Heart and Vessels

, Volume 28, Issue 2, pp 237–245 | Cite as

Pressure applied during surgery alters the biomechanical properties of human saphenous vein graft

  • Necla Ozturk
  • Nehir Sucu
  • Ulku ComelekogluEmail author
  • Banu Coskun Yilmaz
  • Barlas Naim Aytacoglu
  • Ozden Vezir
Original Article


Pressure applied during harvesting of the saphenous vein (SV) graft in coronary artery bypass surgery might change its mechanical properties and thereby decrease the patency. This study was performed to assess the mechanical properties of the SV graft distended manually with different levels of pressure and to determine the pressure level that induces changes in its structure and mechanics. Saphenous vein graft segments, collected from 36 patients undergoing coronary artery bypass surgery, were distended with pressures of either 50–60, 75–100, or 130–150 mmHg. Grafts were tested for the stress–strain relationship; the Young’s moduli at the low- and high-strain regions were calculated, and their structures were examined by light and electron microscopy. Pressures of 50–60 mmHg did not influence the mechanics of the vein graft, whereas pressures of 75–100 mmHg elevated the elastic modulus of the vein at the low-strain region while pressures above 130 mmHg increased the elastic moduli at both low- and high-strain regions. There was a prominent loss of microfibrils at all distending pressure levels. The mechanical results suggest that distending pressures above 75 mmHg might play a role in graft failure. Furthermore, the absence of microfibrils surrounding elastin suggests that application of distending pressures, even as low as 50 mmHg, can cause degeneration of the elastic fibers following implantation, increasing the stiffness of the graft and thus impairing the graft’s function under its new hemodynamic conditions.


Coronary artery bypass grafting Venous graft Modeling Bioengineering Vascular science 


