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@#Objective To evaluate the changes of the flow parameters before and after the anastomotic port exploration and dredging during coronary artery bypass grafting by using the transit time flow measurement (TTFM). Methods A total of 167 patients who underwent continuous coronary artery bypass grafting and anastomotic port exploration and dredging surgery in Beijing Anzhen Hospital from 2018 to 2019 were enrolled in this study. There were 136 male and 31 female patients aged 41-82 (58.35±17.26) years. If the probe entered and exited the anastomotic port smoothly, it was recorded as a non-resistance group; if the resistance existed but the probe could pass and exit, it was recorded as a resistance group; if the probe could not pass the anastomotic port for obvious resistance, it was recorded as the stenosis group. In the stenosis group, the grafts were re-anastomosed and the flow parameters were re-measured by TTFM. Results A total of 202 anastomotic ports were carried out by exploration and dredging. Among them, 87 anastomosis (43.1%) were in the non-resistance group, and there was no significant change in the blood flow volume (BFV) and pulsatility index (PI) before and after exploration and dredging (6.16±3.41 mL/min vs. 6.18±3.44 mL/min, P=0.90; 7.06±2.84 vs. 6.96±2.49, P=0.50). Sixty-four anastomosis (31.7%) were in the resistance group, the BFV was higher after exploration and dredging than that before exploration and dredging (17.11±7.52 mL/min vs. 4.96±3.32 mL/min, P<0.01), while the PI was significantly smaller (3.78±2.20 vs. 8.58±2.97, P<0.01). Fifty-one anastomosis (25.2%) were in the stenosis group, and there was no significant change in the BFV and PI before and after exploration and dredging (3.44± 1.95 mL/min vs. 3.48±2.11 mL/min, P=0.84; 10.74±4.12 vs. 10.54±4.11, P=0.36). After re-anastomosis, the BFV was higher (16.48±7.67 mL/min, P<0.01) and the PI deceased (3.43±1.39, P<0.01) than that before exploration and dredging. Conclusion The application of anastomotic exploration and dredging can reduce the occurrence of re-anastomosis, and promptly find and solve the stenosis of the distal coronary artery, improve the poor perfusion of distal coronary, and thus improves the prognosis of patients.
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Objective: To compare clinical efficacy of interventional treatment with graft vessel and native coronary artery for patients with late saphenous vein grafts disease(SVGD) after coronary artery bypass grafting (CABG). Methods: A total of 1 608 patients underwent CABG in Tianjin Chest from March 2014 to December 2017 were screened. During the follow-up period, 165 hospitalized patients with recurrence of angina pectoris within one year after CABG, who had at least one narrow vein graft(≥50%) confirmed by the coronary angiography were enrolled. According to the results of angiography and surgeon's clinical experiences, the patients received interventional treatment to vein grafts(grafts group, n=53) or native coronary vessels(native group, n=112). The operation success rate, mortality and incidence of serious complications after interventional treatment in two groups at the time of hospitalization were compared.And the incidence of major adverse cardiovascular events(MACE) in two groups at one year after discharge were also compared. Kaplan-Meier survival curve was used to compare the cumulative event-free survival rates. The risk factors for the MACE in the patients with late SVGD and treated by interventional therapy were analyzed by Cox regression analysis. Results: A total of 165 patients were included for analysis, including 98 males(59.4%). The age was (64.2±7.1) years old. The follow-up time was 12 (8, 12) months. In the grafts group, operation success rate was 90.57%(48/53), and 3 cases(5.66%) suffered from serious complications after interventional treatment, 2 cases(3.77%) died. For native group the operation success rate was 88.39%(99/112), and 7(6.25%) cases suffered from serious complications after interventional treatment, and no deaths. The operation success rate and the incidences of serious complications after interventional treatment in two groups had no statistically significant difference(both P>0.05). The mortality in hospital of native group was lower than that in grafts group(P<0.05). Within 12 months after discharge, there was no statistically significant difference in incidence of MACE of two groups (11.32%(6/53) vs. 10.71%(12/112), P>0.05). Survival analysis showed that the cumulative event-free survival rates in two groups were 73.58% (39/53) and 66.13%(74/112), and there was no statistically significant difference (P>0.05). Cox regression analysis showed acute coronary syndrome (HR=41.203, 95%CI 4.859-349.361, P<0.01), and peripheral vascular diseases (HR=2.808, 95%CI 1.067-7.393, P<0.05) were the risk factors of the MACE for the patients treated by interventional therapy with late SVGD. Conclusion: For the patients with late SVGD after CABG, the success rate of intervention with vein grafts and own coronary vessels are both high with satisfactory safety.The in-hospital mortality of interventional therapy in own coronary vessels is lower than in graft vessel. Patients with acute coronary syndrome and peripheral vascular disease have a poor prognosis.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Coronary Angiography , Coronary Artery Bypass , Coronary Artery Disease/surgery , Coronary Vessels , Saphenous Vein , Time Factors , Treatment OutcomeABSTRACT
Objective: To investigate whether pluronic F-127-trypsin gel enhances the efficiency of adeno-associated virus (AAV) mediated gene transfer to vein grafts. Methods: Rat model of venous bridge vascular restenosis was established. The vein grafts were infected with recombinant AAV encoding an enhanced green fluorescent protein (Egfp) reporter gene, and pluronic F-127-trypsin gel was used to increase viral contact time and viral penetration. The expression of EGFP in vein grafts was determined by frozen section, immunohistochemistry staining and quantitative reverse transcriptase-mediated PCR 21 days after surgery. Structural integrity of the tissue was evaluated by measurement of tissue tensile strength. Results: Pluronic F-127-trypsin gel can significantly improve the efficiency of AAV infection in vein grafts, in which AAV serotype 6 was more efficient than AAV 1, 8, and 9 serotypes in infecting vein grafts, and tissue tensile strength was not affected. Conclusion: Pluronic F-127 trypsin gel may be a safe and effective method to improve the efficiency of AAV mediated gene transfer to vein grafts. It can be used for the prevention and treatment of venous bridge vascular restenosis.
