group (the gel group), and a control group. Vein grafts were then harvested after 3, 14, and 28 days. Following transplantation, we used color Doppler ultrasound to assess the patency of the transplanted vein. The grafted veins were stained with hematoxylin and eosin (H&E) and Masson to measure the thickness of the intima and media of the blood vessels. Proliferating cell nuclear antigen (PCNA) and vascular cell adhesion molecule-l (VCAM-1) were assessed in vein grafts by immunohistochemistry and western blotting. We detected a significant reduction in the proliferation of endothelial cells in the BSP group compared with the control group (P < 0.05). H&E and Masson’s trichrome staining showed that the extent of intimal hyperplasia in transplanted veins from the high BSP group (HBS) (67.42 ± 0.54 µm) and low BSP group (LBS) (120.83 ± 1.87 µm) groups was significantly lower than that in the control group (257.03 ± 2.74 µm, P < 0.05), and that the extent of intimal hyperplasia in the HBS group was lower than that in the LBS group (P < 0.05). We found that the effect of BSP was dose-dependent, as high-dose BSP had a more significant inhibitory effect on cell proliferation than low-dose BSP (P < 0.05). The results of immunohistochemistry and western blotting showed that PCNA and VCAM-1 were significantly downregulated in the BSP treatment group on days 14 and 28 (P < 0.05). BSP inhibits the proliferation of vascular endothelial cells and reduces the expression of VCAM-1, thereby inhibiting the restenosis of graft veins.

Inhibition of Myointimal Proliferation by Octreotide in Canine Vein Interposition Grafts

Purpose: The aim of this study was to evaluate the efficacy of octreotide in modulating the progression of intimal hyperplasia in autogenous vein bypass grafts in a canine model. The effect of the drug on the progression of intimal hyperplasia was measured with the Gilman parameter, a measure used extensively as a wound-healing descriptor. Methods: 12 mongrel dogs were randomly and equally divided into two groups. The first group (octreotide group) was administered octreotide 20 µg/kg/day. The control group (group II) received saline solution by subcutaneous injection. Each dog had 8- to 10-cm segments of autogenous jugular vein bypassed to the femoral arteries. Quantitative data on luminel narrowing over time from intimal hyperplasia were compared from calculated Gilman parameters after image analysis of retrieved, histologically processed graft sections. Each vein graft was analyzed by computerized morphometric analysis. Results: The mean Gilman parameter for distal graft segments was 0.47 ± 0.17 mm in the control group and 0.25 ± 0.07 mm in the octreotide group 6 weeks after operation (p < 0.05). Distal graft segments between the control and octreotide groups were statistically significant. In proximal, medial and distal graft segments, the mean Gilman parameters were 0.51 ± 0.16 mm in the control group and 0.37 ± 0.18 mm in the octreotide group, the difference being statistically significant (p < 0.01). Conclusion: Octreotide significantly inhibits myointimal thickening, and these data support the efficacy of octreotide in reducing intimal hyperplasia in arterialized vein grafts during the short postoperative period. Further investigations are required to as certain whether this beneficial effect of octretide persists in the long term.

Changes in the organization of the smooth muscle cells in rat vein grafts.

Mechanical tensile stress in vein grafts increases suddenly under the influence of arterial blood pressure. In this study, we examined the influence of increased tensile stress on the organization of the smooth muscle cells (SMCs) in the neointima and media of the rat vein grafts. An autogenous jugular vein was grafted into the abdominal aorta of the rat, and changes in the organization of the vein graft SMCs were studied by observing the distribution of SMC actin filaments and nuclei at 3 min and 1, 5, 10, and 30 days after surgery. In a normal jugular vein, the average wall circumferential tensile stress was approximately 3 kPa at an internal pressure of 3 mm Hg. The SMCs, that contained long, slender actin filamentous bundles, were oriented mainly in the circumferential direction of the vessel, and constituted a 2- to 3-cell-thick medial layer underneath the endothelium. In a vein graft, the wall circumferential tensile stress suddenly increased by approximately 140 times compared with the control level. In response to this suddenly increased stress, the SMC layer was stretched into a structure with scattered pores and disrupted SMC actin filamentous bundles within 3 min. This initial change was followed by a rapid reduction in the density of the SMC nuclei and actin filaments within 1 day and progressive SMC proliferation, that was associated with medial thickening and a change in the SMC orientation from 5 to 30 days. Further studies showed that a local inflation of normal jugular veins to 120 mm Hg for 3 min induced a similar change as found in the vein grafts, whereas the organization of the SMCs was not significantly changed in vein-vein grafts, that did not experience a change in tensile stress. These results suggested that increased tensile stress contributed to the initial damage of the SMCs and played a role in the regulation of medial SMC remodeling in vein grafts.

