A unique stenosis in saphenous vein graft visualized by optical coherence tomography

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Abstract

We present a case of a unique stenosis in a 12-year-old saphenous vein graft (SVG), to the right coronary artery, which was visualized by optical coherence tomography (OCT), before percutaneous coronary intervention. The patient was an 80-year-old man in whom the stenosis was documented by area-detector coronary computed tomography. OCT imaging demonstrated that the culprit lesion was a venous valve containing a thrombus before preintervention imaging. Coronary stenting was performed with a distal protection device, and pathologic examination of the aspirate verified the OCT findings. Coronary angiography 12 years previously, just after coronary artery bypass surgery (CABG), had shown a completely normal SVG without any suspicion of a venous valve. These OCT images suggested the possibility that the culprit lesion was an “upside down” venous valve that was not visualized by angiography just after surgery, but could be a cause of late SVG stenosis following CABG. OCT imaging is very useful for clarifying the etiology of the stenosis in cases of ambiguous angiographic lesions.

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Mechanisms of vein graft adaptation to the arterial circulation: insights into the neointimal algorithm and management strategies.

Alan Dardik, Akihito Muto, Sammy Eghbalieh … (2010)

For patients with coronary artery disease or limb ischemia, placement of a vein graft as a conduit for a bypass is an important and generally durable strategy among the options for arterial reconstructive surgery. Vein grafts adapt to the arterial environment, and the limited formation of intimal hyperplasia in the vein graft wall is thought to be an important component of successful vein graft adaptation. However, it is also known that abnormal, or uncontrolled, adaptation may lead to abnormal vessel wall remodeling with excessive neointimal hyperplasia, and ultimately vein graft failure and clinical complications. Therefore, understanding the venous-specific pathophysiological and molecular mechanisms of vein graft adaptation are important for clinical vein graft management. Of particular importance, it is currently unknown whether there exist several specific distinct molecular differences in the venous mechanisms of adaptation that are distinct from arterial post-injury responses; in particular, the participation of the venous determinant Eph-B4 and the vascular protective molecule Nogo-B may be involved in mechanisms of vessel remodeling specific to the vein. This review describes (1) venous biology from embryonic development to the mature quiescent state, (2) sequential pathologies of vein graft neointima formation, and (3) novel candidates for strategies of vein graft management. Scientific inquiry into venous-specific adaptation mechanisms will ultimately provide improvements in vein graft clinical outcomes.

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Morphologic findings in saphenous veins used as coronary arterial bypass conduits for longer than 1 year: necropsy analysis of 53 patients, 123 saphenous veins, and 1865 five-millimeter segments of veins.

C. Roberts, Marc J Kalan (1990)

Certain clinical and necropsy findings are described in 53 patients who died from 13 to 185 months (mean 58) after a single aortocoronary bypass operation. Of the 53 patients, 32 (60%) died of a cardiac cause and of their 72 saphenous vein aortocoronary conduits, 36 (49%) were narrowed at some point more than 75% in cross-sectional area by atherosclerotic plaque; the remaining 21 patients (40%) died of a noncardiac cause and of their 50 saphenous vein conduits, 10 (20%) were narrowed at some point more than 75% in cross-sectional area by plaque. Thus the noncardiac mode of death in a large percentage of the patients suggests that the bypass operation prolonged life to a degree sufficient for another condition to develop. The 123 saphenous vein conduits were divided into 5 mm segments, and a histologic section was prepared from each. Of the 1104 five-millimeter segments in the 32 patients dying as a consequence of myocardial ischemia, 291 (26%) were narrowed more than 75% in cross-sectional area by plaque; in contrast, of the 761 five-millimeter segments of veins in the 21 patients with a noncardiac mode of death, 86 (11%) were narrowed more than 75% by plaque. Of the total 1865 five-millimeter segments of vein, only 395 (21%) were narrowed 25% or less in cross-sectional area by plaque. Thus, in patients dying late after coronary bypass the atherosclerotic process continues in all segments of the saphenous veins used as aortocoronary conduits. Therapy after the operation must be directed toward prevention of progression of the atherosclerosis in the "new" coronary "arteries."

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Thinking inside the graft: applications of optical coherence tomography in coronary artery bypass grafting.

Emile N. Brown, Nicholas Burris, Junyan Gu … (2007)

Recent advances in catheter-based optical coherence tomography (OCT) have provided the necessary resolution and acquisition speed for high-quality intravascular imaging. Complications associated with clearing blood from the vessel of a living patient have prevented its wider acceptance. We identify a surgical application that takes advantage of the vascular imaging powers of OCT but that circumvents the difficulties. Coronary artery bypass grafting (CABG) is the most commonly performed major surgery in America. A critical determinant of its outcome has been postulated to be injury to the conduit vessel incurred during the harvesting procedure or pathology preexistent in the harvested vessel. As a test of feasibility, intravascular OCT imaging is obtained from the radial arteries (RAs) and/or saphenous veins (SVs) of 35 patients scheduled for CABG. Pathologies detected by OCT are compared to registered histological sections obtained from discarded segments of each graft. OCT reliably detects atherosclerotic lesions in the RAs and discerns plaque morphology as fibrous, fibrocalcific, or fibroatheromatous. OCT is also used to assess intimal trauma and residual thrombi related to endoscopic harvest and the quality of the distal anastomosis. We demonstrate the feasibility of OCT imaging as an intraoperative tool to select conduit vessels for CABG.

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Author and article information

Contributors

Yorihiko Koeda: ori-aka@hotmail.co.jp

Journal

Journal ID (nlm-ta): Heart Vessels

Journal ID (iso-abbrev): Heart Vessels

Title: Heart and Vessels

Publisher: Springer Japan (Tokyo )

ISSN (Print): 0910-8327

ISSN (Electronic): 1615-2573

Publication date (Electronic): 28 May 2013

Publication date PMC-release: 28 May 2013

Publication date (Print): 2014

Volume: 29

Pages: 278-281

Affiliations

[ ]Division of Cardiology, Department of Internal Medicine and Memorial Heart Center, Iwate Medical University School of Medicine, 1-2-1 Chuo-dori, Morioka, Iwate 020-8505 Japan

[ ]Division of Cardiovascular Medicine, Nephrology and Endocrinology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 1-2-1 Chuo-dori, Morioka, Iwate 020-8505 Japan

Article

Publisher ID: 362

DOI: 10.1007/s00380-013-0362-x

PMC ID: 3948513

PubMed ID: 23712599

SO-VID: e14754bd-990b-4c1e-8d98-20f792b1b694

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

History

Date received : 13 November 2012

Date accepted : 26 April 2013

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: optical coherence tomography,saphenous vein graft,venous valve,coronary artery bypass graft

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: optical coherence tomography, saphenous vein graft, venous valve, coronary artery bypass graft

A unique stenosis in saphenous vein graft visualized by optical coherence tomography

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Abstract

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Karger: Ophthalmology

Most cited references 7

Mechanisms of vein graft adaptation to the arterial circulation: insights into the neointimal algorithm and management strategies.

Morphologic findings in saphenous veins used as coronary arterial bypass conduits for longer than 1 year: necropsy analysis of 53 patients, 123 saphenous veins, and 1865 five-millimeter segments of veins.

Thinking inside the graft: applications of optical coherence tomography in coronary artery bypass grafting.

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