Vein Graft Group Research Articles

Coronary Artery Bypass Grafting Using the No-Touch Great Saphenous Vein Graft Harvesting Technique: A Retrospective Study.

Background We focused on coronary artery bypass grafting using the great saphenous vein and compared the no-touch great saphenous vein and conventional great saphenous vein. Methods Coronary artery bypass grafting using the great saphenous vein was performed at our hospital over a 15-year period from 2007/04 to 2022/08. The primary endpoint was the patency of the great saphenous vein at discharge, and secondary endpoints were delayed healing of the great saphenous vein harvest wound, delayed healing of the mid-thoracic wound, and factors related to coronary artery bypass surgery. Results There were 183 patients who underwent coronary artery bypass surgery using the great saphenous vein during the study period. There were 131 male patients (72%) and 52 female patients (28%) with a mean age of 69 years (38-94 years). The method of harvesting the great saphenous vein was a no-touch great saphenous vein graft (NT-SVG) in 29 cases (16%) and conventional SVG in 154 cases (84%). Patients were divided into two groups: the NT-SVG group and the standard-collection saphenous vein graft (SVG) group. We compared graft patency at discharge, healing failure of the lower leg wound, healing failure of the mid-thoracic wound, and flow by transit-time flow measurement (TTFM). Conclusion There were no significant differences in perioperative outcomes between the NT-SVG and conventional SVG groups in this study.

Administration of a new nano delivery system coated with Tirofiban to prevent early thrombosis of vein graft.

To verify the administration of a new nano delivery system coated with Tirofiban on preventing early thrombosis in vein graft. Forty New Zealand white rabbits were randomly divided into five groups with eight rabbits in each group. The rabbits of all groups underwent jugular vein transplantation, except group I with only neck opening and closing operation. Vein grafts of group II were preprocessed by intravenous injection of normal saline; group III were preprocessed by tirofiban alone; group IV were preprocessed by unloaded nanoparticles of PLGA-PEG; group V were preprocessed by PLGA-PEG coated with tirofiban. Coagulation and platelet function of peripheral and vein graft blood were detected at 1, 2, 4, 12h and 1, 3, 7, 10, 14 days after operation. Patency rate of vein graft and blood flow index were measured by vascular ultrasound at third, seventh, 10th, and 14th days after operation; two rabbits in each group were randomly sacrificed at the corresponding time of detection. Pathological differences of vein grafts were observed by HE stainin. The patency rate of vein grafts in group V was significantly higher than that in group II to IV. The platelet and platelet aggregation rate in group V were inhibited in vein graft blood significantly. The post-operative PT and APTT in vein graft blood in group V were increased obviously while the FBG, D-dimer and FDP were significantly inhibited. Except group I, the lumen loss rate of vein grafts in group V was significantly lower than that in other groups, and vein graft blood in group V had a significant lower expression of platelet P-selectin and GP IIb/IIIa receptor than that in other groups. This study proves that PEG-PLGA coated with tirofiban can effectively prevent early vein graft stenosis from thrombosis by inhibition of platelet function, coagulation function.

Sirolimus-Embedded Silk Microneedle Wrap to Prevent Neointimal Hyperplasia in Vein Graft Model.

We investigated the role of a sirolimus-embedded silk microneedle (MN) wrap as an external vascular device for drug delivery efficacy, inhibition of neointimal hyperplasia, and vascular remodeling. Using dogs, a vein graft model was developed to interpose the carotid or femoral artery with the jugular or femoral vein. The control group contained four dogs with only interposed grafts; the intervention group contained four dogs with vein grafts in which sirolimus-embedded silk-MN wraps were applied. After 12-weeks post-implantation, 15 vein grafts in each group were explanted and analyzed. Vein grafts applied with the rhodamine B-embedded silk-MN wrap showed far higher fluorescent signals than those without the wrap. The diameter of vein grafts in the intervention group decreased or remained stable without dilatation; however, it increased in the control group. The intervention group had femoral vein grafts with a significantly lower mean neointima-to-media ratio, and had vein grafts with an intima layer showing a significantly lower collagen density ratio than the control group. In conclusion, sirolimus-embedded silk-MN wrap in a vein graft model successfully delivered the drug to the intimal layer of the vein grafts. It prevented vein graft dilatation, avoiding shear stress and decreasing wall tension, and it inhibited neointimal hyperplasia.

