Document Detail


Early remodeling of lower extremity vein grafts: inflammation influences biomechanical adaptation.
MedLine Citation:
PMID:  18440187     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The remodeling of vein bypass grafts after arterialization is incompletely understood. We have previously shown that significant outward lumen remodeling occurs during the first month of implantation, but the magnitude of this response is highly variable. We sought to examine the hypothesis that systemic inflammation influences this early remodeling response.
METHODS: A prospective observational study was done of 75 patients undergoing lower extremity bypass using autogenous vein. Graft remodeling was assessed using a combination of ultrasound imaging and two-dimensional high-resolution magnetic resonance imaging.
RESULTS: The vein graft lumen diameter change from 0 to 1 month (22.7% median increase) was positively correlated with initial shear stress (P = .016), but this shear-dependent response was disrupted in subjects with an elevated baseline high-sensitivity C-reactive protein (hsCRP) level of >5 mg/L. Despite similar vein diameter and shear stress at implantation, grafts in the elevated hsCRP group demonstrated less positive remodeling from 0 to 1 month (13.5% vs 40.9%, P = .0072). By regression analysis, the natural logarithm of hsCRP was inversely correlated with 0- to 1-month lumen diameter change (P = .018). Statin therapy (beta = 23.1, P = .037), hsCRP (beta = -29.7, P = .006), and initial shear stress (beta = .85, P = .003) were independently correlated with early vein graft remodeling. In contrast, wall thickness at 1 month was not different between hsCRP risk groups. Grafts in the high hsCRP group tended to be stiffer at 1 month, as reflected by a higher calculated elastic modulus (E = 50.4 vs 25.1 Mdynes/cm2, P = .07).
CONCLUSIONS: Early positive remodeling of vein grafts is a shear-dependent response that is modulated by systemic inflammation. These data suggest that baseline inflammation influences vein graft healing, and therefore, inflammation may be a relevant therapeutic target to improve early vein graft adaptation.
Authors:
Christopher D Owens; Frank J Rybicki; Nicole Wake; Andres Schanzer; Dimitrios Mitsouras; Marie D Gerhard-Herman; Michael S Conte
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2008-04-28
Journal Detail:
Title:  Journal of vascular surgery     Volume:  47     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-02     Completed Date:  2008-07-10     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1235-42     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adaptation, Physiological
Aged
Anastomosis, Surgical / adverse effects
Arm / blood supply*
C-Reactive Protein / metabolism
Female
Hemodynamics*
Humans
Inflammation / etiology,  metabolism,  pathology,  physiopathology*
Intermittent Claudication / etiology,  pathology,  physiopathology,  surgery*
Ischemia / complications,  pathology,  physiopathology,  surgery*
Lower Extremity / blood supply*
Magnetic Resonance Angiography
Male
Middle Aged
Prospective Studies
Regional Blood Flow
Saphenous Vein / pathology,  physiopathology,  transplantation*
Stress, Mechanical
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex
Wound Healing*
Grant Support
ID/Acronym/Agency:
HL75771/HL/NHLBI NIH HHS; K23-882//PHS HHS; M01 RR002635/RR/NCRR NIH HHS; M01 RR002635-235406/RR/NCRR NIH HHS; R01 HL075771/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
9007-41-4/C-Reactive Protein
Comments/Corrections

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