Short-term preservation of autogenous vein grafts: Effectiveness of University of Wisconsin solution

Background. Suboptimal preservation of autologous veins in storage solutions causes endothelial cell damage that can contribute to graft failure. The purpose of this study was to compare the effects of short-term storage of veins in autologous whole blood (AWB), 0.9% normal saline solution (NS), and University of Wisconsin solution (UWs) on vein structure and function after grafting. Methods. Autogenous jugular and femoral veins were atraumatically harvested from mongrel dogs. One vein segment was immediately implanted to serve as a control, and the other segments were stored for 45 minutes in AWB, NS, or UWs. The veins were implanted as reversed interposition graft in the carotid or femoral arteries. After 6 weeks light and scanning electron microscopy and isometric tension studies were performed on explanted vein grafts. Results. Morphologic studies revealed an intact endothelium that stained positively for factor VIII. Intimal thickness was similar between controls (48 ± 12 μm) and veins stored in UWs (53 ± 8 μm) (p = not significant), but it was significantly increased in veins stored in AWB (151 ± 29 μm) and NS (149 ±18 μm) (p < 0.05). Sensitivity and maximum contraction to norepinephrine were not altered in veins preserved in UWs (6.0 ± 0.1 μmol/L and 0.19 ± 0.02 gm/mm 2) but were significantly reduced (p < 0.05) in those stored in AWB (7.2 ± 0.1 μmol/L and 0.08 ± 0.02 gm/mm 2) and NS (7.0 ± 0.3 μmol/L and 0.09 ± 0.02 gm/mm 2) compared with controls (5.9 ± 0.2 μmol/L and 0.20 ± 0.02 gm/mm 2). The sensitivity and maximum relaxation to acetylcholine and sodium nitroprusside of veins preserved in AWB, NS, and UWs were similar to controls (p = not significant). Conclusions. Vein storage in UWs preserves smooth muscle cell function compared with veins stored in NS or AWB. Therefore UWs is a more suitable medium for short-term preservation of veins in cardiovascular operation.

University of Wisconsin Solution Effects on Intimal Proliferation in Canine Autogenous Vein Grafts

This study was carried out to investigate if the University of Wisconsin solution (UWs) is suitable for long-term preservation of autogenous vein grafts (AVG) prior to transplantation, compared to autologous whole blood (AWB) and normal saline (NS). Autogenous jugular and femoral veins were harvested from adult mongrel dogs, using a "no-touch" technique. One segment of vein was immediately implanted to serve as a control, while other segments were stored for 24 hr at 4°C in AWB, NS, or UWs. The control and the preserved veins were implanted as reversed interposition grafts in the common carotid or femoral artery positions. After 6 weeks, scanning electron microscopy revealed an intact endothelial cell monolayer in all vein grafts that was stained positively for factor VIII. The degree of intimal thickening, as assessed by light microscopy in the middle position of the grafts, was similar in controls (52.0 ± 15.8 μm) and in veins stored in UWs (58.5 ± 16.1 μm), but it was significantly increased ( P < 0.05) in veins preserved in NS (198.9 ± 19.5 μm) and in AWB (312.0 ± 171.6 μm). Isometric tension studies revealed that maximum contraction and sensitivities (assessed by EC 50) to norepinephrine were significantly reduced ( P < 0.05) in AVG stored in AWB (0.05 ± 0.02 g/mm 2 and 5.5 ± 2.8 μ M), but not in UWs (0.16 ± 0.03 g/mm 2 0.92 ± 0.34 ± M) and NS (0.09 ± 0.03 g/mm 2 and 3.0 ± 1.1 μ M), compared with controls (0.17 ± 0.03 g/mm 2 and 0.99 ± 0.38 μ M). Acetylcholine (Ach)-induced maximum relaxations were similar in all of the veins. However, vessels stored in AWB were found to be more sensitive ( P < 0.05) to Ach (0.004 ± 0.002 μ M) than those stored in UWs (0.042 ± 0.018 μ M). Sodium nitroprusside produced similar responses in all of the veins. These data demonstrated that storage of veins in UWs for 24 hr prior to transplantation is more suitable than storage in AWB and NS for preserving the morphology and functional integrity of the smooth muscle and endothelium.

