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[Long-term patency of aorto-coronary saphenous vein grafts]
S Tsukamoto1, T Hasegawa, S Kitamura
1Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
Insights
Coronary risk factors significantly impact saphenous vein graft patency, especially hyperlipidemia. Controlling these factors, particularly high cholesterol, is crucial for improving long-term graft survival after bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Medical Risk Factor Analysis
Context:
- Saphenous vein grafts are widely used for coronary artery bypass grafting.
- Graft patency rates decline over time, impacting long-term patient prognosis.
- Coronary risk factors are implicated in graft failure, but their specific impact requires further elucidation.
Purpose:
- To investigate the influence of coronary risk factors on the long-term patency of aorto-coronary saphenous vein grafts.
- To identify specific risk factors that significantly affect graft survival.
- To provide evidence-based recommendations for improving graft patency.
Summary:
- A study of 182 patients with 814 saphenous vein grafts analyzed the impact of smoking, hypertension, hyperlipidemia, diabetes, obesity, and family history on graft patency.
- Long-term patency rates were 66.0%, significantly lower in patients with hyperlipidemia (57.4%) compared to those without (81.8%).
- Pathological findings showed intima-media hyperplasia in grafts from patients with multiple risk factors, indicating systemic effects on graft health.
Impact:
- Effective management of coronary risk factors, particularly hyperlipidemia, is essential for enhancing the long-term patency of saphenous vein grafts.
- Findings suggest that hyperlipidemia is a major modifiable determinant of graft failure.
- Improved control strategies for risk factors could significantly improve outcomes in patients undergoing coronary artery bypass grafting.
Abstract:
One hundred eighty-two cases with 814 aorto-coronary saphenous vein grafts were studied according to coronary risk factors (smoking, hypertension, hyperlipidemia, diabetes mellitus, obesity and family history). The patency rates of all cases were as follows, early-term (within one year after operation): 92.3%, mid-term (within 5 years after operation) 80.7%, long-term (more than 5 years after operation): 66.0%. Coronary risk factors have great influence upon the mid- and long-term patency, especially upon the latter. The long-term patency rate of the grafts complicated with hyperlipidemia was 57.4% and that without hyperlipidemia was 81.8% (p less than 0.01). Hyperlipidemia, complicating 55.5% of all cases, was one of the most influential factors on the patency and also the most difficult one to be controlled. In the United States and Europe, many cases were complicated with hyperlipidemia, and it was considered that the poor patency of the saphenous vein grafts in those countries was due to this fact. Pathological studies revealed that hyperplasia of intima and media, characteristics of venosclerosis, appeared frequently in the saphenous vein grafts having more than three risk factors, and that the factors had effect not only upon arteries but also upon veins. So we conclude that saphenous vein grafts are the materials of good long-term patency, and that the control of the risk factors, particularly hyperlipidemia, is the key to improve the patency.