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Published on: May 15, 2020
Vein graft harvesting induces inflammation and impairs vessel reactivity
Kazuhiro Hinokiyama1, Guro Valen, Shinichi Tokuno
1Crafoord Laboratory, Karolinska Hospital, Stockholm, Sweden.
Insights
Surgical handling of saphenous veins for coronary artery bypass grafting (CABG) increases inflammation and impairs vascular function. This may lead to early and late graft occlusion, highlighting the need for gentler surgical techniques.
Area of Science:
- Vascular Surgery
- Molecular Biology
- Immunology
Background:
- Saphenous veins are commonly used for coronary artery bypass grafting (CABG).
- Graft patency loss is a significant problem in CABG procedures.
- Surgical manipulation may contribute to saphenous vein graft injury.
Purpose of the Study:
- To investigate the impact of surgical handling on saphenous vein inflammation.
- To assess the effect of surgical procedures on vascular function of vein grafts.
- To understand the molecular mechanisms underlying graft injury during CABG.
Main Methods:
- Saphenous vein biopsies from 9 CABG patients were analyzed.
- Gene expression of cytokines, adhesion molecules, and vasoactive substances was measured using RT-PCR.
- Nuclear factor-kappaB (NFkappaB) translocation, endothelial integrity, and in vitro vein reactivity were assessed.
Main Results:
- Gene expression of proinflammatory cytokines and leukocyte adhesion molecules increased post-harvesting.
- Surgical handling led to NFkappaB translocation and partial endothelial loss.
- Impaired contractile function of the vein grafts was observed.
Conclusions:
- Standard surgical handling induces NFkappaB-driven inflammation in vein grafts.
- Surgical manipulation impairs vascular function, potentially affecting graft patency.
- Findings suggest that surgical techniques may contribute to early and late graft occlusion in CABG.
Background:
Saphenous veins are often used for coronary artery bypass grafting (CABG), but loss of patency is a problem. The surgical procedure may contribute to graft injury. Our aim was to study the impact of surgical handling of saphenous veins on graft inflammation and vascular function.
Methods:
Biopsy samples of saphenous veins were taken from 9 patients undergoing elective CABG at the start of vein harvesting (open technique) and after the last proximal anastomosis was sutured. Messenger RNA was extracted and amplified with semiquantitative reverse transcription polymerase chain reaction. Gene expression of proinflammatory cytokines (tumor necrosis factor-alpha, interleukin-1beta), leukocyte adhesion molecules (E-selectin, intercellular adhesion molecule-1), and vasoactive substances (endothelin-1, inducible and endothelial nitric oxide synthase) was investigated. Translocation of nuclear factor-kappaB (NFkappaB) was evaluated with electrophoretic mobility shift assay. Immunostaining for von Willebrand factor was performed to evaluate loss of endothelium, and in vitro vein reactivity to phenylephrine and endothelin-1 was studied.
Results:
Gene expression of cytokines and leukocyte adhesion molecules increased after graft harvesting and storage, whereas vasoactive substances did not change. Nuclear translocation of NFkappaB occurred after surgical handling, concurrent with partial loss of endothelium and impaired contractile function.
Conclusions:
Standard surgical handling of vein grafts induces NFkappaB-driven inflammation in the vessel wall and impairs vascular function. This may potentially contribute to both early and late graft occlusion.
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