Skeletal Muscle Ventricles Seeded With Autogenous Endothelium

Skeletal muscle ventricles (SMVs) are muscular pumping chambers constructed from skeletal muscle. Previously, SMVs were connected to the systemic circulation with vascular conduits and used to assist the heart. In this study, SMVs were constructed from the latissimus dorsi muscle in eight dogs. The SMVs were seeded with autologous endothelial cells, but not connected to the circulation. Endothelial cells were harvested enzymatically from autogenous external jugular vein and grown in tissue culture. After 9 weeks, 6 electrically conditioned SMVs were seeded with endothelial cells by injecting 4-5 ml of culture medium containing 5-8 x 10(6) autogenous endothelial cells into each SMV lumen adjacent to the mandrel. Conditioning was stopped at the time of endothelial seeding. One week after seeding, electrical conditioning was resumed. Two weeks after seeding, the animals were killed and the SMVs excised. Histologic examination confirmed the presence of a confluent monolayer of cells covering 80-100% of the luminal surface in each seeded SMV. The endothelial nature of the cells lining the SMV lumen was established by fluorescent microscopy. Endothelial cells were pre labeled with the cellular marker PKH before seeding; the SMVs were also incubated with the endothelial marker dil-acetylated LDL. Endothelial cells also were identified by staining with fluorescently labeled antibodies to von Willebrand factor. Based upon these data, electrically conditioned SMVs can be seeded successfully with a near-complete, autologous endothelial monolayer. Additionally, this endothelial monolayer can be maintained on the luminal surface of a contracting SMV. In-circulation studies will determine whether endothelial cell seeding of SMVs can decrease or eliminate the incidence of thromboembolism.

Pharmacologic modulation of intimal hyperplasia in canine vein interposition grafts

Purpose: The purpose of this study was to evaluate the efficacy of three drugs (cilazapril, cyclosporine, and aspirin) in modulating the progression of intimal hyperplasia during short postoperative times in short-segment, autogenous vein bypass grafts in a canine model. The relative effects of the drugs on the progression of intimal hyperplasia were compared with the Gilman parameter, a measure used extensively as a wound healing descriptor. To our knowledge this is the first use of the Gilman parameter in assessing vascular disease.Methods: Seventy-two conditioned mongrel dogs were randomly and equally divided according to a three-factor analysis of variance. The factors included (1) drug treatments (cilazapril [10 mg/kg/day], cyclosporine [4 mg/kg/day], aspirin [325 mg/day], and control [nonmedicated]), (2) implantation sites (femoral and carotid arteries), and (3) postoperative times of graft harvest (1, 3, and 6 weeks). Each dog had 2 cm segments of autogenous jugular vein interpositioned bilaterally into each of the paired carotid and femoral arteries. Quantitative data on luminal narrowing over time from intimal hyperplasia were compared from calculated Gilman parameters after image analysis of retrieved, histologically processed graft sections.Results: The observed variability in the data was attributed to drug treatments and time. At 1 week after operation the mean Gilman parameters did not differ significantly among the treatment groups in either midgraft or distal graft segments. At 3 weeks the mean Gilman parameters of midgraft and distal graft sections of cyclosporine-treated dogs differed significantly (p < 0.05) from those of the control group and the cilazapril and aspirin-treated groups, which did not differ from each other. At 6 weeks after operation, mean Gilman parameters from aspirin- and cyclosporine-treated dogs differed statistically from control and cilazapril-medicated dogs and from each other (p < 0.001).Conclusions: These data support the efficacy of aspirin and cyclosporine in reducing intimal hyperplasia in short-segment arterialized vein grafts during short postoperative periods. Additional studies are required to ascertain whether the beneficial effects of aspirin and cyclosporine persist long-term.

