The histological examination of vena saphena magna as a graft In coronary artery bypass surgery

Year 2025, Volume: 42 Issue: 2, 107 - 112, 30.06.2025

Koray Ak , Ahmet Midi , Ahmet Tepecik , Cemre Can Ulukaya , Mehmet Emin Deligöz , Sercan Topal , Sinan Akbaş

Abstract

Coronary artery bypass surgery (CABG) is one of the most frequently performed surgical procedures worldwide, owing to the increasing incidence of coronary artery disease, which remains a leading cause of death globally. Following CABG, the development of occlusion in vein grafts is one of the significant indicators of poor prognosis, resulting in an increased risk of recurrent ischemic events and repeat revascularization. In the early and late postoperative periods, the use of healthy grafts with intact endothelium is critical to reduce mortality and morbidity rates. In this study, the histopathological findings of the vena saphena magna grafts in 12 patients who underwent CABG were evaluated to identify any preoperative degenerative changes in the grafts. The findings of the study showed that preoperative morphological degeneration was minimal in most grafts. However, in one sample, intimal fibrosis narrowed the lumen, while another sample exhibited mild medial sclerosis. In contrast, all other samples showed minimal or no degeneration. Consequently, assessing the histopathological condition of vessels before the operation is crucial to avoid using unsuitable grafts and to direct the surgeon to use different grafts if necessary. This study highlights the importance of examining the histology of vena saphena magna grafts to ensure their suitability as a bypass conduit in CABG surgery.

Keywords

Coronary artery bypass surgery, Vena saphena magna, Graft, Histopathology.

References

• Beerkens FJ, Claessen BE, Mahan M, Gaudino MFL, Tam DY, Henriques JPS, et al. Contemporary coronary artery bypass graft surgery and subsequent percutaneous revascularization. Nat Rev Cardiol. 2022 Mar;19(3):195-208.
• Caliskan E, de Souza DR, Böning A, Liakopoulos OJ, Choi YH, Pepper J, et al. Saphenous vein grafts in contemporary coronary artery bypass graft surgery. Nat Rev Cardiol. 2020 Mar;17(3):155-169.
• Gaudino M, Antoniades C, Benedetto U, Deb S, Di Franco A, Di Giammarco G, et al; ATLANTIC (Arterial Grafting International Consortium) Alliance. Mechanisms, Consequences, and Prevention of Coronary Graft Failure. Circulation. 2017 Oct 31;136(18):1749-1764.
• Kanellaki-Kyparissi M, Kouzi-Koliakou K, Marinov G, Knyazev V. Histological study of arterial and venous grafts before their use in aortocoronary bypass surgery. Hellenic J Cardiol. 2005;46(1):21-30.
• Sun Y, Ding W, Wei Q, Shen Z, Wang C. Dysregulated gene expression of extracellular matrix and adhesion molecules in saphenous vein conduits of hemodialysis patients. J Thorac Cardiovasc Surg. 2012 Sep;144(3):684-689.
• Hess CN, Lopes RD, Gibson CM, Hager R, Wojdyla DM, Englum BR, et al. Saphenous vein graft failure after coronary artery bypass surgery: insights from PREVENT IV. Circulation. 2014 Oct 21;130(17):1445-1451.
• Harskamp RE, Lopes RD, Baisden CE, de Winter RJ, Alexander JH. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Ann Surg. 2013;257(5):824-833.
• Thiene G, Miazzi P, Valsecchi M, Valente M, Bortolotti U, Casarotto D, et al. Histological survey of the saphenous vein before its use as an autologous aortocoronary bypass graft. Thorax. 1980 Jul;35(7):519-522.
• Lawrie GM, Boswick JA, Gaskell PE, Lee M, Morris GC, Goldman S. Morphological features of the internal thoracic artery and the great saphenous vein used as a conduit in aortocoronary bypass surgery. J Thorac Cardiovasc Surg. 1976 Dec;72(6):859-868.
• Perek B, Ciszewski A, Nowakowski A, Mazur M, Błaszczyk E. Age-related histological changes in saphenous vein grafts used for coronary artery bypass grafting. J Geriatr Cardiol. 2012 Mar;9(1):36-42.
• Giannoukas AD, Labropoulos N, Stavridis G, Bailey D, Glenville B, Nicolaides AN. Pre-bypass quality assessment of the long saphenous vein wall with ultrasound and histology. Eur J Vasc Endovasc Surg. 1997 Jul;14(1):37-40.
• Nielsen TG, Laursen H, Grønholdt ML, Schroeder TV. Histopathological features of in situ vein bypass stenoses. Eur J Vasc Endovasc Surg. 1997 Dec;14(6):492-498.
• Ak E, Ak K, Midi A, Kervancıoğlu-Demirci E, Arsan S, Çetinel Ş, et al. Histopathologic evaluation of saphenous vein grafts in patients with type II diabetes mellitus undergoing coronary artery bypass grafting. Cardiovasc Pathol. 2021 May-Jun;52:107328.