Vein grafts

Apart from its role in atherogenesis, recent observations suggest that high Lp(a) levels are also associated with early occlusion of coronary artery bypass grafts and femoropopliteal vein grafts (H33, W17). In this situation, however, a thrombotic rather than an atherogenic mechanism may be responsible for the events. 

Support for the theories about a relation between plasma Lp(a) concentration and vascular disease came from the determination of abnormal high concentrations of Lp(a) in coronary bypass vein grafts (C14, R3). 

H33. Hoff, H. F., Beck, G. J., Skibinsky, C. 1., Jurgens, G., O Neill, J., Kramer, J., and Lytle, B., Serum Lp(a) level as a predictor of vein graft stenosis after coronary artery bypass surgery in patients. Circulation 77, 1238-1244 (1988). 

Favalaro RG. Saphenous vein graft in the surgical treatment of coronary artery disease operative technique. J Thorac Cariovasc Surg 1969 58 178. 

Adenoviruses carrying the gene that expresses TIMP-3 has been shown to be able to overexpress TIMP3 within the extracellular matrix. As a result MMP activity was decreased and apoptosis levels in the neointima and medial layer were significantly elevated by TIMP-3 overexpression. Consequently neointimal formation declined by 84% in human veins at 14 days and by 58% in pig vein grafts. 

George, S.J., C.T. Lloyd, G.D. Angehni,A.C. Newby, and A.H. Baker, Inhibition of late vein graft neointima formation in human and porcine models by adenovirus-mediated overexpression of tissue inhibitor of metalloproteinase-3. Circulation, 2000.101(3) 296-304. 

Vein-graft stenosis, infrainguinal bypass surgery Pressure ex vivo delivery E2F Decoy Oligonucleotide Mann, M.J., Dzau, V.J. etal. Multicenter trial, USA... 

Gene therapy offers new possibilities for the treatment of cardiovascular diseases. This area of research has focused mainly on the treatment of postangioplasty restenosis, in-stent restenosis, and vein graft thickening. First clinical trials have shown that vascular gene transfer to humans is generally safe and well tolerated. Even... 

Mann, M.J., Gibbons, G.H., Tsao, P.S., vonderLeyen, H.E., Cooke, J.P., Buitrago, R. etal. (1997) Cell cycle inhibition preserves endothelial function in genetically engineered rabbit vein grafts. J. Clin. Invest., 99, 1295-1301. 

ChesebroJH, Clementsw IP FusterV etal. A platelet-inhibitor drug trial in coronary-artery bypass operation Benefit of eariy perioperative dipyridamole and aspirin therapy on eariy postoperative vein-graft patency. N Engl J Med 1982 307 73-78. 

Chesebro JH, Fuster V Elveback LR, et al. Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations. N Engl J Med 1984 3 10 209-214. 

Silva JA, White CJ, Collins TJ, et al. Morphologic comparison of atherosclerotic lesions in native coronary arteries and saphenous vein grafts with intracoronary angioscopy in patients with unstable angina. Am Heart J 1998 136 156-163. 

Among these 76 patients, 109 bare-coronary stents were deployed in 103 de novo lesions in an equal number of major native epicardial vessels. Patients with in-stent restenosis, bifurcation lesions, vein graft lesions, lesion length of >0.20 mm, acute myocardial infarction in the previous 72 hours, poor left ventricular function (ejection fraction <35%), renal failure defined as creatinine concentration of >2 mg, or under immunosuppressive treatment were excluded from the study. 

Van Langenhove G, Vermeersch P Serrano P et al. Saphenous vein graft disease treated with the Wiktor Hepamed stent procedural outcome, in-hospital complications and six-month angiographic follow-up, Can J Cardiol 2000 I 6(4) 473—480. 

Since these original studies, there have been numerous clinical randomized trials and prospective registries detailing the efficacy of ICB as an adjunctive therapy for de novo native coronary or sapheneous vein graft lesions treated with balloon angioplasty and/or stent implantation (Table I), The... 

Castagna MT, Mintz GS, Waksman R, et al, Comparitive efficacy of gamma-irradition for treatment of in-stent restenosis in sapheneous vein graft versus native coronary artery in-stent restenosis. Circulation 2001 104 3020-3022. 

Photodynamic therapy seems to offer broad applicability as either an adjunct to other endovascular procedures or as a means to treat de novo disease. At this juncture enough is known to imagine its potential without yet knowing its limitations. PDT could be an exciting tool for the emerging specialty of endovascular therapy, with potential applications in the heart, peripheral arteries, saphenous vein grafts, and arteriovenous grafts. 

Yamaguchi A, Woodburn KW, Hayase M, et al. Reduction of vein graft disease using photodynamic therapy with motexafin lutetium in a rodent isograft model. Circulation 2000 ... 

Schepers A, Pires NM, Eefting D, de Vries MR, van Bockel JH, Quax PH. Shortterm dexamethasone treatment inhibits vein graft thickening in hypercholesterol-emic ApoE3Leiden transgenic mice. J Vas Surg 2006 43 809-15. 

Chesebro JH, Foster V, Elveback LR, Clements IP, Smith HC, Holmes DR Jr, Bardsley WT, Pluth JR, Wallace RB, Puga FJ Effect of dipyridamole and aspirin on Ide vein-graft pdency after coronary bypass operdions New Eng. J. Med. 310 209,1984... 

Goldman S, Copeland J, Moritz T, Hendo-sonW, Zadina K, Ovitt T, Doherty J, ReadR, ChederE. Sako Y Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy Results of a Veterans Admin-istration Cooperative Study. Circulation 22 1324,1988... 

Fuster V, Chesebro JH. Role of platdets and platdet inhibitors in aorto-coronary vein graft disease. 

Israel DH, Adams PC, Stein B, Chesebro JH, Fuster V. Antithrombotic therapy in the coronary vein graft... 

The issue of whether the use of aprotinin is associated with an increased risk of vein graft thrombosis in cardiac bypass surgery has not been resolved (14,15). The use of... 

Westaby S, Katsumata T. Aprotinin and vein graft occlusion—the controversy continues. J Thorac Cardiovasc Surg 1998 116(5) 731-3. 

K.-H. Mak, R. Challapalli, M. J. Eisenberg, K. M. Anderson, R. M. Califf and E. J. Topol, Effect of platelet glycoprotein Ilb/Illa receptor inhibition on distal embolization during percutaneous revascularization of aortocoronary saphenous vein grafts, Am J Cardiol 80,985-988 (1997). 

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