scholarly journals Technical factors affecting autogenous vein graft failure: Observations from a large multicenter trial

2007 ◽  
Vol 46 (6) ◽  
pp. 1180-1190 ◽  
Author(s):  
Andres Schanzer ◽  
Nathanael Hevelone ◽  
Christopher D. Owens ◽  
Michael Belkin ◽  
Dennis F. Bandyk ◽  
...  
Keyword(s):  
Vein Graft ◽  
Graft Failure ◽  
Multicenter Trial ◽  
Factors Affecting ◽  
Autogenous Vein ◽  
Technical Factors ◽  
Vein Graft Failure

scholarly journals Torsion Does Not Affect Early Vein Graft Patency in the Rat Femoral Artery Model

2018 ◽  
Vol 35 (04) ◽  
pp. 299-305
Author(s):  
Amro Harb ◽  
Maxwell Levi ◽  
Akio Kozato ◽  
Yelena Akelina ◽  
Robert Strauch
Keyword(s):  
Vein Graft ◽  
Graft Failure ◽  
Blood Flow Rate ◽  
Graft Patency ◽  
Sprague Dawley ◽  
Rat Models ◽  
Vein Grafts ◽  
Sprague Dawley Rats ◽  
Training Courses ◽  
Vein Graft Failure

Background Torsion of vein grafts is a commonly cited reason for graft failure in clinical setting. Many microsurgery training courses have incorporated vein graft procedures in their curricula, and vein graft torsion is a common technical error made by the surgeons in these courses. To improve our understanding of the clinical reproducibility of practicing vein graft procedures in microsurgery training courses, this study aims to determine if torsion can lead to early vein graft failure in nonsurvival surgery rat models. Methods Sprague-Dawley rats were divided into five cohorts with five rats per cohort for a total of 25 rats. Cohorts were labeled based on degree of vein graft torsion (0, 45, 90, 135, and 180 degrees). Torsion was created in the vein grafts at the distal arterial end by mismatching sutures placed between the proximal end of the vein graft and the distal arterial end. Vein graft patency was then verified 2 and 24 hours postoperation. Results All vein grafts were patent 2 and 24 hours postoperation. At 2 hours, the average blood flow rate measurements for 0, 45, 90, 135, and 180 degrees of torsion were 0.37 ± 0.02, 0.38 ± 0.04, 0.34 ± 0.01, 0.33 ± 0.01, and 0.29 ± 0.02 mL/min, respectively. At 24 hours, they were 0.94 ± 0.07, 1.03 ± 0.15, 1.26 ± 0.22, 1.41 ± 0.11, and 0.89 ± 0.15 mL/min, respectively. Conclusion Torsion of up to 180 degrees does not affect early vein graft patency in rat models. To improve the clinical reproducibility of practicing vein graft procedures in rat models, we suggest that microsurgery instructors assess vein graft torsion prior to clamp release, as vessel torsion does not seem to affect graft patency once the clamps are removed.

Gene Therapy for Vein Graft Failure Using Tissue Inhibitors of Metalloproteinases

1999 ◽  
Vol 97 (s41) ◽  
pp. 15P-15P
Author(s):  
SJ George ◽  
AH Baker ◽  
GD Angelini ◽  
AC Newby
Keyword(s):  
Gene Therapy ◽  
Vein Graft ◽  
Graft Failure ◽  
Tissue Inhibitors Of Metalloproteinases ◽  
Tissue Inhibitors ◽  
Vein Graft Failure

About the Impact of Extracardiac Vascular Disease on Vein Graft Failure

2014 ◽  
Vol 98 (5) ◽  
pp. 1889-1890 ◽  
Author(s):  
Ismail Yurekli ◽  
Habib Cakir ◽  
Yuksel Besir ◽  
Orhan Gokalp
Keyword(s):  
Vascular Disease ◽  
Vein Graft ◽  
Graft Failure ◽  
The Impact ◽  
Vein Graft Failure

Abstract 293: Clinical Predictors of Endothelial Function in Human Saphenous Vein

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Michael J Osgood ◽  
Kyle Hocking ◽  
Eric S Wise ◽  
Kevin W Sexton ◽  
Padmini Komalavilas ◽  
...  
Keyword(s):  
Endothelial Function ◽  
Saphenous Vein ◽  
Intimal Hyperplasia ◽  
Vein Graft ◽  
Graft Failure ◽  
Univariate Analysis ◽  
Clinical Predictors ◽  
Human Saphenous Vein ◽  
Graft Harvest ◽  
Vein Graft Failure