Radial artery vs saphenous vein grafts for sequential coronary bypass grafting as a second conduit for the left coronary territory.

Although the radial artery graft has an adaptive property to flow demand, its flow characteristics in aorto-coronary sequential bypass grafting are not well elucidated. We evaluated the differences between the vein and radial artery grafts in the patency and the transit time flow meter-derived parameters (flow and pulsatile index), according to the stenosis rate of terminal target vessels and the number of anastomoses, in sequential bypass grafting to the left coronary territories as a second conduit. We analyzed 222 patients who underwent isolated on-pump beating coronary artery bypass grafting with an aorto-coronary bypass to the left coronary territory. The patients were divided into radial artery group (n = 154) and vein graft group (n = 68). Sequential bypass was performed 1n 171 patients (127 radial arteries, 44 veins). Flow of the radial artery grafts was lower than that of the vein grafts (40.9 ± 22.3 vs 47.5 ± 23.8mL/min, p = 0.044), while it became higher as the number of anastomoses per graft increased (1: 28.9 ± 16.3 vs 2: 40.9 ± 19.9 vs 3: 55.8 ± 27.5, p < 0.001). The patency of radial artery grafts was better than that of vein grafts (98.0% vs 92.6%, p = 0.010; p < 0.001 after propensity score weighting). Although intraoperative flow rate of the radial artery graft is lower, it has sufficient flow reserve for sequential bypass grafting, and its early patency is high enough. Radial artery is suitable for sequential bypass grafting to the left coronary territories as a second arterial conduit.

The role of vein grafts in reconstructive head and neck microsurgery

ObjectiveFree tissue transfer is widely used for head and neck reconstruction. In certain circumstances, vein grafting is required to elongate free flap pedicles to connect them to appropriate recipient vessels. Because of controversy regarding the use of interposition vein grafts in free tissue reconstruction, this paper reports vein graft indications, techniques, safety, and outcomes for head and neck microvascular surgery. MethodsTwenty-six patients (23 men and 3 women) who underwent interposition vein grafting concurrent with free tissue transfer were included in this study. The most common reason for head and neck reconstruction with vein graft was tumor recurrence, followed by flap salvage. The interposition vein grafts were applied in two manners as temporary arteriovenous (A–V) loop and conduit to extend the length of the free flap for venous drainage. ResultsThe most common reconstructions were anterolateral thigh flaps (15 cases), followed by vastus lateralis myocutaneous (3 cases) and radial forearm (2 cases) flaps. The common recipient vessels were superior thyroid artery, superficial temporal artery and external jugular vein. The free flap loss rate was 7.7% with vein grafts and 4.9 without vein grafts (p = 0.380). The free flap complication rate was 50.0% and 16.8% in patients with and without vein grafts, respectively (p < 0.001). Radiation therapy, chemotherapy, prior neck dissection, and prior free flap transfer were more common in the vein graft group (all p < 0.001). The hospital stay was significantly longer for the vein graft group than for the non–vein graft group (29.5 vs. 19.0 days; p = 0.001). ConclusionOverall free flap survival rates of 92.3% and 95.1% in the vein and non-vein graft groups, respectively – indicating the reliability of the vein grafts in challenging head and neck reconstructions, particularly in salvage cases and patients with multiple reconstructions. Level of evidenceLevel 3.

Excimer Laser Coronary Angioplasty in Coronary Lesions: Use and Safety From the NCDR/CATH PCI Registry.

