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ATHEROSCLEROSIS OF AORTOCORONARY ARTERY SAPHENOUS VEIN BYPASS GRAFTS.

Tomas Klima1, Earl F. Beard, John D. Milam

  • 1Divisions of Pathology and Surgery of the Texas Heart Institute and St. Luke's Episcopal and Texas Children's Hospitals, Houston, Texas.

Cardiovascular Diseases
|September 1, 1979
PubMed
Summary

Atherosclerosis in saphenous vein grafts is infrequent, developing within 6 years post-operation. Poorly cellular intimal fibrosis causes graft rigidity, leading to irregular flow and dissection, though clinical risk factors showed no correlation.

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Area of Science:

  • Cardiovascular Surgery
  • Vascular Biology
  • Pathology

Background:

  • Saphenous vein grafts (SVGs) are commonly used for aortocoronary artery bypass (CABG) reoperations.
  • Atherosclerosis can compromise the long-term patency and function of SVGs.
  • Understanding SVG atherosclerosis is crucial for improving surgical outcomes.

Purpose of the Study:

  • To investigate the incidence and pathological characteristics of atherosclerosis in SVG explants.
  • To explore the relationship between clinical factors and SVG atherosclerosis.
  • To elucidate the pathogenetic mechanisms underlying SVG atherosclerosis.

Main Methods:

  • Analysis of 168 SVG explants from 109 patients undergoing CABG reoperation.
  • Histopathological examination of graft specimens obtained at reoperation or postmortem.

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  • Correlation of pathological findings with available clinical data and patient history.

    • Main Results:

    • Atherosclerosis was identified in 29 of 168 SVGs (17.3%), with plaques observed 3 months to 6 years post-operation.
    • SVG atherosclerosis was frequently associated with mural thrombi, intimal fibrosis, or thickened intima with hematomas.
    • No significant correlation was found between clinical risk factors (hypercholesterolemia, hypertension, diabetes) and SVG atherosclerosis.
    • Poorly cellular intimal fibrosis led to graft rigidity, irregular flow, and dissection in some cases.

    Conclusions:

    • Hemodynamically significant stenosis due to atherosclerosis is an infrequent complication of SVGs.
    • The pathogenesis may involve standard atherogenesis and thrombus transformation.
    • Graft rigidity due to intimal fibrosis is a key factor in graft dysfunction.