Patency in canine inferior vena cava grafting: Effects of graft material, size, and endothelial seeding

We studied 117 inferior vena cava (IVC) replacements in dogs to determine the effects of graft material, graft size, endothelial seeding, and cultured endothelial linings on graft patency. As a control, the IVC was removed and reimplanted in 11 dogs. Dacron (n = 7) and expanded polytetrafluoroethylene (e-PTFE) grafts (n = 12) were seeded immediately with the use of enzymatically derived autogenous jugular vein endothelium. Cultured linings were prepared for e-PTFE grafts (n = 9) by inoculating the graft with jugular endothelium and nurturing the lining in tissue culture for 14 to 30 days before implantation. Unseeded grafts (n = 27) were prepared according to the manufacturer's recommendations. These six methods of preparation were tested in grafts measuring 6 mm I.D. and 60 mm in length. Other sizes were tested with a Latin square study design. After 30 to 60 days the grafts were perfusion fixed and studied with light and transmission electron microscopy. Patency was determined by contrast cavography after 7 and 30 days. Patency in the IVC reimplantation was 100% compared with 28.0% of the e-PTFE (p = 0.001) and none of the Dacron grafts that measured 6 mm I.D. and 60 mm long. e-PTFE and Dacron graft patency also differed significantly (p = 0.035). Seeded and culture-lined e-PTFE grafts in that same size were patent in 31.6% compared with 16.7% of unseeded e-PTFE. With grafts measuring 80 mm long, three of the five e-PTFE grafts were patent between 3 and 7 days. All progressed to occlusion by 30 days and compared poorly with all other graft sizes tested (2.6% progression to occlusion [p = 3 × 10−8]). Recanalization was not seen in 10 occluded grafts that were followed for 60 days. The histologic features of seeded grafts differed remarkably from grafts previously studied in the arterial circulation and from culture-lined and unseeded venous prostheses in that 60% had prominent large, random, endothelium-lined channels within the inner capsule. Larger graft diameters (p = 0.009) and the omission of an endothelial surface treatment (p = 0.004) were associated with anastomotic subendothelial fibrous hyperplasia. We conclude that graft material is the major determinant of patency in IVC replacements, that an extensive endothelial surface promotes patency, but that simply seeding e-PTFE or Dacron grafts with 105 endothelial cells does not provide sufficient endothelium to alter early patency. Graft dimensions are also critical to long-term patency and the development of subendothelial fibrous hyperplasia. Graft recanalization is not a major feature in the healing of synthetic venous replacements.

Comparison of platelet adherence and aggregation in modified human umbilical vein and autogenous vein grafts

The use of glutaraldehyde-tanned human umbilical vein as a vascular conduit has recently become popular. In previous studies in our laboratory, neointimal fibrous hyperplasia was responsible for poor long-term patency of this material in a canine model. The present study was undertaken to compare the platelet-adhering characteristics of autogenous vein and modified human umbilical vein. After platelets were labelled with chromium-51, 10 mongrel dogs underwent bilateral end-to-side femoral artery bypass grafts. Human umbilical vein and autogenous jugular vein were placed in opposing groins of each dog. Two hours after graft implantation, the animals were killed and the grafts retrieved along with 1 cm of the host artery at each anastomosis. These specimens and an aliquot of blood were placed in a scintillation counter and radioactivity levels were determined. The human umbilical vein had significantly more platelet adherence than the autogenous veins as determined by counts per gram per 10 minutes. The handling characteristics of human umbilical vein were also suboptimal. Separation of the graft layers was occasionally observed, sometimes resulting in intramural hematomas and graft dissection. The previously reported poor performance of human umbilical vein in the canine model is most likely a result of its platelet-adhering surface and poor handling characteristics.

