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Intimal hyperplasia in reversed and in situ vein grafts: an intra-individual canine study
M J Segers1, F L Moll, F J vd Molengraft
1Diakonessenhuis Department of Surgery Utrecht, The Netherlands.
The apparent superiority of the in situ vein graft over the reversed vein graft in long arterial reconstructions has been explained by a superior hemodynamic performance and a reduction of intimal hyperplasia in the in situ graft. To examine this, an intracomparative canine study was performed with respect to the progression of intimal and medial changes in both in situ and reversed vein grafts. Paired femoropopliteal artery grafts were inserted in six dogs using the in situ technique in the right leg and the reversed technique in the left leg. The grafts were excised at 1 day, 3 months, and 6 months after operation. Substantial changes were shown both in histologic structure and in absolute intimal and medial thickness, without a significant intra-individual difference between in situ and reversed grafts. The intima-to-media ratio increased in the first 3 months and stabilized in the 3- to 6-month interval. In this intra-individual canine study preservation of adventitia and vasa vasorum had no biologic effect on the development of the same intimal changes in the midsection of reversed and in situ vein grafts.
The apparent superiority of the in situ vein graft over the reversed vein graft in long arterial reconstructions has been explained by a superior hemodynamic performance and a reduction of intimal hyperplasia in the in situ graft. To examine this, an intracomparative canine study was performed with respect to the progression of intimal and medial changes in both in situ and reversed vein grafts. Paired femoropopliteal artery grafts were inserted in six dogs using the in situ technique in the right leg and the reversed technique in the left leg. The grafts were excised at 1 day, 3 months, and 6 months after operation. Substantial changes were shown both in histologic structure and in absolute intimal and medial thickness, without a significant intra-individual difference between in situ and reversed grafts. The intima-to-media ratio increased in the first 3 months and stabilized in the 3- to 6-month interval. In this intra-individual canine study preservation of adventitia and vasa vasorum had no biologic effect on the development of the same intimal changes in the midsection of reversed and in situ vein grafts.