  1. 1.
    Athanasiou T, Saso S, Rao C, Vecht J, Grapsa J, Dunning J, Lemma M, Casula R (2011) Radial artery versus saphenous vein conduits for coronary artery bypass surgery: forty years of competition—which conduit offers better patency? A systematic review and meta-analysis. Eur J Cardiothorac Surg 40:208–220PubMedCrossRefGoogle Scholar
  2. 2.
    Tsui JC, Souza DS, Filbey D, Karlsson MG, Dashwood MR (2002) Localization of nitric oxide synthase in saphenous vein grafts harvested with a novel “no-touch” technique: potential role of nitric oxide contribution to improved early graft patency rates. J Vasc Surg 35:356–362PubMedCrossRefGoogle Scholar
  3. 3.
    Hinokiyama K, Valen G, Tokuno S, Vedin JB, Vaage J (2006) Vein graft harvesting induces inflammation and impairs vessel reactivity. Ann Thorac Surg 82:1458–1464PubMedCrossRefGoogle Scholar
  4. 4.
    Chello M, Mastroroberto P, Frati G, Patti G, D’Ambrosio A, Sciascio GD, Covino E (2003) Pressure distension stimulates the expression of endothelial adhesion molecules in the human saphenous vein graft. Ann Thorac Surg 76:453–458PubMedCrossRefGoogle Scholar
  5. 5.
    Kaplan S, Morgan JA, Bisleri G, Cheema FH, Akman HO, Topkara VK, Oz MC (2005) Effects of resveratrol in storage solution on adhesion molecule expression and nitric oxide synthesis in vein grafts. Ann Thorac Surg 80:1773–1778PubMedCrossRefGoogle Scholar
  6. 6.
    Chen F, Eriksson P, Whatling C, Vaage J, Valen G (2008) Surgical handling of saphenous vein grafts induces expression of matrix metalloproteinase 9. Scand Cardiovasc J 42:327–336PubMedCrossRefGoogle Scholar
  7. 7.
    Dashwood MR, Anand R, Loesch A, Souza DS (2004) Hypothesis: a potential role for the vasa vasorum in the maintenance of vein graft patency. Angiology 55:385–395PubMedCrossRefGoogle Scholar
  8. 8.
    Dashwood M, Savage K, Tsui J (2009) Retaining perivascular tissue of human saphenous vein grafts protects against surgical and distension-induced damage and preserves endothelial nitric oxide synthase and nitric oxide synthase activity. J Thorac Cardiovasc Surg 138:334–340PubMedCrossRefGoogle Scholar
  9. 9.
    Souza DS, Bomfim V, Skoglund H, Dashwood MR, Borowiec JW, Bodin L, Filbey D (2001) High early patency of saphenous vein graft for coronary artery bypass harvested with surrounding tissue. Ann Thorac Surg 71:797–800PubMedCrossRefGoogle Scholar
  10. 10.
    Kidson IG (1983) The effect of wall mechanical properties on patency of arterial grafts. Ann R Coll Surg Engl 65:24–29PubMedGoogle Scholar
  11. 11.
    Davies AH, Magee TR, Baird RN, Sheffield E, Horrocks M (1992) Vein compliance: a pre-operative indicator of vein morphology and of veins at risk of vascular graft stenosis. Br J Surg 79:1019–1021PubMedCrossRefGoogle Scholar
  12. 12.
    Gusic RJ, Myung R, Petko M, Gaynor JW, Gooch KJ (2005) Shear stress and pressure modulate saphenous vein remodeling ex vivo. J Biomech 38:1760–1769PubMedCrossRefGoogle Scholar
  13. 13.
    Gusic RJ, Petko M, Myung R, Gaynor JW, Gooch KJ (2005) Mechanical properties of native and ex vivo remodeled porcine saphenous veins. J Biomech 38:1770–1779PubMedCrossRefGoogle Scholar
  14. 14.
    Zhao J, Andreasen JJ, Yang J, Rasmussen BS, Liao D, Gregersen H (2007) Manual pressure distension of the human saphenous vein changes its biomechanical properties—implication for coronary artery bypass grafting. J Biomech 40:2268–2276PubMedCrossRefGoogle Scholar
  15. 15.
    Guvenc Tuna B, Ozturk N, Comelekoglu U, Yilmaz BC (2011) Effects of organophosphate insecticides on mechanical properties of rat aorta. Physiol Res 60:39–46PubMedGoogle Scholar
  16. 16.
    Fischer EIC, Armentano RL, Levenson J, Barra JG, Morales MC, Breitbart GJ, Pichel RH, Simon A (1991) Paradoxically decreased aortic wall stiffness in response to vitamin D3-induced calcinosis. A biphasic analysis of segmental elastic properties in conscious dogs. Circ Res 68:1549–1559CrossRefGoogle Scholar
  17. 17.
    Shuhaiber JH, Evans AN, Massad MG, Geha AS (2002) Mechanisms and future directions for prevention of vein graft failure in coronary bypass surgery. Eur J Cardiothorac Surg 22:387–396PubMedCrossRefGoogle Scholar
  18. 18.
