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The Annals of Thoracic Surgery, Vol 55, 1210-1217, Copyright © 1993 by The Society of Thoracic Surgeons
GW He, FL Rosenfeldt and JA Angus
Spasm of the saphenous vein frequently occurs during harvesting from the
leg and high-pressure distension is required to restore an adequate
diameter for grafting. Forceful distention has been shown to damage the
intima and media and may predispose to subsequent occlusion of the vein
graft. Various pharmacologic vasodilators are capable of relaxing veins; in
this study, we carried out a systematic investigation to determine the
appropriate agents and concentrations for use during vein graft operations.
In organ baths, human saphenous vein segments were contracted with
potassium or a thromboxane mimetic, and vasodilator agents were then
applied. Glyceryl trinitrate, 7.2 micrograms/mL, or papaverine
hydrochloride, 11.9 micrograms/mL, caused 80% to 100% relaxation of
contraction induced by potassium or thromboxane. Verapamil, 15.5
micrograms/mL, relaxed the potassium contraction by 100% and the
thromboxane contraction by 75%. Comparison of the time course of action
showed that glyceryl trinitrate had a rapid onset and a short duration of
maximal action, whereas verapamil (like papaverine) had delayed onset and a
long duration. A mixture of glyceryl trinitrate and verapamil combined
rapid onset with long duration of action. We now use a mixture of glyceryl
trinitrate and verapamil (pH 7.4) topically and intraluminally during
harvesting of the saphenous vein to provide a relaxed conduit for coronary
artery bypass grafting.
ARTICLES
Pharmacological relaxation of the saphenous vein during harvesting for coronary artery bypass grafting
Baker Medical Research Institute, Melbourne, Australia.
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