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@#Objective To investigate the effect and mechanism of epigallocatechin-3-gallate (EGCG) on restenosis of the vein graft. Methods Totally 90 Sprague-Dawley rats were randomly divided a the control group, a vein graft group and an EGCG+vein graft group. At week 1, 2 and 4, the intimal and tunica thickness of the venous graft wall was evaluated by hematoxylin-eosin staining, and the expression of Ki-67 was assessed by immunohistochemistry analysis, and then the expression of hairy and enhancer of split-1 (HES1) was measured by Western blot assay. Results At week 2, the intimal thickness (46.76±4.89 μm vs. 8.93±0.82 μm, 46.76±4.89 μm vs. 34.24±3.57 μm), tunica thickness (47.28±4.37 vs. 16.33±1.52 μm, 47.28±4.37 vs. 36.27±3.29 μm), positive cell rate of Ki-67 (21.59%±2.29% vs. 1.12%±0.22%, 21.59%±2.29%vs. 15.38%±1.30%), expression of HES1 respectively increased in the experimental group than those in the control group and the EGCG+vein graft group (P<0.05, respectively). At week 4, the intimal thickness (66.38±6.23 μm vs. 8.29±0.79 μm, 66.38±6.23 μm vs. 48.39±4.23 μm), tunica thickness (63.27±6.18 μm vs. 15.29±1.49 μm, 63.27±6.18 μm vs. 44.63±4.49 μm), positive cell rate of Ki-67 (33.19%±3.03% vs. 1.09%±0.19%, 33.19%±3.03% vs. 24.37%±2.73%), expression of HES1 increased in the experimental group than those in the control group and EGCG+vein graft group (P<0.05, respectively). Conclusion EGCG may inhibite restenosis of vein graft by inhibiting Notch signal pathway.
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ObjectiveTo review our experience in the use of a pedicled umbilical vein graft in the repair of the defect in the bile duct in Mirizzi's syndrome. MethodsThis is a retrospective study on the use of a pedicled umbilical vein graft to repair the defect in the bile duct in 35 patients with Mi rizzi's syndrome. These patients suffered for Mirizzi's syndrome type Ⅱ in 19 patients, type Ⅲ in 15 patients, and type Ⅳ in 1 patient. ResultsThere was no peri-operative death. Five patients developed postoperative biliary leak which healed spontaneously after drainage of the bile collection. All patients had been followed up for at least 6 months, and 27 patients had been followed up for 3 years.There was no biliary complication. ConclusionsBile duct reconstruction with a pedicled umbilical vein graft is simple. It is a good procedure to repair the defect in the bile duct in Mirizzi's syndrome.
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Objective:To study the role of vascular endothelial growth factor(VEGF) in vein sheath prevention of arterial bypass graft stricture and the efficacies of vein sheath of different diameters. Methods: The vein grafts and their specimens were obtained via animal experiment of sheath intervention. Immunohistochemistry method was used to examine the expression of VEGF and proliferating cell nuclear antigen (PCNA) and the status of nutrient vessel in the specimens, so as to investigate the function of VEGF. Results: Compared with the control group, the vein sheath intervention group had significantly lower VEGF content in the media (P<0.05) and higher content in the adventitia (P<0.05); it also had lower PCNA content in the media (P<0.05) and increased blood vessel density in the adventitia (P<0.05). Conclusion: Vein sheath can effectively increase the distribution of VEGF in the adventitia and decrease its distribution in the media and intima, thus promoting the growth of nutrient blood vessels and decreasing media hyperplasia and re-stenosis.