BACKGROUND: Human saphenous vein (HSV) remains the most widely utilized conduit for vascular bypass procedures. Outcomes remain limited by vein graft failure and intimal hyperplasia. Endothelial function is considered an important determinant of vein graft failure. We have observed significant variability in endothelial function in freshly isolated HSV samples. We therefore evaluated clinical predictors of endothelial function in HSV. Methods: We obtained freshly isolated HSV samples from the operating room immediately following harvest from patients undergoing coronary artery bypass procedures from Vanderbilt University Hospital and the Nashville VA Hospital. We obtained HSV samples prior to any intraoperative manipulations. HSV viability, smooth muscle function, and endothelial-dependent relaxation (EDR) were measured in a muscle bath. We collected the following clinical and demographic information: age, height, weight, gender, ethnicity, medical comorbidities, laboratory values (creatinine, HbA1c, lipids), ejection fraction, preoperative medication regimen, and method of vein graft harvest. We performed a univariate and multivariate analysis of predictors of endothelial function in HSV. Results: HSV samples were obtained from 149 patients. HSV EDR varied from -11% to 63%. Open harvest was employed for 39 HSV samples, compared with endoscopic harvest in 110 HSV samples. On univariate analysis, only open harvest was a statistically significant predictor of endothelial function (p=0.02): mean HSV EDR was 21.5% in HSV samples harvested open, compared with 15.4% in HSV harvested with an endoscopic technique. HSV EDR was also improved with preoperative aspirin use: mean HSV EDR was 18% in patients with preoperative aspirin use compared with 11.6% in patients who were not administered preoperative aspirin in a multivariate model when controlling for method of vein graft harvest (p=0.05). Conclusions: Endoscopic vein graft harvest is associated with endothelial dysfunction in HSV, while preoperative aspirin use is associated with improved endothelial function. Further work will be necessary to determine whether these factors are associated with development of intimal hyperplasia and vein graft failure.

Abstract 2056: Blockade of PDGF Receptor Tyrosine Kinase by Ex Vivo Nano-DDS of Imatinib Mesylate into the Vein Suppresses Vein Graft Neointima Formation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Satoshi Kimura ◽  
Kensuke Egahira ◽  
Hiroyuki Tsujimoto ◽  
Kaori Hara ◽  
Yoshiaki Kawashima ◽  
...  
Keyword(s):  
Tyrosine Kinase ◽  
Receptor Tyrosine Kinase ◽  
Vein Graft ◽  
Graft Failure ◽  
Therapeutic Strategy ◽  
Jugular Vein ◽  
Ex Vivo ◽  
Pdgf Receptor ◽  
Neointima Formation ◽  
Vein Graft Failure

Background: Clinical outcome of surgical revascularization using autologous vein graft is limited by vein graft failure due to neointima formation. Platelet-derived growth factor (PDGF), expressed by vascular smooth muscle cells (VSMCs), plays a central role in the pathogenesis of vein graft failure. Therefore, optimal nanotechnology-based drug delivery system (Nano-DDS) of PDGF receptor tyrosine kinase (TK) inhibitor, imatinib mesylate (STI571), can be an innovative therapeutic strategy for clinical application. We have developed such Nano-DDS using bioabsorbable PLGA nanoparticles (NP) for local ex vivo delivery. Hypothesis: Blockade of PDGF receptor TK by Nano-DDS of imatinib suppresses vein graft neointima formation. Methods and Results: [studies in human VSMCs in vitro] Addition of fluorescence (FITC)-encapsulated NP resulted in rapid and stable uptake by 99 % of cells. The Nano-DDS of imatinib prevented PDGF-induced phosphorylation of PDGF receptor TK, and thus normalized the PDGF-induced proliferation. [ ex vivo studies] Incubation of excised rabbit jugular vein and human saphenous vein ex vivo in FITC-encapsulated NP for 30 min resulted in highly efficient intracellular delivery rate (> 90 % cells) into cells of the venous wall. [ in vivo studies in rabbits] The excised jugular vein was treated ex vivo with PBS, imatinib only (100 mM), FITC NP only, or imatinib NP (100 mM) (n=5– 6, each) for 30 min, and then interposed into the carotid artery position of hypercholesterolemic rabbits. Seven and 28 days after ex vivo FITC NP treatment, FITC-positive cells were detected in many cells in the neointima and media (cellular uptake rate: 60 –70 %). Significant neointima was formed 28 days after grafting in PBS group, which was suppressed in imatinib NP group, but not in FITC NP only or imatinib only groups. Imatinib NP also inhibited the appearance of proliferating PCNA-positive cells and increased phosphorylation of PDGF receptor TK, but did not affect monocyte infiltration or endothelial regeneration process. Conclusions: Nano-DDS of imatinib into the excised vein ex vivo was feasible and suppressed vein graft neointima formation in rabbits. Nano-DDS of imatinib may be a clinically promising therapeutic strategy for prevention of vein graft failure.

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