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Reconstruction of Tendon Sheath by a Vein Graft in Flexor Tendon Repair in Adjacent Digits

Background: Adhesion formation after tendon injury isa challenging clinical problem.Aim: We compare the outcome of reconstructing the flexortendon sheath after primary flexor tendon repair using anautogenous vein graft to reduce post-operative peritendiniousadhesions.Methods: Eight patients have acute flexor tendon injuriesof both FDS and FDP in zone II in more than one digit.Primary tenorrhaphy was done using traditional technique.In one-digit vein graft was used to reconstruct tendon sheathwindow, while in the other digit, the tendon sheath leftuntreated. Post-operative physiotherapy program of controlledactive motion is used for both group. All patients were assessedusing the second Buck-Gramcko scale at 2 and 6 months.Results: For the vein graft group, 2 patient had excellentresult, 2 had very good, and 4 patients had good result. Ingroup II, 2 patients had very good result, 2 patients had goodresult, and 4 patients had fair result.Conclusion: The use of autologous vein graft as a substituteof tendon sheath is a good treatment modality. Compared toconventional tendon repair technique, it was associated withless adhesion formation and less joint contracture.Evidence Based Medicine: Level IV, vase series.

Preliminary application and evaluation of autograft reconstruction of parotid duct defect with submandibular gland duct for buccal cancer

Background: We aimed to preserve parotid function in patients with buccal carcinoma by applying a new surgical protocol based on reconstruction of parotid ductal defect with submandibular gland ductal.Aims/Objectives: The aim of this study is to introduce the method of autologous submandibular gland duct reconstruction for the treatment of parotid duct defect in buccal carcinoma, and to evaluate its clinical application in follow-up.Material and methods: A total of 28 patients with buccal carcinoma who underwent buccal and neck combined with radical surgery and vascularized flap transplantation were enrolled. Function of the reconstructed duct was reviewed in 6 months after surgery.Results: Both groups achieved good short-term results within 1 month after surgery. The 6-month postoperative angiography examination of the submandibular gland duct showed that 6% of patients in the submandibular gland duct graft group had a blockage or was not smooth. At the same time, 45% of the patients in the vein graft group had failure or obstruction, and the VAS score of pain was higher than that of the submandibular gland ductal graft group (p < .05).Conclusion and significance: Compared with vein grafting, the reconstruction of parotid ductal defect with submandibular gland ductal graft has better long-term effects.

Survival rates and risk factors for failure using an interposition vein graft for fingertip amputations with segmental vessel defects

This study aimed to compare survival rates and risk factors of replantation failures using an interposition vein graft in fingertip amputations with segmental vessel defects with those using simple end-to-end anastomosis in amputations. Between 2004 and 2015, 776 (647 males and 129 females) with single Zone I or II amputations of digits underwent replantation. Among these, simple end-to-end anastomosis was performed in 698 replantations, while interposition vein grafts were used for either arterial or venous repair or both in 78 amputated fingertips. The survival rate was compared between the groups. Logistic regression analysis was performed to identify risk factors predicting replantation failure in all study subjects. Among 776 replantations, 713 (91.9%) survived. At latest follow-up, of 698 cases in the simple anastomosis group, 650 (93.1%) survived; of 78 cases in the vein graft group, 63 (80.8%) survived (p > .001). Logistic regression analysis revealed that avulsion type (odds ratio [OR] 3.121; 95% confidence interval [CI], 1.211-8.064; p = .018) and zone II amputation (OR, 2.370; 95% CI, 1.382-4.065; p = .002) were significant risk factors for replantation failure. This study demonstrates that the survival rate (80.8%) of the vein graft in fingertip amputation with segmental vessel defects was shown to be a possible option to increase the survival rates in case with segmental vessel defects where simple anastomosis could not be performed. However, avulsion type and zone II amputation are important risk factors of replantation failures.

Eligibility of Circumferential Fence With the Autologous Peritoneal Patch for Venous Reconstruction in Right Lobe Living-Donor Liver Transplant: A Case Control Study.

