Pathophysiology of Aortocoronary Saphenous Vein Bypass Graft Disease

Hasantash, SA; Bikdeli, B.; Kalantarian, Sh.; Sadeghian, M.; Afshar, H.; Tahmsbi Rad, M.

Pathophysiology of Aortocoronary Saphenous Vein Bypass Graft Disease

Document Type : Original Article

Authors

SA Hasantash ¹

B. Bikdeli ²

Sh. Kalantarian ³

M. Sadeghian ³

H. Afshar ³

M. Tahmsbi Rad ⁴

¹ Professor of Cardiovascular Surgery, Shahid Beheshti University of Medical Sciences and Health Services, Shahid Modares Hospital, Tehran, Iran

² Medical Student, Shahid Beheshti University of Medical Sciences and Health Services, Students’ Manager of Credit Vascular Research Center, Tehran, Iran

³ Medical Student, Shahid Beheshti University of Medical Sciences and Health Services, Vascular Research Center, Tehran, Iran

⁴ General Physician

Abstract

Introduction & Objective: Aortocoronary saphenous vein bypass grafting relieves anginal pain in patients with coronary artery disease. However, its effectiveness is limited due to graft failure; the 10-year patency rate is 50%–60%. Materials & Methods: This article with reviewing of 80 different papers focuses on the pathophysiologic aspects of this widespread, costly, and disabling disease, with emphasis on late graft occlusion and distinctions between arterial and venous atherosclerosis in terms of histology, pathophysiology, and risk factors. Results: Early, 1-year, and late graft failure may be due to thrombosis, fibrointimal hyperplasia, and atherosclerosis, respectively. There is general agreement that vein graft atherosclerosis differs from arterial lesions in terms of temporal and histological changes. Vein graft atherosclerosis is more rapid, with diffuse concentric changes and a less noticeable fibrous cap, making venous plaques more vulnerable to rupture and subsequent thrombus formation. Conclusions: Despite progress in understanding the pathophysiology, some aspects of vein graft atherosclerosis need to be clarified. As new research and clinical experience broadens our knowledge of the pathogenesis and pathophysiology of vein graft atherosclerosis, it will not seen farfetched to introduce novel treatment options against this widespread, costly and disabling disease.

Keywords

CABG

Saphenous Vein

Atherosclerosis