Document Detail


High-pressure distention of the saphenous vein during preparation results in increased markers of inflammation: a potential mechanism for graft failure.
MedLine Citation:
PMID:  22206954     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Coronary artery disease is the single leading cause of death in the United States. Commonly it is treated with coronary bypass grafting using the saphenous vein (SV) or internal mammary artery (IMA) as a conduit. Unfortunately, the SV has much lower patency rates compared with the IMA. Several hypotheses exist as to why occlusion occurs more commonly in SV grafts than in IMA grafts. However detailed studies in this area have been limited. This study investigates the effects of pressure distention on inflammation in SV conduit used in coronary artery bypass grafting (CABG).
METHODS: Saphenous vein distention pressure was measured intraoperatively during 48 CABG procedures. A segment of SV was excised from the conduit before distention. Because the vein was used for coronary artery grafting, sequential pieces were archived for evaluation. Real-time polymerase chain reaction (RT-PCR) and immunohistochemical analyses were performed to investigate a change in the expression of biomarkers.
RESULTS: Upregulation of various biomarkers occurred. These biomarkers included scavenger receptors A and B (SR-A, SR-B), toll-like receptors 2 and 4 (TLR2, TLR4), platelet endothelial cell adhesion molecule (PECAM), vascular cell adhesion molecule (VCAM), and intercellular cell adhesion molecule (ICAM) in segments of SV that were subjected to distention. Immunohistochemical results mirrored RT-PCR findings. A significant correlation was observed between biomarkers and pressure values.
CONCLUSIONS: These studies demonstrate that markers of inflammation are upregulated in response to SV distention. The data suggest that the pressure used in graft preparation procedures should be regulated to avoid inflammation and its potential to induce graft failure.
Authors:
Maseeha S Khaleel; Tracy A Dorheim; Michael J Duryee; Harold E Durbin; Walter D Bussey; Robert P Garvin; Lynell W Klassen; Geoffrey M Thiele; Daniel R Anderson
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-12-28
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  93     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-24     Completed Date:  2012-03-20     Revised Date:  2013-01-11    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  552-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska 68198-4455, USA. mkhaleel@unmc.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers
Cell Adhesion Molecules / analysis*,  biosynthesis,  genetics
Coronary Artery Bypass / methods*
Coronary Disease / surgery
Female
Graft Occlusion, Vascular / etiology*,  metabolism
Humans
Hyperplasia
Male
Middle Aged
Phlebitis / etiology,  metabolism
Pressure / adverse effects
RNA, Messenger / analysis
Real-Time Polymerase Chain Reaction
Receptors, Scavenger / analysis*,  biosynthesis,  genetics
Saphenous Vein / metabolism,  pathology,  transplantation*
Tissue and Organ Harvesting / adverse effects*,  methods
Toll-Like Receptors / analysis*,  biosynthesis,  genetics
Up-Regulation
Vascular Patency
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Cell Adhesion Molecules; 0/RNA, Messenger; 0/Receptors, Scavenger; 0/Toll-Like Receptors
Comments/Corrections
Comment In:
Ann Thorac Surg. 2012 Dec;94(6):2177-8; author reply 2178-9   [PMID:  23176943 ]
Ann Thorac Surg. 2012 Dec;94(6):2179; author reply 2179   [PMID:  23176945 ]

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