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Ann Thorac Surg 1987;43:648-652
© 1987 The Society of Thoracic Surgeons

Articles

The Healing Characteristics of Autogenous Saphenous Vein Used in the Reconstruction of Previously Implanted Arterial Saphenous Vein Grafts

Karl J. Karlson, M.D., M.M.S., Robert Brescia, M.D., Hassan Najafi, M.D.*

From the Department of Cardiovascular-Thoracic Surgery, Rush-Presbyterian-St. Luke's Medical Center, 1753 W Congress Pkwy, Chicago, IL

Accepted for publication October 27, 1986.

* Address reprint requests to Dr. Najafi, Department of Cardiovascular-Thoracic Surgery, Rush-Presbyterian-St. Luke's Medical Center, 1753 W Congress Pkwy, Chicago, IL 60612

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.






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Copyright © 1987 by The Society of Thoracic Surgeons.