From the Department of Cardiology, Cleveland Clinic Foundation,
Cleveland, Ohio.
Correspondence to Joseph G. Motwani, MD, Department of Cardiology, Freeman Hospital, High Heaton, Newcastle-on-Tyne NE7 7DN, UK.
Abstract—Aortocoronary saphenous
vein graft disease, with its increasing clinical sequelae, presents an
important and unresolved dilemma in cardiological practice. During the
1st month after bypass surgery, vein graft attrition results from
thrombotic occlusion, while later the dominant process is
atherosclerotic obstruction occurring on a foundation of neointimal
hyperplasia. Although the risk factors predisposing to vein graft
atherosclerosis are broadly similar to those recognized for native
coronary disease, the pathogenic effects of these risk factors are
amplified by inherent deficiencies of the vein as a conduit when
transposed into the coronary arterial circulation. A multifaceted
strategy aimed at prevention of vein graft disease is emerging,
elements of which include: continued improvements in surgical
technique; more effective antiplatelet drugs; increasingly intensive
risk factor modification, in particular early and aggressive
lipid-lowering drug therapy; and a number of evolving therapies, such
as gene transfer and nitric oxide donor administration, which target
vein graft disease at an early and fundamental level. At present, a key
measure is to circumvent the problem of vein graft disease by
preferential selection of arterial conduits, in particular the internal
mammary arteries, for coronary bypass surgery whenever possible.
© 1998 American Heart Association, Inc.
Current Perspectives
Aortocoronary Saphenous Vein Graft Disease
Pathogenesis, Predisposition, and Prevention
Key Words: atherosclerosis • bypass • grafting • risk factors • prevention
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J. V. Manchio, J. Gu, L. Romar, J. Brown, J. Gammie, R. N. Pierson III, B. Griffith, and R. S. Poston Disruption of Graft Endothelium Correlates With Early Failure After Off-Pump Coronary Artery Bypass Surgery Ann. Thorac. Surg., June 1, 2005; 79(6): 1991 - 1998. [Abstract] [Full Text] [PDF]
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A. Zampetaki, Z. Zhang, Y. Hu, and Q. Xu Biomechanical stress induces IL-6 expression in smooth muscle cells via Ras/Rac1-p38 MAPK-NF-{kappa}B signaling pathways Am J Physiol Heart Circ Physiol, June 1, 2005; 288(6): H2946 - H2954. [Abstract] [Full Text] [PDF]
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 R. Marano, M. L. Storto, B. Merlino, N. Maddestra, G. Di Giammarco, and L. Bonomo A Pictorial Review of Coronary Artery Bypass Grafts at Multidetector Row CT Chest, April 1, 2005; 127(4): 1371 - 1377. [Abstract] [Full Text] [PDF]
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K. Peppel, L. Zhang, E. S. Orman, P.-O. Hagen, A. Amalfitano, L. Brian, and N. J. Freedman Activation of vascular smooth muscle cells by TNF and PDGF: overlapping and complementary signal transduction mechanisms Cardiovasc Res, February 15, 2005; 65(3): 674 - 682. [Abstract] [Full Text] [PDF]
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T. Schachner, A. Oberhuber, Y. Zou, A. Tzankov, H. Ott, G. Laufer, and J. Bonatti Rapamycin treatment is associated with an increased apoptosis rate in experimental vein grafts Eur. J. Cardiothorac. Surg., February 1, 2005; 27(2): 302 - 306. [Abstract] [Full Text] [PDF]
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R. M.A. van de Wal, B. L. van Brussel, A. A. Voors, T. D.J. Smilde, J. C. Kelder, H. A. van Swieten, W. H. van Gilst, D. J. van Veldhuisen, and H.W. T. Plokker Mild preoperative renal dysfunction as a predictor of long-term clinical outcome after coronary bypass surgery J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 330 - 335. [Abstract] [Full Text] [PDF]
