Recent Strategies to Reduce Vein Graft Occlusion: a Need to Limit the Effect of Vascular Damage

Despite early identification and aggressive modification of atherosclerotic risk factors, many patients still require surgical revascularisation for established atherosclerotic vascular disease. However, bypass surgery is hampered by a high incidence of vein graft failure. New strategies are being i...

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Bibliographic Details
Published in:European Journal of Vascular & Endovascular Surgery 2002-03, Vol.23 (3), p.202-208
Main Authors: Tsui, J.C.S, Dashwood, M.R
Format: Article
Language:English
Subjects:
Animals
Bypass surgery
Coronary Artery Bypass - adverse effects
Coronary Artery Disease - physiopathology
Coronary Artery Disease - surgery
Disease Models, Animal
Dogs
Graft
Graft Occlusion, Vascular - physiopathology
Graft Occlusion, Vascular - prevention & control
Humans
Occlusion
Prosthesis Failure
Rats
Saphenous vein
Swine
Vascular damage
Vascular Patency - physiology
Veins - injuries
Veins - physiopathology
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Summary:Despite early identification and aggressive modification of atherosclerotic risk factors, many patients still require surgical revascularisation for established atherosclerotic vascular disease. However, bypass surgery is hampered by a high incidence of vein graft failure. New strategies are being introduced to improve these results, with early data suggesting that improved patency rates are possible. These vary from the use of adjuvant pharmacological agents and local gene transfer strategies to the modification of vein harvesting techniques in order to reduce vascular damage to all layers of the graft. Advances in vascular biology have resulted in new insights into the role of the endothelium and adventitia in vein graft remodelling. Although recent pharmacological adjuvant therapy and molecular techniques have been described that may be used to reduce the incidence of vein graft occlusion a more desirable approach for improved graft patency rates may be achieved simply by using atraumatic surgical techniques aimed at minimising vascular damage during vessel harvesting and subsequent anastamoses during bypass surgery.
ISSN:1078-5884
1532-2165
DOI:10.1053/ejvs.2002.1600