Araştırma Makalesi
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Histopathological Results of Endothelıal Injury in Great Saphaneous Vein Harvested For Coronay Artery Bypass Surgery

Yıl 2021, Cilt: 1 Sayı: 1, 15 - 22, 16.12.2021
https://doi.org/10.29228/HMJ.4

Öz

Objective
The most important determinant of the success of coronary bypass surgery is the long-term remaining open of primary autograft conduit, vena saphenous magna. Endothelial injury is to be accepted as leading reason of graft occlusion. In this study, we aimed to displace histopathological consequences of endothelial injury occurred on great saphenous vein.
Materials and Methods
Between May 2011 and June 2011, 10 patients who underwent coronary artery bypass surgery were included to the study. Great saphenous vein samples were taken before and after harvesting the vessel. Samples were investigated histopathologically, immunohistochemically, and via tunnel studies to displace endothelial injury.
Results
Endothelial cell shapes were broken in harvested vessels. Thickness of subendothelial layer and number of cytoplasmic vacuoles and collagenous fibers in subendothelial layer was increased. Also, endothelial cell eNOS positivity, CD-34 positivity, and TUNEL positive endothelial cell number were much more higher in harvested vessels.
Conclusion
In order to minimalize the endothelial injury in great saphenous vein during coronary artery bypass surgery; different harvesting, preserving, and usage ways are to be compared with each other with prospective studies.

Kaynakça

  • Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries Lancet, 2001;358:870–5.
  • Favaloro RG. Saphenous vein autograft replacement of severe segmental coronery artery acclusion: operative technique. Ann Thorac Surg, 1968;5(4):334-9.
  • Duran E, Halıcı Ü. Dünyada kalp-damar cerrahisinin tarihçesi. Duran E (Editör). Kalp ve Damar Cerrahisi’nde. İstanbul: Çapa Tıp Kitabevi; 2004. s.3-13.
  • Fitzgibbon GM, Kafka HB, Leach HA, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival in reoperation in 1,388 patients during 25 years. J Am Coll Cardiol, 1996;28:616-26
  • Fulton GJ, Davies MG, Hagen PO. Preservation of the endothelium ın venous bypass grafts: relevance for graft patency. Asia Pacific Heart J, 1997;6(2):98-106.
  • Tsui JC, Souza DS, Filbey D, Karlsson MG, Dashwood MR. Localization of nitric oxide synthase in saphenousvein grafts harvested with a novel “no-touch” technique: potential role of nitric oxide contribution to improved early graft patency rates. J Vasc Surg, 2002;35(2):356-62.
  • Boerboom LE, Bonchek LI, Kissebah AH, Werner PH, Pepper JR, Olinger GN et al. Effect of surgical trauma on tissue lipids in primate vein grafts: relation of plasma lipids. Circulation, 1980;62:142-7.
  • Bonchek LI. Prevention of endothelial damage during preparation of saphenous veins for bypass grafting. J Thorac Cardiovasc Surg, 1980;79(6):911-5.
  • Angelini GD, Williams HM, Morgan R, Newby AC. Distention promotes platelet and leukocyte adhesion and reduces short-term patency in pig arteriovenous bypass grafts. J Thorac Cardiovasc Surg, 1990;99(3):433-9.
  • He G, Rosenfeldt FL, Angus JA. Pharmacological relaxation of the saphenous vein during harvesting for coronary artery bypass grafting. Ann Thorac Surg, 1993;55:1210-7.
  • Souza DSR, Christofferson RHB, Bomfim V, Filbey D. “No-touch” Technique using Saphenous Vein Harvested with its Surrounding Tissue for Coronary Artery Bypass Grafting Maintains an Intact Endothelium. Scand Cardiovasc J, 1999;(33):323-9.
  • Souza DS, Bomfim V, Skoglund H, Dashwood MR, Borowiec JW, Bodin L et.al. High early patency of saphenous vein graft for coronary artery bypass harvested with surrounding tissue. Ann Thorac Surg, 2001;71:797-800.
  • Thatte HS, Khuri SF. The coronary artery bypass conduit: I. Intraoperative endothelial injury and its implication on graft patency. Ann Thorac Surg, 2001;72:2245-52.
  • Karabulut H, Karabulut 0, Arbak S, Şan T, Sokullu O, Korukçu A ve ark. Koroner bypass cerrahisinde kullanılan safen veninin hazırlanmasinda endotel hasarı: Işık ve elektron mikroskopik inceleme Türk Kardiyoloji Dern Arş, 1998,26:416-24.
  • Angelini GD, Passani SL, Breckenridge IM, Newby AC. Nature and pressure dependence of damage induced by distension of human saphenous vein coronary artery bypass grafts. Cardiovasc Res, 1987;21(12):902-7.
  • Cambria RP, Megerman J, Abbott WM. Endothelial preservation in reversed and in situ autogeneous vein grafts: a quantitative experimental study. Ann Surg, 1985;202:50-5.
  • Kosugi I, Urayama H, Kasashima F, Ohtake H, Watanabe Y. Matrix metalloproreinase-9 and urokinase-type plasminogen activator in varicose veins. Ann Vasc Surg, 2003;17:234-8.
  • O’Donnell TF, Iafrati MD. Varicose veins. In: Haimovici H, Ascer E, Hollier LH, Strandness DE, Towne JB (Eds). Haimovici’s Vascular Surgery Principles and Techniques. 4th Ed. Cambridge Massachusets, USA: Blackwell Science Inc; 1996. p.1187-98.