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U. Khanderia, K. A. Townsend, K. Eagle, and R. Prager Statin Initiation Following Coronary Artery Bypass Grafting: Outcome of a Hospital Discharge Protocol Chest, February 1, 2005; 127(2): 455 - 463. [Abstract] [Full Text] [PDF]
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T. Sakaguchi, T. Asai, D. Belov, M. Okada, D. J. Pinsky, A. M. Schmidt, and Y. Naka Influence of ischemic injury on vein graft remodeling: Role of cyclic adenosine monophosphate second messenger pathway in enhanced vein graft preservation J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 129 - 137. [Abstract] [Full Text] [PDF]
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Z. Wang, P. J. Rao, M. R. Castresana, and W. H. Newman TNF-{alpha} induces proliferation or apoptosis in human saphenous vein smooth muscle cells depending on phenotype Am J Physiol Heart Circ Physiol, January 1, 2005; 288(1): H293 - H301. [Abstract] [Full Text] [PDF]
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L. Zhang, K. Peppel, L. Brian, L. Chien, and N. J. Freedman Vein Graft Neointimal Hyperplasia Is Exacerbated by Tumor Necrosis Factor Receptor-1 Signaling in Graft-Intrinsic Cells Arterioscler Thromb Vasc Biol, December 1, 2004; 24(12): 2277 - 2283. [Abstract] [Full Text] [PDF]
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J. P. Carrozza Jr and F. W. Sellke A 69-Year-Old Woman With Left Main Coronary Artery Disease JAMA, November 24, 2004; 292(20): 2506 - 2514. [Full Text] [PDF]
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N. Tabuchi, M. Shichiri, A. Shibamiya, T. Koyama, F. Nakazawa, J. Chung, S. Hirosawa, and M. Sunamori Non-viral in vivo thrombomodulin gene transfer prevents early loss of thromboresistance of grafted veins Eur. J. Cardiothorac. Surg., November 1, 2004; 26(5): 995 - 1001. [Abstract] [Full Text] [PDF]
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 R. S. Dieter, S. L. Stevens, D. S. Rush, J. P. Pacanowski Jr, M. H. Goldman, and M. B. Freeman Endovascular Exclusion of Saphenous Vein Graft Aneurysms Complicating Abdominal Aortic Aneurysm Repair: A Case Report Vascular and Endovascular Surgery, November 1, 2004; 38(6): 579 - 582. [Abstract] [PDF]
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E. C. Douville, J. W. Asaph, R. J. Dworkin, J. R. Handy Jr, C. S. Canepa, G. L. Grunkemeier, and Y. Wu Sternal Preservation: A Better Way to Treat Most Sternal Wound Complications After Cardiac Surgery Ann. Thorac. Surg., November 1, 2004; 78(5): 1659 - 1664. [Abstract] [Full Text] [PDF]
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G. J. Murphy, A. J. Bryan, and G. D. Angelini Hybrid Coronary Revascularization in the Era of Drug-Eluting Stents Ann. Thorac. Surg., November 1, 2004; 78(5): 1861 - 1867. [Abstract] [Full Text] [PDF]
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R. Friedl, J. Li, B. Schumacher, H. Hanke, J. Waltenberger, A. Hannekum, and S. Stracke Intimal Hyperplasia and Expression of Transforming Growth Factor-{beta}1 in Saphenous Veins and Internal Mammary Arteries Before Coronary Artery Surgery Ann. Thorac. Surg., October 1, 2004; 78(4): 1312 - 1318. [Abstract] [Full Text] [PDF]
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X. Li, K.-Y. Chyu, J. R. F. Neto, J. Yano, N. Nathwani, C. Ferreira, P. C. Dimayuga, B. Cercek, S. Kaul, and P. K. Shah Differential Effects of Apolipoprotein A-I-Mimetic Peptide on Evolving and Established Atherosclerosis in Apolipoprotein E-Null Mice Circulation, September 21, 2004; 110(12): 1701 - 1705. [Abstract] [Full Text] [PDF]
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C. Chen-Scarabelli, T. Scarabelli, A. Zacharias, R. H. Habib, T. A. Schwann, C. J. Riordan, S. J. Durham, and A. Shah Factors Affecting Graft Patency: The Operating Room and Beyond * Response Circulation, August 10, 2004; 110(6): e64 - e64. [Full Text] [PDF]
