JTCS Speed Up Your Browser
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Lovendran Moodley
Peter Zilla
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Human, P.
Right arrow Articles by Zilla, P.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Human, P.
Right arrow Articles by Zilla, P.
Related Collections
Right arrow Coronary disease
Right arrow Peripheral vascular

J Thorac Cardiovasc Surg 2009;137:1101-1108
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Dimensional analysis of human saphenous vein grafts: Implications for external mesh support

Paul Human, PhD, Thomas Franz, PhD, Jacques Scherman, MBChB, Lovendran Moodley, MBChB, Peter Zilla, MD, PhD*

Christiaan Barnard Department of Cardiothoracic Surgery, University of Cape Town, Observatory, South Africa

Received for publication March 11, 2008; revisions received September 5, 2008; accepted for publication October 3, 2008.

* Address for reprints: Peter Zilla, MD, PhD, Christiaan Barnard Department of Cardiothoracic Surgery, Cape Heart Centre, Faculty of Health Sciences, University of Cape Town, Anzio Road, 7925 Observatory, South Africa. (Email: Peter.Zilla{at}uct.ac.za).

Objective: Constrictive external mesh support of vein grafts was shown to mitigate intimal hyperplasia in animal experiments. To determine the degree of constriction required for the elimination of dimensional irregularities in clinically used vein grafts, a detailed anatomic study of human saphenous veins was conducted.

Methods: In 200 consecutive patients having coronary artery bypass grafting, harvested saphenous veins (length 34.4 ± 10.8 cm) were analyzed regarding diameter irregularities, side branch distribution, and microstructure.

Results: The mean outer diameter of surgically distended saphenous veins was 4.2 ± 0.6 mm (men, 4.3 ± 0.6 mm vs women, 3.9 ± 0.5 mm; P < .0001). Although the outer diameter significantly decreased over the initial 18 cm (–7.6%; P < .0001), the overall increase between malleolus and thigh was not significant (+11.2%). Smaller-diameter veins (<3.5 mm) had more pronounced diameter fluctuations than larger veins (31.8% ± 11.0% vs 21.2% ± 8.8%; P < .0001), with more than 71% of all veins showing caliber changes of more than 20%. There was 1 side branch every 5.4 ± 4.3 cm, with a significantly higher incidence between 20 and 32 cm from the malleolus (P < .0001 to distal, P < .0004 to proximal). Generally, women had more side branches than men (0.30 ± 0.15 cm–1 vs 0.25 ± 0.12 cm–1; P = .0190). Thick-walled veins (565.7 ± 138.4 µm) had a significantly higher number of large side branches (P < .0001), and thin-walled veins (398.7 ± 123.2 µm) had significantly more small side branches (P < .0001). Pronounced intimal thickening ("cushions") was found in 28% of vessels (119.8 ± 28.0 µm vs 40.1 ± 18.2 µm; P < .0001).

Conclusion: Although the preferential location of side branches may be addressed by the deliberate discarding of infragenicular vein segments, a diameter constriction of 27% on average would eliminate diameter irregularities in 98% of vein grafts.

Abbreviations and Acronyms BMI = body mass index; CABG = coronary artery bypass grafting; OD = outer diameter






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2009 by The American Association for Thoracic Surgery.