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The Annals of Thoracic Surgery, Vol 55, 667-671, Copyright © 1993 by The Society of Thoracic Surgeons
AG Violaris, AC Newby and GD Angelini
Late occlusion of the saphenous vein graft appears to result in part from
wall thickening as an adaptation to increased mean wall stress. Using an
established pig model of arteriovenous bypass grafting, the effect of
reducing wall stress with an external porous polytetrafluoroethylene stent
was investigated. Segments of autologous saphenous vein were implanted by
end-to-end anastomoses into both carotid arteries, with one graft supported
by a stent 4 mm in diameter. Increases in graft wall dimensions were
quantified 4 weeks later by computer-aided planimetry of transverse
histological sections. The contribution of hyperplasia (i.e., cell
proliferation) to the changes observed was further clarified by
measurements of DNA concentration. All grafts showed an increase in
external size, but this was restricted by stenting. All grafts also showed
an increase in cross-sectional area of the tunica media and tunica intima
that was only partly accounted for by an increase in DNA concentration,
which indicated that both hyperplasia and hypertrophy had occurred. Stented
grafts showed less enlargement of the media but greater enlargement of the
intima. Overall wall size was therefore similar in stented and unstented
grafts. Stented grafts showed less increase in DNA concentration than
unstented grafts. In stented grafts, the residual luminal cross-sectional
area was significantly less than in unstented grafts. The data show that
external stenting reduces medial enlargement and hyperplasia but increases
encroachment of the intima into the lumen. Because final luminal size is
thought to be of paramount importance in maintaining long-term patency,
external stenting is unlikely to be of benefit.
ARTICLES
Effects of external stenting on wall thickening in arteriovenous bypass grafts
Cardiac Surgery Department, University of Sheffield, United Kingdom.
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