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M. Sata and R. Nagai Origin of Neointimal Cells in Autologous Vein Graft Arterioscler Thromb Vasc Biol, July 1, 2004; 24(7): 1147 - 1149. [Full Text] [PDF]
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B. C. Cooley Murine Model of Neointimal Formation and Stenosis in Vein Grafts Arterioscler Thromb Vasc Biol, July 1, 2004; 24(7): 1180 - 1185. [Abstract] [Full Text] [PDF]
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E. Torsney, U. Mayr, Y. Zou, W. D. Thompson, Y. Hu, and Q. Xu Thrombosis and Neointima Formation in Vein Grafts Are Inhibited by Locally Applied Aspirin Through Endothelial Protection Circ. Res., June 11, 2004; 94(11): 1466 - 1473. [Abstract] [Full Text] [PDF]
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J. Y. Jeremy, R. Bulbulia, J. L. Johnson, P. Gadsdon, V. Vijayan, N. Shukla, F. C. T. Smith, and G. D. Angelini A bioabsorbable (polyglactin), nonrestrictive, external sheath inhibits porcine saphenous vein graft thickening J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1766 - 1772. [Abstract] [Full Text] [PDF]
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J. F. Christiansen, D. Hartwig, J.F. M. Bechtel, H. Kluter, H. H. Sievers, U. Schonbeck, and C. Bartels Diseased vein grafts express elevated inflammatory cytokine levels compared with atherosclerotic coronary arteries Ann. Thorac. Surg., May 1, 2004; 77(5): 1575 - 1579. [Abstract] [Full Text] [PDF]
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T. Schachner, Y. Zou, A. Oberhuber, A. Tzankov, T. Mairinger, G. Laufer, and J. O. Bonatti Local application of rapamycin inhibits neointimal hyperplasia in experimental vein grafts Ann. Thorac. Surg., May 1, 2004; 77(5): 1580 - 1585. [Abstract] [Full Text] [PDF]
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P. C. Saunders, G. Pintucci, C. S. Bizekis, R. Sharony, K. M. Hyman, F. Saponara, F. G. Baumann, E. A. Grossi, S. B. Colvin, P. Mignatti, et al. Vein graft arterialization causes differential activation of mitogen-activated protein kinases J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1276 - 1284. [Abstract] [Full Text] [PDF]
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S. Wan, A. P. C. Yim, J. L. Johnson, N. Shukla, G. D. Angelini, F. C. T. Smith, M. R. Dashwood, and J. Y. Jeremy The endothelin 1A receptor antagonist BSF 302146 is a potent inhibitor of neointimal and medial thickening in porcine saphenous vein-carotid artery interposition grafts J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1317 - 1322. [Abstract] [Full Text] [PDF]
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T. Schachner, Y. Zou, A. Oberhuber, T. Mairinger, A. Tzankov, G. Laufer, H. Ott, and J. Bonatti Perivascular application of C-type natriuretic peptide attenuates neointimal hyperplasia in experimental vein grafts Eur. J. Cardiothorac. Surg., April 1, 2004; 25(4): 585 - 590. [Abstract] [Full Text] [PDF]
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J. Cornelissen, J. Armstrong, and C. M. Holt Mechanical Stretch Induces Phosphorylation of p38-MAPK and Apoptosis in Human Saphenous Vein Arterioscler Thromb Vasc Biol, March 1, 2004; 24(3): 451 - 456. [Abstract] [Full Text]
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L. Zhang, N. J. Freedman, L. Brian, and K. Peppel Graft-Extrinsic Cells Predominate in Vein Graft Arterialization Arterioscler Thromb Vasc Biol, March 1, 2004; 24(3): 470 - 476. [Abstract] [Full Text]
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 E. McGregor, L. Kempster, R. Wait, M. Gosling, M. J. Dunn, and J. T. Powell F-actin Capping (CapZ) and Other Contractile Saphenous Vein Smooth Muscle Proteins Are Altered by Hemodynamic Stress: A PROTEOMIC APPROACH Mol. Cell. Proteomics, February 1, 2004; 3(2): 115 - 124. [Abstract] [Full Text] [PDF]
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