Koroner Arter Bypass Ameliyatında Kullanılmak Üzere Hazırlanan Büyük Safen Veninde Gelişen Endotel Hasarının Histopatolojik Sonuçları

Yıl 2021, Cilt: 1 Sayı: 1, 15 - 22, 16.12.2021
https://doi.org/10.29228/HMJ.4

Öz

Amaç
Koroner arter bypass greft operasyonlarında birincil venöz otogreft olarak kullanılan büyük safen veninin uzun süre açık kalabilmesi yapılan girişimin başarısını tayin eden en önemli faktördür. Greft başarısızlığında en büyük neden endotel hasarı olarak bildirilmektedir. Bu çalışmamızda otogreft olarak kullanılmak üzere hazırlanan büyük safen veninde görülen endotel hasarının histopatolojik sonuçlarını araştırdık
Gereç ve Yöntem
Mayıs - Haziran 2011 tarihleri arasında opere edilen 10 hasta çalışmaya alındı. Hastalardan alınan büyük safen ven örneklerinden çalışma ve kontrol grupları oluşturuldu. Bu gruplar histopatolojik incelenmeye alındı. Çalışmadaki; histopatolojik (ışık mikroskopik inceleme), immünohistokimyasal (Nitrik oksid sentetaz ve CD34 reaktivitesi) ve tunel çalışmaları ile oluşan endotel hasarının sonuçları tespit edildi.
Bulgular
Işık mikroskopi incelemesinde çalışma grubunda endotel hücre şekillerinin bozulmuş olduğu ayrıca subendotelyal tabakadaki sitoplazmik vakulollerin sayısının, subendotelyal tabakanın kalınlığının ve subendotel katmanda kollagen liflerin sayısında artma olduğu izlendi. Yapılan incelemelerde çalışma grubuna ait safen ven doku-sunda , kontrol grubuna göre endotel hücrelerindeki eNOS pozitivitesinin daha da artmış olduğu gözlendi Endotel hücrelerindeki CD-34 pozitivitesinin çalışma grubunda artmış olduğu tesbit edildi. Yapılan incelemelerde çalışma grubuna ait safen ven dokusunda çok daha fazla sayıda TUNEL pozitif endotel hücresi gözlendi .SonuçOtogreft olarak kullanılmak üzere hazırlanan büyük safen veninde oluşması muhtemel endotel hasarının en aza indirilmesi amacıyla; otogreftin çıkarılma, saklanma ve kullanım koşullarının optimize edilebilmesi amacı ile karşılaştırmalı çalışmaların yapılması gerektiği düşüncesindeyiz.

