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Rapidly progressive atherosclerosis in aortocoronary saphenous vein grafts. Possible immune-mediated disease
1Department of Pathology, Cleveland Clinic Foundation, OH 44106.
Insights
Atherosclerosis in aortocoronary saphenous vein grafts may be immune-mediated. Examination of 115 grafts revealed diffuse intimal fibroplasia and rapid atherosclerosis, suggesting an immune response.
Area of Science:
- Cardiovascular Pathology
- Immunology
- Vascular Biology
Background:
- Saphenous vein grafts are commonly used in coronary artery bypass grafting.
- Graft failure due to atherosclerosis and intimal hyperplasia remains a significant clinical challenge.
Purpose of the Study:
- To investigate the histological characteristics of aortocoronary saphenous vein grafts.
- To determine the potential underlying mechanisms of graft atherosclerosis and intimal fibroplasia.
Main Methods:
- Histological examination of 115 aortocoronary saphenous vein grafts from 100 reoperations.
- Analysis of graft features including intimal fibroplasia and atherosclerotic changes.
Main Results:
- 99% of grafts exhibited diffuse concentric intimal fibroplasia.
- 46% of grafts showed rapid, diffuse atherosclerosis with inflammatory cells and foam cells.
- Histological features resembled those in experimental immune-mediated atherosclerosis models.
Conclusions:
- Atherosclerosis in saphenous vein grafts may be an immune-mediated disease.
- Intimal fibroplasia might also be linked to immune responses.
Abstract:
One hundred fifteen aortocoronary saphenous vein grafts from 100 consecutive reoperations were examined. Ninety-nine percent of the grafts contained diffuse concentric intimal fibroplasia. Forty-six percent of the grafts were atherosclerotic. The atherosclerosis was typically rapid in development, concentric, diffuse, without a fibrous cap, with numerous foam cells and inflammatory cells, including multinucleate giant cells, with erosion of the media by the inflammatory reaction. The histologic features of the grafts were similar to those reported in experimental models of immune-mediated atherosclerosis. On this basis we propose that aortocoronary saphenous vein graft atherosclerosis, and possibly intimal fibroplasia, may be an immune-mediated disease.