: Our aim was to evaluate the eligibility of hepatic venous drainage technique using circumferential fence with peritoneal patch graft and saphenous vein graft in right lobe living-donor liver transplant. Between November 2007 and December 2017, our center performed 1413 rightlobe living-donor liver transplants. A circumferential fence was created using the peritoneal patch graft for venous drainage reconstruction in 31 of these patients. We compared data of these 31 patients with data of 62 patients who had circumferential fence created with cryopreserved homologous saphenous vein graft (1:2 ratio). Patients with anastomotic stenosis (n = 10) and without anastomotic stenosis (n = 69) were also compared. No statistically significant differences were found between the peritoneal patch graft group and the saphenous vein graft group in terms of clinical parameters, circumferential fence diameter, and postoperative anastomotic stenosis (7.1% vs 26.1%; P = .056). Postoperative anastomotic stenosis developed in 10 patients. No statistically significant differences were found between patients with and without anastomotic stenosis in terms of clinical parameters except for diameter of circumferential fence (P = .001). Diameter of circumferential fence less than 18 mm in patients with and without anastomotic stenosis was shown in 80% and 34.6% of patients, respectively (P = .02). Stenosis-free survival in saphenous vein graft group was significantly better than in the peritoneal patch graft group (P = .023). Our correlation analyses showed a strong correlation between diameter of circumferential fence and the tenosis rate in patients (P = .001). Autologous peritoneal patch graft can be used for creating circumferential fence for hepatic outflow in living-donor liver transplant patients if no better option is available. Despite high anastomotic stenosis rates, peritoneal fencing responded well to radiologic dilatation or stent applications and provided good long-term patency.

Prevention of peritendinious adhesions in zone II primary flexor tendon repair using a vein patch graft: A comparative study

Adhesion after intrasynovial tendon injury is a major clinical problem. Here we assess autogenous vein graft over the primary flexor tendon repair to prevent postoperative peritendinious adhesions. Twenty-six patients (30 digits) had an acute flexor tendon injury in zone II. Primary tenorrhaphy was done using the traditional Kessler repair technique. Patients were divided into two groups according to the management of tendon sheath defects. In group I (n = 15 digits), a patch of a marked forearm vein was harvested, divided and sutured to the tendon sheath window. In group II (n = 15 digits), the tendon sheath was left untreated. Patients were evaluated using the second Buck-Gramcko scale at 8 weeks and 6 months. We detected no statistically significant difference between the groups. For the vein graft group, excellent results were achieved in four digits, five digits with very good results, five digits with good results and one digit with fair results. Using the traditional technique, excellent results were achieved in three digits, very good results were achieved in four digits, good results were achieved in six digits and fair results were achieved in two digits. The use of autologous vein graft has many advantages; it is inexpensive, autologous and will not affect tendon healing. Comparing autologous vein graft to the conventional tendon repair technique, we detected no statistically significant difference. Clinically, less adhesion formation and fewer joint contractures were noted when using the autologous vein graft. Level of Evidence: Level I, therapeutic study.

Antiplatelet therapy after pancreaticoduodenectomy with portal vein resection may be the optimal anticoagulatant

Background: Choice of postoperative anticoagulation after pancreaticoduodenectomy with portal vein resection (PDVR) is important in maintaining vein patency. In this study, patients undergoing PDVR were evaluated to determine optimal anticoagulation regimen. Methods: A total of 70 patients underwent PDVR; those with pancreatic adenocarcinoma (PC) were retrospectively analyzed. Patients were divided into three groups: tangential resection (TR), segmental resection with primary anastomosis (SR), and segmental resection with vein graft (VG). Type of anticoagulation included: None, antiplatelet therapy (AP), and low molecular weight heparin bridge with warfarin (W). The primary outcome measure was vein patency at 2, 4, and 6 months. Results: 35 patients underwent PDVR for PC: 7 with TR, 18 with SR, and 10 with VG. 2, 4, and 6-month vein patency was 91.4%, 90%, 89.2%, respectively. Amongst TR patients, all 7 patients (None and AP) demonstrated vein patency at 6 months. In the SR group, vein patency was 81.8% with AP and 20% with None. In the VG group, vein patency was 80% with AP and 60% with W. Conclusion: For patients undergoing PDVR for PC, TR may not require any AC while SR patients may benefit from AC. In VG patients, anticoagulation can either be antiplatelet or warfarin therapy.

Pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition grafts for cancer: a meta-analysis.

The use of interposition grafts for portal-superior mesenteric vein (PV-SMV) reconstruction during pancreatoduodenectomy (PD) with venous resection (VR) for localized periampullary tumors is a controversial topic. The present meta-analysis aimed to evaluate the perioperative and long-term outcomes in patients who received interposition grafts for PV-SMV reconstruction after PD with VR. The correlative databases were systematically searched to identify relevant trials comparing vein grafts versus no vein grafts during PD with VR. 14 studies including 257 patients with vein grafts and 570 patients without vein grafts were extracted. The meta-analysis indicated no difference in perioperative morbidity, mortality, or thrombosis between the two groups, but the vein graft group was associated with a significantly increased venous thrombosis rate (≥ 6 months) (odds ratio [OR] = 2.75; 95% confidence interval [CI], 1.32–5.73; P = .007). The autologous vein group subgroup analysis also revealed a significantly increased vein thrombosis rate (OR = 3.13; 95% CI, 1.45–6.76; P = .004) between the two groups. Meanwhile, the prosthetic vein group subgroup analysis indicated no difference. Additionally, the oncological value of vein grafts during PD for pancreatic cancer survival was analyzed and revealed no difference in 1-year, 3-year, or 5-year survival between the two groups. Using interposition grafts for PV-SMV reconstruction is safe and effective, and has perioperative outcomes and long-term survival rates compared to those with no vein grafts during PD with VR. However, the lower long-term vein patency rate in patients with vein grafts indicate that interposition grafts may be more likely to lose function.

Does the use of arteriovenous loops increase complications rates in posttraumatic microsurgical lower extremity reconstruction?-A matched-pair analysis.

The use of arteriovenous (AV) loops in microsurgical lower extremity reconstruction is a controversial topic. The objective of the present study was to assess the impact of AV loops on complication rates following microsurgical reconstruction of posttraumatic lower extremity defects. Patients who underwent free flap coverage of posttraumatic defects in combination with an AV loop (Group 1) were identified and matched for age, body mass index (BMI), tobacco use, defect location, and flap type with patients who underwent reconstruction without vein grafts (Group 2). Outcomes of interest included complication rate and flap loss rate. Groups 1 and 2 consisted of 10 patients each with a mean age of 51 years (range, 21-79 years) and 47.3 years (range, 22-69 years), respectively (P = 0.596). No differences were noted regarding flap loss (P = 1.0), intraoperative (P = 0.474) or postoperative complication rate [surgical site infection (P = 1.0), bleeding (P = 1.0), delayed wound healing (P = 0.23), dehiscence (P = 0.58), and osseous non-union (P = 1.0)]. Only one flap loss was noted in Group 1. The only differences were increased operative time (P = 0.03) and increased length of stay (P = 0.009) in Group 1. Our results suggest that utilization of vein grafts with creation of AV loops followed by single-stage division and free flap transfer for reconstruction of posttraumatic lower extremity defects achieve reconstructive outcomes similar to those obtained in patients in whom no vein grafts are necessary.

Comparative study between standard and inside-out vein graft techniques on sciatic nerve repair of rats. Muscular and functional analysis.

To compare the functional result of standart vein grafts and inside-out vein graft technique on sciatic nerve repair. We used 24 male Wistar rats divided into 4 groups: control group (CG), standard vein graft group (SVG), Inside-out vein graft group (IOVG) and denervated Group (DG). SVG, IOVG and DG underwent total section of the sciatic nerve, SVG and IOVG however underwent nerve repair surgery using a graft with normal jugular vein and inside-out jugular vein, respectively. Histological analysis of the soleus and Extensor Digitorum Longus (EDL), and Sciatic Functional Index were used to compare the results after 6 weeks. Both grafts acted favorably in muscle recovery and improved functionality; They were similar in all parameters, however, in more points SVG achieved similar to the CG, in the other hand IOVG more times was similar to DG. Fact that makes the graft with normal vein the most viable option between the two options. Both types of grafts acted beneficially wherein the graft normal vein has proved to be the best option.

