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Ann Thorac Surg 1986;41:54-57
© 1986 The Society of Thoracic Surgeons
From the Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Dalhousie University, Halifax, NS, Canada
* Address reprint requests to Dr. Landymore, Room 3065, R. C. Dickson Centre, Victoria General Hospital, Halifax, NS, Canada B3H 2Y9
The combination of aspirin and dipyridamole is currently used to prevent intimal hyperplasia and to improve long-term vein graft patency following myocardial revascularization. Preliminary studies indicate that cod-liver oil, rich in eicosapentaenoic acid, an unsaturated fatty acid, may also be effective in the prevention of intimal hyperplasia. Twenty-four mongrel dogs were used to compare the effectiveness of aspirin-dipyridamole and cod-liver oil on vein graft intimal hyperplasia following arterial bypass. Forty-eight segments of undistended autologous external jugular vein were interposed between bilaterally divided femoral arteries. All animals received a 2% cholesterol diet for 1 week before and 6 weeks after operation. Eight controls received the diet alone. Eight other animals received dipyridamole (2.5 mg per kilogram of body weight) two days before operation and dipyridamole (2.5 mg/kg) and aspirin (30 mg/kg) daily for 6 weeks after operation. Another 8 animals received cod-liver oil containing 1.8 gm of eicosapentaenoic acid daily 1 week before and for 6 weeks following operation. Serum cholesterol increased similarly in all groups; it rose from 4.5 ± 0.2 mm/L to 8.3 ± 0.8 mm/L in the controls, to 7.2 ± 0.5 mm/L in the aspirin-dipyridamole group, and to 7.1 ± 0.5 mm/L in the cod-liver oil group (p < 0.01). Prothrombin time, partial thromoboplastin time, total platelet counts, and bleeding times were unchanged. Intimal hyperplasia was measured at 6 weeks with a Zeiss computerized microscope; 376 ± 25 measurements were made from each graft. The intima increased from 4.5 ± 0.2 to 83 ± 10 µm in the control dogs. Aspirin and dipyridamole reduced intimal hyperplasia to 37 ± 3 µm (p < 0.001), while cod-liver oil decreased it to 24 ± 2.5 µm (p < 0.001). Although both medical regimens reduced intimal hyperplasia, cod-liver oil was more effective than aspirin-dipyridamole (p < 0.004). These data indicate that cod-liver oil decreases fibrous intimal hyperplasia in canine autologous vein grafts, and suggest the need for further studies to determine whether cod-liver oil could be used to prevent intimal hyperplasia in human beings.
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