Document Detail


Lower extremity vein graft failure: a translational approach.
MedLine Citation:
PMID:  18372442     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with the most severe manifestations of lower extremity arterial occlusive disease often require peripheral bypass surgery for limb salvage and preservation of function. Although good quality saphenous vein offers the most durable conduit for reconstruction, 5-year failure rates are 30-50% and have remained largely unchanged for the past two decades. The majority of these failures occur within the first year of implantation, which is regarded as the most biologically active time during which the vein graft adapts to the arterial environment. Although intimal hyperplasia is generally regarded as the primary culprit of vein graft failure, geometric remodeling of the healing vein graft has recently emerged as a potentially significant contributing factor. While hemodynamic forces, including an increase in shear stress and wall tension, are undoubtedly central to the magnitude and direction of vein graft remodeling, we have determined that these forces alone cannot account for the extent of variability noted in early remodeling patterns. Therefore, we hypothesize that circulating factors, such as mediators of inflammation, may modulate the vein graft response to mechanical forces. This article reviews the definition and diagnosis of vein graft failure and summarizes our current efforts to understand the mechanisms of normal and abnormal vein graft adaptation to the arterial environment.
Authors:
Christopher D Owens; Karen J Ho; Michael S Conte
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Vascular medicine (London, England)     Volume:  13     ISSN:  1358-863X     ISO Abbreviation:  Vasc Med     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-03-28     Completed Date:  2008-08-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9610930     Medline TA:  Vasc Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  63-74     Citation Subset:  IM    
Affiliation:
Division of Vascular and Endovascular Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. cmowens@partners.org
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MeSH Terms
Descriptor/Qualifier:
Animals
Graft Occlusion, Vascular / pathology,  physiopathology*
Graft Survival*
Hemodynamics
Humans
Hyperplasia
Lower Extremity / blood supply*
Peripheral Vascular Diseases / pathology,  physiopathology,  surgery*
Stress, Mechanical
Treatment Failure
Vascular Surgical Procedures*
Veins / transplantation*
Wound Healing
Grant Support
ID/Acronym/Agency:
HL 75771/HL/NHLBI NIH HHS; T32 HL007734/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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