Recanalization of Chronic Total Occlusions in Patients With Previous Coronary Bypass Surgery and Consideration of Retrograde Access via Saphenous Vein Grafts

The prevalence of native coronary chronic total occlusions (CTOs) after coronary artery bypass grafts (CABGs) is higher than in non-CABG population. We examined outcomes of CTO percutaneous coronary intervention (PCI) post-CABG versus without CABG. Then, we looked at feasibility and outcomes of retrograde CTO PCI via patent or occluded saphenous vein graft. We compared patient and procedural characteristics of 470 CTO cases treated from January 2010 to December 2015 depending on history of CABG. We assessed major adverse cardiac events, including cardiac death, myocardial infarction, ischemia-driven target-vessel revascularization, or reocclusion 1 year after successful CTO PCI in patients treated before February 2015. Post-CABG patients (175 cases) had a higher J-CTO score (2.5 versus 2.1; P=0.002). In-hospital complications were similar, although the incidence of contrast-induced nephropathy was higher in post-CABG patients (4.6% versus 1%; P=0.01). With multivariable analysis, post-CABG status was associated with higher incidence of 1-year major adverse cardiac event (hazards ratio=2.2; P=0.02). As a second level analysis, we looked at the feasibility and safety of CTO PCI via saphenous vein grafts (19% of post-CABG cases) versus collateral channels (36%) versus with an antegrade-only approach (45%), and assessed short-term outcomes and complications. High success was achieved in the saphenous vein graft group. In-hospital events were similar in the 3 groups. Post-CABG CTO PCI is associated with similar high success and low complications compared with CTO PCI in patients who never had CABG. However, it is associated with higher recurrent events at 1 year. To achieve high success rate, use of saphenous vein grafts as retrograde conduits seems to be safe and effective.

Cavernous nerve reconstruction with autologous vein graft and platelet-derived growth factors.

In this study, we investigated the feasibility of using autologous vein graft and platelet-derived growth factors to bridge transected cavernous nerve in a rat model. A short defect in the bilateral cavernous nerve was created and repaired with vein graft from the right jugular vein or vein graft plus platelet-derived growth factors. The 32 rats were divided into four groups, namely Group 1 - no repair as a negative control, Group 2 - vein graft alone, Group 3 - vein graft plus platelet-derived growth factors, and Group 4 - sham operation as a positive control. We evaluated nerve regeneration and functional recovery using retrograde tracing study with FluoroGold, Toluidine blue staining of cavernous nerve, and the intracavernous pressure at 3 months. Three months after surgery, rich FluoroGold-positive cells were observed in the sham and vein graft plus platelet-derived growth factors group, but very few were found in the no repair group. The number of myelinated axons of regenerated cavernous nerve and intracavernous pressure were increased obviously in the two vein graft groups, especially in the vein graft plus platelet-derived growth factors group. These findings confirm the feasibility of using autologous vein as guides for cavernous nerve regeneration, and the regeneration can be further enhanced when the vein is filled with platelet-derived growth factors.

A biological tube technique for the repair of peripheral nerve defects using 'stuffed nerves'.

Presently described is research examining the "stuffed nerve" technique to repair peripheral nerve defects. Twenty-one male Wistar Albino rats were divided into 3 groups of 7, and standard 10-mm defects were created in the sciatic nerve of all subjects. Rats were treated with autogenous nerve graft (Group 1), hollow vein graft (Group 2), or vein graft stuffed with shredded nerves (Group 3). After 12 weeks, electrophysiological and histomorphological analyses were performed to evaluate axonal regeneration. Rat groups were compared in terms of latency period and peak-to-peak potential. Latency period was significantly shorter and peak-to-peak potential was significantly greater in Group 1 than in Group 2. However, latency period and peak-to-peak potential did not differ significantly between Groups 1 and 3 or between Groups 2 and 3. To evaluate axonal regeneration, number of axons, axon diameter and myelin sheath thickness was compared between groups. Results indicated that axonal regeneration was similar in Groups 1 and 3, and was better than results seen in Group 2. The stuffed nerve technique is an alternative to autogenous nerve grafting and produces similar electrophysiological and histomorphological properties.