A Comparison of Rapid-Healing Prosthetic Arterial Grafts and Autogenous Veins

The patency rates and healing characteristics during a nine-month period of internal velour Dacron grafts, external velour Dacron grafts, and Sparks-Mandril grown grafts were compared with autogenous jugular veins when used to bypass short segments of the canine femoral artery. Graft thrombosis occurred in three of 11 external velour grafts, in six of 11 internal velour grafts, and in three of 11 Sparks-Mandril grafts, None of 33 autogenous veins occluded. Graft thrombosis was not correlated with the degree of graft healing but rather with a hyperplastic proliferative intimal lesion observed at the proximal anastomosis of the occluded grafts.

Human umbilical veins and autogenous veins as canine arterial bypass grafts.

Glutaraldehyde treated human umbilical veins (Dardik Biograft) were used to bypass short segments of the femoral artery in 15 dogs and were compared to autogenous jugular veins placed in the contralateral femoral artery of each animal. All 15 autogenous jugular veins remained patent for the four month period of observation whereas thrombosis occurred in seven of 15 umbilical vein grafts. This patency rate of 53% was significantly lower than that observed for autogenous jugular veins (p less than 0.01). Neointimal Fibrous Hyperplasia (NFH) a the proximal anastomosis was responsible for six of the seven umbilical vein graft occlusions. Of the eight patent umbilical veins, five had varying degrees of proximal anastomotic stenosis secondary to NFH. Histological examination of each graft revealed significant fibroblastic proliferation and collagen deposition within the lumen of stenosed and thrombosed grafts. Although human umbilical veins have distinct advantages over other prosthetics, such as availability and flexibility, the incidence of experimental neointimal fibrous hyperplasia causing anastomotic stenosis and thrombosis is prohibitively high.

Results of Interposition “H” Grafts for Portal Hypertension

During the past nine years, 54 patients underwent interposition graft shunting for variceal bleeding in 48 and intractable ascites in six, either electively (35 instances) or as an emergency (13 instances). Autogenous jugular was used in 41 instances, homologous vena cava in nine and Dacron in five. The interposition graft was placed between superior mesenteric vein and vena cava in 36 instances and the portal vein and vena cava in 19. Using Child's Clinical Classification 44 were Class C and 10 Class B. There were six (11%) operative deaths with one (2.4%) in the elective and five (38%) in the emergency group. Encephalopathy was seen in 4 (10%) of those surviving more than one year. Two Dacron and two homografts thrombosed. Eight of the autografts were patent at autopsy, 18 on angiography and 15 assumed to be patent because patients were asymptomatic. Only one of 12 late deaths was related to grafts failure. Apparently the operation controls ascites and the autogenous jugular vein is the ideal material. Interposition "H" grafting is a simple safe procedure that can be used for portal decompression in patients with bleeding varices.

Portal decompression in infants and children with the interposition mesocaval shunt

The mesocaval graft for portal decompression is applicable in infants and children with portal hypertension secondary to extrahepatic or intrahepatic causes. It is recommended in patients in whom extensive previous surgery in the portahepatis (Kasai procedure) would make dissection of the portal vein difficult and endanger the integrity of the functioning biliary conduit. It can be performed in patients who have had previous splenectomy or in whom portacaval or splenorenal shunts have failed. Autogenous jugular vein is favored for creation of the shunt.

