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Histopathologic Insight into Saphenous Vein Bypass Graft Disease

Behnood Bikdeli a,h,i, Seyed-Ahmad Hassantash a,b, Mihan Pourabdollah c,d, Shadi Kalantarian a,j, Maryam Sadeghian a, Haleh Afshar a Shahram Sabeti a,f,  Mehrab Marzban g, Hossein Ahmadi j, Foroozan Mohammadi e
a Cardiovascular Research Center, b Department of Cardiovascular Surgery, Modarres Hospital, c Pediatric
Respiratory Diseases Research Center, NRITLD, d Chronic Respiratory Diseases Research Center, NRITLD, e Department of Pathology, Masih Daneshvari Hospital, and f Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, and g Department of Cardiovascular Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran , Iran; h Section of Cardiovascular Medicine, Department of Internal Medicine, and i Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Conn. , and j Harvard School of Public Health, Boston, Mass. , USA


Objectives: Vein graft disease is a major drawback of coronary artery bypass grafting. However, histopathologic studies of old human aortocoronary grafts are scarce

Methods: We screened patients undergoing redo coronary artery bypass grafting at three university hospitals and selected those with at least one excisable old vein graft. Native non-grafted saphenous veins were also obtained as controls. Clinical and
angiographic data were separately documented

Results: We evaluated 117 segments from 29 veins. All but 4 old graft segments showed degrees of luminal narrowing and fibrointimal
proliferation. Moreover, 61 segments demonstrated atherosclerotic plaques. Such plaques were typically concentric and, compared with other segments, more frequently represented necrosis, calcification and giant cells (p < 0.001 for all comparisons) and had a higher inflammatory cell
count, predominantly of lymphocytic origin. Native saphenous veins frequently showed fibrosis, but no calcification oractive inflammation. Angiographic findings showed moderate correlation with the histological degree of luminal stenosis (Spearman’s  = 0.564, p ! 0.001)

Conclusions: Human vein graft atherosclerosis and arterial atherosclerosis share many features; however, we found lymphocytes to be the
dominant inflammatory cells within plaques. Conventional angiography underestimated the atherosclerosis burden in vein grafts. Improved understanding of disease pathophysiology could lead to the development of novel interventions that reduce costly and suboptimal repeat revascularizations

Download ZIP Download PDF                                                     Cardiology 2012;123:208–215

 

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