Arterial coronary artery bypass grafting is safe and effective in elderly patients

ObjectivesBilateral internal thoracic artery grafting in elderly patients is controversial. We compared the outcome of bilateral internal thoracic artery grafting with that of single internal thoracic artery and saphenous vein and radial artery conduits in these patients. MethodsPatients aged 70 years or more who underwent bilateral internal thoracic artery grafting between 1996 and 2008 (n = 1045) were compared with patients who underwent coronary artery bypass grafting with a single internal thoracic artery + saphenous vein graft (n = 582) or a single internal thoracic artery + radial artery (n = 249). ResultsPrevalence of female gender, diabetes, emergency operation, and chronic obstructive pulmonary disease was lower in the bilateral internal thoracic artery grafting group compared with the internal thoracic artery + radial artery and internal thoracic artery + saphenous vein graft groups, whereas congestive heart failure and recent myocardial infarction were more prevalent in the bilateral internal thoracic artery grafting group. Operative mortality and sternal wound infections were not significantly different between groups. The mean follow-up was 8.17 ± 4.45 years. Ten-year survival (Kaplan–Meier) in the internal thoracic artery + saphenous vein graft group was significantly lower than in the bilateral internal thoracic artery grafting and internal thoracic artery + radial artery groups (P < .001). Assignment to the saphenous vein graft group was also associated with decreased adjusted survival (P < .001) compared with the bilateral internal thoracic artery and internal thoracic artery + radial artery groups. ConclusionsThis study supports the use of arterial grafts in elderly patients undergoing coronary artery bypass grafting.

Targeted mesenchymal stem cell and vascular endothelial growth factor strategies for repair of nerve defects with nerve tissue implanted autogenous vein graft conduits.

Peripheral nerve gaps exceeding 1 cm require a bridging repair strategy. Clinical feasibility of autogenous nerve grafting is limited by donor site comorbidity. In this study we investigated neuroregenerative efficacy of autogenous vein grafts implanted with tissue fragments from distal nerve in combination with vascular endothelial growth factor (VEGF) or mesenchymal stem cells (MSCs) in repair of rat peripheral nerve defects. Six-groups of Sprague-Dawley rats (n = 8 each) were evaluated in the autogenous setting using a 1.6 cm long peroneal nerve defect: Empty vein graft (group 1), Nerve graft (group 2), Vein graft and nerve fragments (group 3), Vein graft and nerve fragments and blank microspheres (group 4), Vein graft and nerve fragments and VEGF microspheres (group 5), Vein graft and nerve fragments and MSCs (group 6). Nerve fragments were derived from distal segment. Walking track analysis, electrophysiology and nerve histomorphometry were performed for assessment. Peroneal function indices (PFI), electrophysiology (amplitude) and axon count results for group 2 were -9.12 ± 3.07, 12.81 ± 2.46 mV, and 1697.88 ± 166.18, whereas the results for group 5 were -9.35 ± 2.55, 12.68 ± 1.78, and 1566 ± 131.44, respectively. The assessment results did not reveal statistical difference between groups 2 and 5 (P > 0.05). The best outcomes were seen in group 2 and 5 followed by group 6. Compared to other groups, poorest outcomes were seen in group 1 (P ≤ 0.05). PFI, electrophysiology (amplitude) and axon count results for group 1 were -208.82 ± 110.69, 0.86 ± 0.52, and 444.50 ± 274.03, respectively. Vein conduits implanted with distal nerve-derived nerve fragments improved axonal regeneration. VEGF was superior to MSCs in facilitating nerve regeneration. © 2015 Wiley Periodicals, Inc. Microsurgery 36:578-585, 2016.