The Effect of Vasodilator Drugs on Intima Damage in Preparation of the Saphenous Vein Graft

Year 2022, Volume: 25 Issue: 2, 187 - 192, 20.08.2022

Mehmet Alaaddin Pekedis

Abstract

Introduction: The most important issue in the success of coronary bypass surgery is the quality of the grafts used. In this study, the effect of vasodilator drugs for intimal damage on the harvested saphenous veins of coronary bypass patients was investigated.

Patients and Methods: A total of 10 patients who underwent coronary bypass surgery, had 2-cm long segments of saphenous veins harvested and divided into four study groups. Isotonic solutions in Group I (control group) and Group II, verapamil in Group III, and nitroglycerin in Group IV were applied to the saphenous veins at equal times, in the control group under 20 mmHg and in the other groups 100 mmHg pressure. Upon the completion of the preparation, saphenous vein grafts were studied with light and electron microscopy. Endothelial cell loss and intimal and medial edema were considered in evaluations. Scoring was done from 0 to 3. A median score was assessed for each group.

Results: There was a statistically significant difference between the control and saline groups in terms of endothelial and media damage (0.7 ± 0.48, 2.8 ± 0.42) (p< 0.001), while there was no statistically significant difference between the control group and the verapamil and nitroglycerin groups (0.7 ± 0.48, 1.4 ± 0.54) (0.7 ± 0.48, 1.2 ± 0.44) (p> 0.05). Likewise, no statistically significant difference was found between verapamil and nitroglycerin (1.4 ± 0.54, 1.2 ± 0.44) (p> 0.05). It was determined that the verapamil and nitroglycerin groups had the closest score to the control group, the endothelial and medial damage was minimal in the verapamil and nitroglycerin group, like the control group, and a large amount of endothelial and media damage was observed in the saline group.

Conclusion: The use of vasodilators (verapamil or nitroglycerin) in the preparation of the saphenous vein graft increases the early and late success of vein grafts by protecting the tunica intima and media in the graft, preventing the formation of thrombus in the early period and the development of branchendothelial fibromuscular hyperplasia and atherosclerosis in the late period.

Keywords

Saphenous vein graft, endothelium damage, vasodilators, verapamil, nitrogliserin

References

• 1. Favaloro RG. Saphenous vein autograft replacement of severe segmental coronary artery occlusion: Operative technique. Ann Thorac Surg 1968;5:334-9. [Crossref]
• 2. Berki T. Koroner arterlerin tıkayıcı hastalıkları. Bozer EY (Ed.). Kalp Hastalıkları ve Cerrahisi, Ankara: Ayyıldız A.Ş. 1985:827-890.
• 3. Erentürk S. Koroner bypass operasyonlarında greft seçimi. GKD Derg 1997;5:145-55.
• 4. Fitz Gibbon GM, Leach AJ, Keon WJ, Burton JR, Kafka HP. Coronary bypass graft fate. Angiographic study of 1,179 vein grafts early, one year, and five years after operation. J Thorac Cardiovasc Surg 1986;91:773-8.
• 5. Webb JG, Aldridge HE, Fulop J, Haq A. Aortocoronary saphenous vein graft spasm inducing ventricular fibrillation. Am Heart J. 1989 Feb;117(2):485-6. [Crossref]
• 6. Çaynak B, Sicim H. Routine minimally invasive approach via left anterior mini-thoracotomy in multivessel coronary revascularization. J Card Surg 2022;37(4):769-776. [Crossref]
• 7. Bourassa MG, Campeau L, Lesperance J, Grondin CM. Changes in grafts an coronoary arteries after saphenous vein aortocoronary bypass surgery: Results at repeat angiography. Circulation 1982;65:90-7. [Crossref]
• 8. Grondin CM, Campeau L, Lesperance J, Enjalbert M, Bourassa MG. Comparison of late changes in internal mammary artery and saphenous vein grafts in two consercutive series of patients 10 years after operation. Circulation 1984;70:208-12.
• 9. Okies JE, Page US, Bigelow JC, Krause AH, Salomon NW. The left internal mammary artery: The graft of choice. Circulation 1984;70:213-21.
• 10. Lytle BW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC. Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass graft. J Thorac Cardiovasc Surg 1985;89:248-58. [Crossref]
• 11. Ramos JR, Berger K, Mansfield PB, Sauvage LR. Histologic fate and endothelial changes of distended and nondistended vein grafts. Ann Surg 1976;183:205-28. [Crossref]
• 12. Bonchec LI. Prevention of endothelial damage during preparation of saphenous veins for bypass grafting. J Thorac Cardiovasc Surg 1980;79:911-5. [Crossref]
• 13. Baumann FG, Catinella FP, Cunningham JN, Spencer FC. Vein contraction and smooth muscle cell extensions as causes of endothelial damage during graft preparation. Ann Surg 1981;194:199-211. [Crossref]
• 14. Karabulut H, Karabulut O, Arbak S, Şan T, Sokullu O, Korukçu A, et al. Koroner bypass cerrahisinde greft olarak kullanılan safen veninin hazırlanmasında endotel hasarı: Işık ve elektron mikroskopik inceleme. Türk Kardiyol Dern Arş 1998;26:416-24.
• 15. Roberts AJ, Hay DA, Mehta JL, Mehta P, Roy L, Faro RS, et al. Biochemical and ultrastructural integrity of the saphenous vein conduit during coronary artery bypass grafting. Preliminary results of the effect of papaverine. J Thorac Cardiovasc Surg 1984;88(1):39-48. [Crossref]
• 16. He GW, Angus Ja, Rosenfelt FL. Reactivity of the canine isolated internal mammary artery, saphenous vein, and coronary artery to constrictor and dilator substances: Relevance to coronary bypass graft surgery. J Cardiovasc Pharmacol 1988;12:12-22. [Crossref]
• 17. Roubos N, Rosenfeldt FL, Richards SM, Conyers RA, Davis BB. Improved preservation of saphenous vein grafts by the use of glyceryl trinitrate-verapamil solution during harvesting. Circulation 1995;92(9 Suppl):II31-6. [Crossref]
• 18. Dashwood MR, Loesch A. Endothelin-1, endothelin receptor antagonists, and vein graft occlusion in coronary artery bypass surgery: 20 years on and still no journey from bench to bedside. Can J Physiol Pharmacol 2020;98:570-8. [Crossref]