Portal decompression by interposition mesocaval shunt in patients with biliary atresia

Surgical correction of portal hypertension in infants and children has often been frustrated by limitations imposed by the diminutive vessel size. During the past 18 mo, five patients from 1 to 7 yr of age and weighing between 9 and 19 kg, have required portal decompression for bleeding from esophageal varices. In two patients, a previous dissection in the area of the porta hepatis imposed a further technical obstacle. Both of these patients had biliary atresia and one had undergone a successful portoenterostomy (Kasai). 1 Success of the interposition mesocaval graft in adult patients led us to adopt this procedure in our five patients. Autogenous jugular vein was utilized for construction of the shunt in the smaller patients. Radiographic confirmation of shunt patency has been obtained 1 yr postoperatively.

Interposition grafting for portal hypertension

During the past six years, thirty-seven patients underwent interposition graft shunting for thirty-three instances of bleeding from varices and five instances of intractable ascites, either electively (twenty-seven instances) or as an emergency (eleven instances). Autogenous jugular vein was used in twenty-five instances, homologous vena cava in nine, and Dacron in four. Portacaval and mesocaval anastomoses were done in equal numbers (nineteen). Using Childs' method of clinical evaluation, thirty-three patients were Class C and four Class B. There were five (13.2 per cent) early deaths with one (3.5 per cent) in the elective and four (36 per cent) in the emergency group. Twelve grafts were open at autopsy, fifteen at splenoportography, and seven assumed patent because patients were asymptomatic. Two Dacron grafts and two homografts thrombosed. There were ten late deaths, only one related to graft failure. Apparently, the operation controls ascites, with autogenous jugular vein being the ideal material. Interposition grafting is a simple, safe procedure that can be used for portal decompression in patients with bleeding varices.

Evaluation of prosthetic grafts of different porosity for arterial reconstruction

Autogenous jugular veins and Dacron grafts of different porosities were implanted as short bypass grafts around ligated femoral arteries in the dog. Patency rates for periods up to eight months were: vein, 79 per cent; DeBakey Dacron (lowest porosity), 39 per cent; Wesolowski Weavenit (intermediate porosity), 56 per cent; high porosity Dacron, 8 per cent. The failure of sixteen of the twenty-four high porosity grafts was related to perigraft hematomas that occurred two to seven days after operation and later thrombosis. The higher the porosity of the graft, the better the healing pattern as evidenced by fibrous bonding of the inner and outer linings of the grafts through the interstices. In the spectrum of grafts with increasing porosity there is apparently an optimal porosity beyond which late bleeding counterbalances the better healing properties of the higher porosity graft.

Proceedings: Interposition "H" grafting for protal hypertension.

During the past 4½ years, 24 patients bleeding from varices and three with intractable ascites underwent interposition H graft shunting, either electively (21 patients) or as an emergency (7 patients). Autogenous jugular vein was used in 15, homologous vena cava in 9, and Dacron in 4. Portacaval anastomosis was done in 14 and mesocaval in 14. Twenty-five were Child class C and two Child class B. There were four (14.8%) early deaths, with one (4.8%) in the elective and three (43%) in the emergency group. Nine grafts were open at autopsy, eight at splenoportography, and seven assumed patent because patients were asymptomatic. Two Dacron grafts and two homografts thrombosed. There were eight late deaths, only one related to failure of the graft. Apparently, the operation controls ascites, with autogenous jugular vein being the ideal material. Interposition H grafting is a simple, safe procedure that can be used for portal decompression in patients with bleeding varices.

Use of the autogenous jugular vein for interposition grafting in portal hypertension : Bernard W. Thompson and Raymond C. Read. South. Med. J. 66:818–822 (July), 1973

Use of the autogenous jugular vein for interposition grafting in portal hypertension : Bernard W. Thompson and Raymond C. Read. South. Med. J. 66:818–822 (July), 1973

Use of the autogenous jugular vein for interposition grafting in portal hypertension.

Relief of portal hypertension has been achieved in both man and animals by the use of the autogenous jugular vein for interposition grafting. During the past two years, we have treated eight men with bleeding varices by this technic. They underwent portosystemic interposition of the autogenous inter