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The spectrum of pathologic changes in aortocoronary saphenous vein grafts
Insights
Autopsy examination of aortocoronary vein grafts revealed early occlusion by thrombi. Intimal proliferation caused graft occlusion within 6 months, progressing to fibrotic changes and atherosclerosis in long-term survivors.
Area of Science:
- Cardiovascular Surgery
- Pathology
- Biomedical Engineering
Background:
- Aortocoronary vein grafts are crucial for coronary artery bypass grafting (CABG).
- Graft patency and long-term survival remain significant challenges in cardiovascular surgery.
- Understanding graft degeneration is vital for improving patient outcomes.
Purpose of the Study:
- To investigate the pathological changes and progression of degeneration in aortocoronary vein grafts.
- To identify the timeline and morphological features of graft occlusion and atherosclerosis.
- To correlate graft changes with patient survival duration post-CABG.
Main Methods:
- Autopsy examination of 182 aortocoronary vein grafts from patients deceased up to 5 years post-CABG.
- Utilized light and electron microscopy for detailed morphological analysis.
- Assessed graft occlusion, intimal proliferation, and atherosclerotic development.
Main Results:
- Graft occlusion within the first month was primarily due to thrombi (recent and organized).
- Intimal proliferation, leading to total lumen occlusion, was observed as early as 6 months post-surgery.
- Grafts implanted for over 1 year showed cellular intimal thickening progressing to fibrotic and hyaline-like changes.
- Atherosclerosis developed in vein grafts in 3 out of 6 patients surviving over 3 years.
Conclusions:
- Early aortocoronary vein graft failure is often attributed to thrombosis.
- Intimal hyperplasia is a progressive process leading to graft occlusion within the first year.
- Long-term vein graft degeneration involves significant morphological changes, including the development of atherosclerosis.
Abstract:
Aortocoronary vein grafts removed at autopsy of 182 patients who died up to 5 years after the bypass operation were examined by light and electron microscopy. During the first month after surgery, graft occlusion was due to thrombi, some of them recent, some organized and recanalized. Intimal proliferation of the graft first appeared 4 weeks after the bypass surgery; several cases of total occlusion of the lumen by this process were seen within 6 months of the operation. A change in the morphological features of the intimal thickening from cellular to fibrotic and hylain-like was observed in several grafts implanted for more than 1 year. Typical atherosclerosis developed in vein grafts in three of the six patients surviving the operation for more than 3 years.