Kaynakça

  • Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries Lancet, 2001;358:870–5.
  • Favaloro RG. Saphenous vein autograft replacement of severe segmental coronery artery acclusion: operative technique. Ann Thorac Surg, 1968;5(4):334-9.
  • Duran E, Halıcı Ü. Dünyada kalp-damar cerrahisinin tarihçesi. Duran E (Editör). Kalp ve Damar Cerrahisi’nde. İstanbul: Çapa Tıp Kitabevi; 2004. s.3-13.
  • Fitzgibbon GM, Kafka HB, Leach HA, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival in reoperation in 1,388 patients during 25 years. J Am Coll Cardiol, 1996;28:616-26
  • Fulton GJ, Davies MG, Hagen PO. Preservation of the endothelium ın venous bypass grafts: relevance for graft patency. Asia Pacific Heart J, 1997;6(2):98-106.
  • Tsui JC, Souza DS, Filbey D, Karlsson MG, Dashwood MR. Localization of nitric oxide synthase in saphenousvein grafts harvested with a novel “no-touch” technique: potential role of nitric oxide contribution to improved early graft patency rates. J Vasc Surg, 2002;35(2):356-62.
  • Boerboom LE, Bonchek LI, Kissebah AH, Werner PH, Pepper JR, Olinger GN et al. Effect of surgical trauma on tissue lipids in primate vein grafts: relation of plasma lipids. Circulation, 1980;62:142-7.
  • Bonchek LI. Prevention of endothelial damage during preparation of saphenous veins for bypass grafting. J Thorac Cardiovasc Surg, 1980;79(6):911-5.
  • Angelini GD, Williams HM, Morgan R, Newby AC. Distention promotes platelet and leukocyte adhesion and reduces short-term patency in pig arteriovenous bypass grafts. J Thorac Cardiovasc Surg, 1990;99(3):433-9.
  • He G, Rosenfeldt FL, Angus JA. Pharmacological relaxation of the saphenous vein during harvesting for coronary artery bypass grafting. Ann Thorac Surg, 1993;55:1210-7.
  • Souza DSR, Christofferson RHB, Bomfim V, Filbey D. “No-touch” Technique using Saphenous Vein Harvested with its Surrounding Tissue for Coronary Artery Bypass Grafting Maintains an Intact Endothelium. Scand Cardiovasc J, 1999;(33):323-9.
  • Souza DS, Bomfim V, Skoglund H, Dashwood MR, Borowiec JW, Bodin L et.al. High early patency of saphenous vein graft for coronary artery bypass harvested with surrounding tissue. Ann Thorac Surg, 2001;71:797-800.
  • Thatte HS, Khuri SF. The coronary artery bypass conduit: I. Intraoperative endothelial injury and its implication on graft patency. Ann Thorac Surg, 2001;72:2245-52.
  • Karabulut H, Karabulut 0, Arbak S, Şan T, Sokullu O, Korukçu A ve ark. Koroner bypass cerrahisinde kullanılan safen veninin hazırlanmasinda endotel hasarı: Işık ve elektron mikroskopik inceleme Türk Kardiyoloji Dern Arş, 1998,26:416-24.
  • Angelini GD, Passani SL, Breckenridge IM, Newby AC. Nature and pressure dependence of damage induced by distension of human saphenous vein coronary artery bypass grafts. Cardiovasc Res, 1987;21(12):902-7.
  • Cambria RP, Megerman J, Abbott WM. Endothelial preservation in reversed and in situ autogeneous vein grafts: a quantitative experimental study. Ann Surg, 1985;202:50-5.
  • Kosugi I, Urayama H, Kasashima F, Ohtake H, Watanabe Y. Matrix metalloproreinase-9 and urokinase-type plasminogen activator in varicose veins. Ann Vasc Surg, 2003;17:234-8.
  • O’Donnell TF, Iafrati MD. Varicose veins. In: Haimovici H, Ascer E, Hollier LH, Strandness DE, Towne JB (Eds). Haimovici’s Vascular Surgery Principles and Techniques. 4th Ed. Cambridge Massachusets, USA: Blackwell Science Inc; 1996. p.1187-98.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Cerrahi, Kalp ve Damar Cerrahisi
Bölüm Araştırma Makaleleri
Yazarlar

Muhammet Murat Cantürk Bu kişi benim 0000-0003-2367-0800

Hayrettin Tekümit Bu kişi benim 0000-0003-2367-0800

Yayımlanma Tarihi 16 Aralık 2021
Gönderilme Tarihi 18 Kasım 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 1 Sayı: 1

Kaynak Göster

Vancouver Cantürk MM, Tekümit H. Koroner Arter Bypass Ameliyatında Kullanılmak Üzere Hazırlanan Büyük Safen Veninde Gelişen Endotel Hasarının Histopatolojik Sonuçları. HTD / HMJ. 2021;1(1):15-22.

e-ISSN: 2791-9935