Copyright © 1989 by the European Society of Cardiology.
© 1989 The European Society of Cardiology
The future of saphenous vein as a coronary artery bypass conduit
Department of Cardiology, University of Wales College of Medicine Cardiff U.K.
Received 9 September 1988; .
Address for correspondence: Dr A C. Newby PhD, Senior Lecturer in Cardiology, Department of Cardiology, University of Wales College of Medicine, Heath Park, CardirTCF4 4XN, U.K.
Abstract
Continuing widespreaduse ofautologous saphenous veinfor coronary artery by pass grafting seems unavoidable despite its poor-term patency. We review here the evidence that platelet activation is reponsible for early and late vein graft occlusion and conclude that other mechanisms probably contribute to late occlusions. We suggest that a rational strategy to improve vein graft patency should include: improved endothelial preservation during surgical implantation; use of better antiplatelet agents, in particular those which prevent platelet adhesion as well as aggregation; reduction of risk factors including serum cholesterol; and application of agents (e.g. heparin) which inhibit smooth muscle cell proliferation directly. We draw parallels between the pathogenesis of vein graft occlusion and coronary atherosclerosis and suggest that testing strategies for improving vein graft patency may also shed light on atherogenesis.
Key Words: Coronary surgery • arteriovenous bypass grafts • platelets • endothelial cells • vascular smooth muscle human • saphenous vein • arteriosclerosis
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