From the Department of Cardiology, Cleveland Clinic Foundation,
Cleveland, Ohio.
Correspondence to Joseph G. Motwani, MD, Department of Cardiology, Freeman Hospital, High Heaton, Newcastle-on-Tyne NE7 7DN, UK.
Abstract—Aortocoronary saphenous
vein graft disease, with its increasing clinical sequelae, presents an
important and unresolved dilemma in cardiological practice. During the
1st month after bypass surgery, vein graft attrition results from
thrombotic occlusion, while later the dominant process is
atherosclerotic obstruction occurring on a foundation of neointimal
hyperplasia. Although the risk factors predisposing to vein graft
atherosclerosis are broadly similar to those recognized for native
coronary disease, the pathogenic effects of these risk factors are
amplified by inherent deficiencies of the vein as a conduit when
transposed into the coronary arterial circulation. A multifaceted
strategy aimed at prevention of vein graft disease is emerging,
elements of which include: continued improvements in surgical
technique; more effective antiplatelet drugs; increasingly intensive
risk factor modification, in particular early and aggressive
lipid-lowering drug therapy; and a number of evolving therapies, such
as gene transfer and nitric oxide donor administration, which target
vein graft disease at an early and fundamental level. At present, a key
measure is to circumvent the problem of vein graft disease by
preferential selection of arterial conduits, in particular the internal
mammary arteries, for coronary bypass surgery whenever possible.
© 1998 American Heart Association, Inc.
Current Perspectives
Aortocoronary Saphenous Vein Graft Disease
Pathogenesis, Predisposition, and Prevention
Key Words: atherosclerosis • bypass • grafting • risk factors • prevention
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