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The ideal graft requires acceptable size, less tissue toxicity, resistance to infection, and long-term durability. Great saphenous veins are gaining popularity as acceptable graft conduits, but they require time to grow in caliber. We report 2 cases of graft bypass and reconstruction using superficial femoral veins to acheive immediate high-flow patency.
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Femoral Vein , Saphenous Vein , Transplants , Vascular Diseases , VeinsABSTRACT
Objective: To assess the effect of auto-bone marrow mononuclear cells (BMMNCs) transplantation on reendothelialization and neointima formation in vein grafts. Methods: BMMNCs were extracted from the bone marrows of adult rabbit under sterile environment and were labelled with DAPI before transplanted into vein grafts. Twenty adult rabbits were randomly divided into 2 groups: BMMNCs transplantation group(group I, n 10) and PBS transplantation group (group II, n=10). The left external jugular vein of 20 rabbits were harvested and transplanted between ipsolateral common carotid artery (AVG). Three days later, animals in group I were transplanted with BMMNCs(6x108 cells)/100 μl via periotic veins and those in group II were injected with 100 μl PBS. Animals were killed 4 weeks later and graft veins were harvested to observe the reendothelialization and the thickness of vein grafts. Results: We found that the transplanted cells survived and were incorporated into the endothelium of vein grafts in group I. The endothelium integrity of the vein grafts in group I was significantly better than that of group II. The intima thickness of vein grafts in group I was significantly thicker than that of group II. Conclusion: BMMCs transplantation therapy may improve re-endothelialization of the vein graft and inhibits intimal hyperplasi the vein graft.
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Objective To investigate the expression of matrix metalloproteinases 1 (TIMP-1)products inhibitor on smooth muscle cell (SMC) proliferation in rat autologous vein graft.Methods Autogenous vein transplantation model was established in 30 Wistar rats. The vein grafts were harvested at different time after grafting. The change of TIMP-1 was detected by using hematoxylin and eosin, immunohistochemistry and in situ hybridization (ISH). Results 1. Changes of histopathology in vein grafts: Intimal hyperplasia (IH) could be seen in 7 - 14 days, the peak at 2 ~ 4 weeks after operation.2. ISH results: TIMP-1mRNA positive cells appeared at 24 hours, increased significantly in 72 hours and reached the peak at 1 ~ 2 week after operation. There was significant difference between day 1 and 2 week.TIMP-I expression was not detected in normal vessels (P <0. 01). 3. Immunohistochemistry results: There was trace TIMP-I expression in normal vessels. The expression of TIMP-1 appeared at 72 hours after vein graft, increased mostly in 1 week, reached the peek at 2 week and reduced later. There was significant difference between day 1 and 2 week (P < 0. 01). Conclusions 1. The activation of TIMP-1 exists in autogenous vein grafts. 2. The intima experienced hyperplasia in spite of increased secretion of endogenous TIMP-1 after autogenous vein grafts.
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The graft infection within the abdomen is a notorious condition, which usually develops serious complications of anastomotic rupture or distal embolism that ended in death. There has been many controversies in the treatment of an aortobiiliac graft infection and varying results have been reported. The authors treated a case of aortobiiliac graft infection after abdominal aortic aneurysm surgery. The operation was performed with re-aortobiiliac bypass using bilateral superficial femoral veins. The result was successful.
Subject(s)
Abdomen , Aortic Aneurysm, Abdominal , Embolism , Femoral Vein , Prostheses and Implants , Rupture , TransplantsABSTRACT
Objective:To assess the effect of auto-bone marrow mononuclear cells (BMMNCs) transplantation on reendothelialization and neointima formation in vein grafts. Methods: BMMNCs were extracted from the bone marrows of adult rabbit under sterile environment and were labelled with DAPI before transplanted into vein grafts. Twenty adult rabbits were randomly divided into 2 groups: BMMNCs transplantation group(groupⅠ,n=10) and PBS transplantation group (group Ⅱ, n=10). The left external jugular vein of 20 rabbits were harvested and transplanted between ipsolateral common carotid artery(AVG). Three days later, animals in group Ⅰ were transplanted with BMMNCs(6?108 cells)/100 ?l via periotic veins and those in groupⅡwere injected with 100 ?l PBS. Animals were killed 4 weeks later and graft veins were harvested to observe the reendothelialization and the thickness of vein grafts. Results: We found that the transplanted cells survived and were incorporated into the endothelium of vein grafts in groupⅠ.The endothelium integrity of the vein grafts in groupⅠwas significantly better than that of groupⅡ. The intima thickness of vein grafts in groupⅠwas significantly thicker than that of groupⅡ. Conclusion: BMMCs transplantation therapy may improve reendothelialization of the vein graft and inhibits intimal hyperplasi the vein graft.