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Ann Thorac Surg 2003;76:1533-1538
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

Pressure-diameter relationship in the human greater saphenous vein

Wim Stooker, PhDa*, Murat Göka, Pieter Sipkema, PhDa,d, Hans W. M. Niessen, PhDc,d, Alexi Baidoshvili, MDd, Nico Westerhof, PhDb,d, Evert K. Jansen, MDa, Charles R. H. Wildevuur, PhDe, Léon Eijsman, PhDa

a Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam Netherlands
b Laboratory of Physiology, Amsterdam, Netherlands
c Institute of Pathology, Amsterdam, Netherlands
d Institute of Cardiovascular Research, University Hospital VU University Medical Center, Amsterdam, Netherlands
e Department of Experimental Thoracic Surgery, University of Groningen, Groningen, Netherlands

Accepted for publication May 14, 2003.

* Address reprint requests to Dr Stooker, Onze Lieve Vrouwe Gasthuis, Department of Cardiothoracic Surgery, PO Box 95500, 1090 HM Amsterdam, Netherlands.
e-mail: w.stooker{at}olvg.nl

Abstract

BACKGROUND: Compliance of artificial and autologous vascular grafts is related to future patency. We investigated whether differences in compliance exist between saphenous vein grafts derived from the upper or lower leg, which might indicate upper or lower leg saphenous vein preference in coronary artery bypass surgery. Furthermore, the effect of perivenous application of fibrin glue on mechanical vein wall properties was studied to evaluate its possible use as perivenous graft support.

METHODS: Vein segments (N = 10) from upper or lower leg saphenous vein grafts were collected for histopathologic examination and smooth muscle cell/extracellular matrix (SMC/ECM) ratio was calculated. This ratio is suggested to be related with vascular elastic compliance. In a second group vein graft segments (N = 6) from upper and lower leg were placed in an in vitro model generating stepwise increasing static pressure up to 150 cm H2O. Outer diameter was measured continuously with a video micrometer system. Distensibility was calculated from the pressure-diameter curves. A third group of vein graft segments (N = 7) was pressurized after fibrin glue application to prevent overdistension, and studied in the same setup.

RESULTS: Vein segments from the lower leg demonstrated a consistent higher relative response compared with the upper leg saphenous vein graft (0.9176 ± 0.03993 vs 0.5245 ± 0.02512). Both reach a plateau in the high-pressure range (> 100 cm H2O). A significant difference in in vitro distensibility between upper and lower leg saphenous vein was only found at a pressure of 50 cm H2O (p < 0.05). With fibrin glue, support overdistension is prevented as revealed by the maximum relative response between fibrin glue supported upper and lower leg saphenous vein segments (0.4080 ± 0.02464 vs 0.582 ± 0.051), and no plateau is reached in the pressure range up to 150 cm H2O.

CONCLUSIONS: No upper or lower leg saphenous vein preference could be deduced from the differences in pressure-diameter response due to loss of distensibility (and thus of compliance) in the high-pressure range. Fibrin glue effectively prevents overdistension and preserves some distensibility in the high-pressure range in both the upper and lower leg saphenous vein. This might provide a basis for clinical application of perivenous support.




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