The Annals of Thoracic Surgery, Vol 43, 648-652, Copyright © 1987 by The Society of Thoracic Surgeons
The healing characteristics of autogenous saphenous vein used in the reconstruction of previously implanted arterial saphenous vein grafts
KJ Karlson, R Brescia and H Najafi
Aortocoronary saphenous vein grafts with early isolated stenoses pose the
technical problem of how to deal with these grafts at reoperation. The
advisability of using a portion of old graft when reconstructing these
grafts was examined. An experimental model was devised in which the
anatomical and pathological interfaces between fresh vein and previously
inserted vein were studied. Superficial femoral artery from the thigh of 15
dogs was replaced by reversed autogenous saphenous vein. Four months later,
the animals were divided into two groups. Group 1 consisted of 8 animals
that underwent transection and reimplantation of the middle 4 cm of the
vein graft in exactly the same position in which it had been. In Group 2,
the 7 animals had the middle 4 cm of the graft replaced with newly
harvested reversed saphenous vein. Six months after initial vein graft
implantation, the animals were studied. No critical stenoses were seen in
the grafts. Pathological study of Group 1 grafts revealed fibrous graft
disease of uniform severity throughout the graft, thereby demonstrating
that new anastomoses in an old graft do not affect graft disease. Group 2
grafts revealed that the severity of disease in the new interposed segment
of the vein graft was less than in the old retained portions of the graft.
No untoward reaction causing acceleration of graft disease occurred between
old and new vein. Operations using undiseased portions of old vein grafts
should be considered a viable option in repeat coronary revascularization
for early stenoses.
