 | |  | |  | |  | |  | |  | |  | |  |
| IJCEM Copyright © 2008-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711 |
Int J Clin Exp Med 2(2):95-113;2009
Original Article
Extensive deendothelialization and thrombogenicity in routinely prepared vein
grafts for coronary bypass operations: facts and remedy
Dominik Roger Weiss, Gerd Juchem, Bernhard Michael Kemkes, Brigitte Gansera, Michael Geier, Stephan Nees
Department of Transfusion Medicine and Hemostaseology , University of Erlangen-Nuremberg (FAU), 91054 Erlangen, Germany;
Department of Cardiac Surgery, University of Munich (LMU), 81377 Munich, Germany; Department of Cardiac Surgery, Hospital
Bogenhausen, 81925 Munich, Germany; Department of Physiology, University of Munich (LMU), 80336 Munich, Germany
Received May 16, 2009; accepted May 25, 2009; available online May 28, 2009
Abstract: The objective of this study was to gain deeper insight into the early reasons for saphenous vein graft disease and to find a
practical approach to obviate it. Intraoperative storage of freshly explanted venous grafts (45 min, 20°C; n=25 in each case) in saline,
saline + 5% albumin, or HTK-solution and also in heparinized autologous blood was poorly tolerated by the endothelium. Large
endothelial areas (mostly >75% of total surface) were detached already during brief non-pulsatile flushing just before the
transplantation. Contact of deendothelialized areas in graft remnants with defined mixtures of coagulation factors or blood (n=11-17)
caused rapid coagulatory processes via expression of tissue factor and assembly of prothrombinase in the subendothelium. Attached
platelets and leukocytes accelerated the procoagulatory processes further, and endothelium-dependent anticoagulatory activities were
significantly abolished. During pulsatile arterial flow, the resulting blood clots exacerbated the damage of the intima markedly, because
they were flushed away tearing off further endothelium. In contrast, storage of venous grafts in a plasma preparation freed from
isoagglutinins and coagulation factors preserved the endothelium, which resisted arterial flow and revealed anticoagulatory activity in
the presence of antithrombin III and/or protein C. We conclude that gentle preparation and preservation of the vascular endothelium
with a suitable storage solution during bypass surgery is a decisive first step to obviate saphenous vein graft disease. (IJCEM905001).
Key Words: Saphenous vein graft disease, endothelium, thrombosis, subendothelium, atherosclerosis
Full Text PDF
Address all correspondence to:
Stephan Nees, MD, PhD
Department of Physiology
University of Munich (LMU)
80336 Munich
Germany,
E-mail:Stephan.Nees@med.uni-muenchen.de
Original Article
Extensive deendothelialization and thrombogenicity in routinely prepared vein
grafts for coronary bypass operations: facts and remedy
Dominik Roger Weiss, Gerd Juchem, Bernhard Michael Kemkes, Brigitte Gansera, Michael Geier, Stephan Nees
Department of Transfusion Medicine and Hemostaseology , University of Erlangen-Nuremberg (FAU), 91054 Erlangen, Germany;
Department of Cardiac Surgery, University of Munich (LMU), 81377 Munich, Germany; Department of Cardiac Surgery, Hospital
Bogenhausen, 81925 Munich, Germany; Department of Physiology, University of Munich (LMU), 80336 Munich, Germany
Received May 16, 2009; accepted May 25, 2009; available online May 28, 2009
Abstract: The objective of this study was to gain deeper insight into the early reasons for saphenous vein graft disease and to find a
practical approach to obviate it. Intraoperative storage of freshly explanted venous grafts (45 min, 20°C; n=25 in each case) in saline,
saline + 5% albumin, or HTK-solution and also in heparinized autologous blood was poorly tolerated by the endothelium. Large
endothelial areas (mostly >75% of total surface) were detached already during brief non-pulsatile flushing just before the
transplantation. Contact of deendothelialized areas in graft remnants with defined mixtures of coagulation factors or blood (n=11-17)
caused rapid coagulatory processes via expression of tissue factor and assembly of prothrombinase in the subendothelium. Attached
platelets and leukocytes accelerated the procoagulatory processes further, and endothelium-dependent anticoagulatory activities were
significantly abolished. During pulsatile arterial flow, the resulting blood clots exacerbated the damage of the intima markedly, because
they were flushed away tearing off further endothelium. In contrast, storage of venous grafts in a plasma preparation freed from
isoagglutinins and coagulation factors preserved the endothelium, which resisted arterial flow and revealed anticoagulatory activity in
the presence of antithrombin III and/or protein C. We conclude that gentle preparation and preservation of the vascular endothelium
with a suitable storage solution during bypass surgery is a decisive first step to obviate saphenous vein graft disease. (IJCEM905001).
Key Words: Saphenous vein graft disease, endothelium, thrombosis, subendothelium, atherosclerosis
Full Text PDF
Address all correspondence to:
Stephan Nees, MD, PhD
Department of Physiology
University of Munich (LMU)
80336 Munich
Germany,
E-mail:Stephan.Nees@med.uni-muenchen.de
