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Remodeling leads to distinctly more intimal hyperplasia in coronary than in infrainguinal vein grafts  Peter Zilla, MD, PhD, Loven Moodley, MBBS, FCS,

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Presentation on theme: "Remodeling leads to distinctly more intimal hyperplasia in coronary than in infrainguinal vein grafts  Peter Zilla, MD, PhD, Loven Moodley, MBBS, FCS,"— Presentation transcript:

1 Remodeling leads to distinctly more intimal hyperplasia in coronary than in infrainguinal vein grafts  Peter Zilla, MD, PhD, Loven Moodley, MBBS, FCS, Jacques Scherman, MBChB, FCS, Hugo Krynauw, MS, Jeroen Kortsmit, PhD, Paul Human, PhD, Michael F. Wolf, BS, Thomas Franz, PhD  Journal of Vascular Surgery  Volume 55, Issue 6, Pages (June 2012) DOI: /j.jvs Copyright © 2012 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Mean wall shear stress (WSS) in the native femoral and left anterior descending coronary arteries before grafting (black) and in their vein grafts. In femoral arteries (top) the peak shear stress occurs during the main forward flow phase during systole, followed by a brief second peak during the reverse-flow period. As a result of moderately larger luminal dimension, shear forces in femoral vein grafts mirror those of the femoral artery in a mildly damped fashion. In left anterior descending coronary arteries (bottom), a consistent biphasic pattern was seen with a predominant early diastolic peak. The early systolic flow reversal precedes a mild late-systolic second peak in WSS. The distinct caliber mismatch between coronary bypass grafts and their target arteries causes a dramatic “flattening” of WSS in the vein grafts. The range bars show the standard deviation. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Saphenous vein grafts in (a and b) coronary and (c and d) infrainguinal position at (a and c) implantation and (b and d) after 6 months. The femoral grafts represent the two subgroups of dilation and constriction. The ruler displays millimeters. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Neointimal tissue was significantly thicker in (a and b) coronary bypass grafts than in (c and d) infrainguinal grafts. Whereas (a and b) coronary grafts regularly showed a massive concentric layer of neointimal tissue, (c and d) femoral grafts often had one-half of the luminal circumference lacking neointimal tissue and the other half covered by a modest, excentric layer of crescent-shaped neointima (a and c, Azan, original magnification, ×12; b and d, Masson's trichrome, original magnification, ×40). The (d) high magnifications show both sites. The neointimal layers are delineated with triangles. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Media development during 6 months of implantation in coronary grafts (solid lines) and femoral grafts (dashed lines). Rather than “arterialization,” media remodeling represents a fibrotic process where an increase in media thickness (black lines) is accompanied by a mirror-image decrease in muscle content (red lines). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Dimensional remodeling of saphenous vein grafts in the coronary (COR) and femoral (FEM) positions during 6 months of implantation. Independent from neointimal tissue, subintimal diameters (SID, dashed red lines) significantly decreased in all coronary grafts but increased in most femoral grafts. The true luminal inner diameter (ID, solid green line) of coronary grafts even decreased by 63% vs a 31% increase in more than half of the femoral grafts. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

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