    Higuchi Y, Hirayama A, Shimizu M, Sakakibara T, Kodama K (2002) Postoperative changes in angiographically normal saphenous vein coronary bypass grafts using intravascular ultrasound. Heart Vessels 17:57–60PubMedCrossRefGoogle Scholar
  19. 19.
    Kumazaki S, Koyama J, Aizawa K, Kasai H, Koshikawa M, Izawa A, Tomita T, Takahashi M, Ikeda U (2010) Effect of graft adaptation of the internal mammary artery on longitudinal phasic blood flow velocity characteristics after surgery. Heart Vessels 25:515–521PubMedCrossRefGoogle Scholar
  20. 20.
    Milesi V, Rebolledo A, Paredes FA, Sanz N, Tommasi J, Rinaldi GJ, Grassi AO (1998) Mechanical properties of human saphenous veins from normotensive and hypertensive patients. Ann Thorac Surg 66:455–461PubMedCrossRefGoogle Scholar
  21. 21.
    Krasinski Z, Biskupski P, Dzieciuchowicz L, Kaczmarek E, Krasinska B, Staniszewski R, Pawlaczyk K, Stanisic M, Majewski P, Majewski W (2010) The influence of elastic components of the venous wall on the biomechanical properties of different veins used for arterial reconstruction. Eur J Vasc Endovasc Surg 40:224–229PubMedCrossRefGoogle Scholar
  22. 22.
    Janowski K, Sopiński M, Topol M (2007) Changes in the wall of the great saphenous vein at consecutive stages in patients suffering from chronic vein disease of the lower limbs. Folia Morphol 66:185–189Google Scholar
  23. 23.
    Canham PB, Finlay HM, Boughner DR (1997) Contrasting structure of the saphenous vein and internal mammary artery used as coronary bypass vessels. Cardiovasc Res 34:557–567PubMedCrossRefGoogle Scholar
  24. 24.
    Roach MR, Burton AC (1957) The reason for the shape of the distensibility curves of arteries. Can J Biochem Physiol 35:681–690PubMedCrossRefGoogle Scholar
  25. 25.
    Lillie MA, David GJ, Gosline JM (1998) Mechanical role of elastin associated microfibrils in pig aortic elastic tissue. Connect Tissue Res 37:121–141PubMedCrossRefGoogle Scholar
  26. 26.
    Sherratt MJ, Baldock C, Haston JL, Holmes DF, Jones CJ, Shuttleworth CA, Wess TJ, Kielty CM (2003) Fibrillin microfibrils are stiff reinforcing fibres in compliant tissues. J Mol Biol 332:183–193PubMedCrossRefGoogle Scholar
  27. 27.
    Bashey RI, Cox R, McCann J, Jimenez SA (1989) Changes in collagen biosynthesis, types, and mechanics of aorta in hypertensive rats. J Lab Clin Med 113:604–611PubMedGoogle Scholar
  28. 28.
    Brüel A, Ørtoft G, Oxlund H (1998) Inhibition of cross-links in collagen is associated with reduced stiffness of the aorta in young rats. Atherosclerosis 140:135–145PubMedCrossRefGoogle Scholar
  29. 29.
    Ramirez F (2000) Pathophysiology of the microfibril/elastic fiber system: introduction. Matrix Biol 19:455–456PubMedCrossRefGoogle Scholar
  30. 30.
    Kielty CM (2006) Elastic fibres in health and disease. Expert Rev Mol Med 8:1–23PubMedCrossRefGoogle Scholar
  31. 31.
    Akhtar S, Meek KM, James V (1999) Ultrastructure abnormalities in proteoglycans, collagen fibrils, and elastic fibers in normal and myxomatous mitral valve chordae tendineae. Cardiovasc Pathol 8:191–201PubMedCrossRefGoogle Scholar
  32. 32.
    Zachrisson H, Lindenberger M, Hallman D, Ekman M, Neider D, Lanne T (2011) Diameter and compliance of the greater saphenous vein—effect of age and nitroglycerine. Clin Physiol Funct Imaging 31:300–306PubMedCrossRefGoogle Scholar
  33. 33.
    Angelini GD, Passani SL, Breckenridge IM, Newby AC (1987) Nature and pressure dependence of damage induced by distension of human saphenous vein coronary artery by pass grafts. Cardiovasc Res 21:902–907PubMedCrossRefGoogle Scholar
  34. 34.
    Angelini GD, Bryan AJ, Hunter S, Newby AC (1992) A surgical technique that preserves human saphenous vein functional integrity. Ann Thorac Surg 53:871–874PubMedCrossRefGoogle Scholar
  35. 35.
    Adcock OT Jr, Adcock GL, Wheeler JR, Gregory RT, Snyder SO Jr, Gayle RG (1984) Optimal techniques for harvesting and preparation of reversed autogenous vein grafts for use as arterial substitutes: a review. Surgery 96:886–894PubMedGoogle Scholar
  36. 36.
    Underwood MJ, More R, Weeresena N, Firmin RK, De Bono DP (1993) The effect of surgical preparation and in-vitro distension on the intrinsic fibrinolytic activity of human saphenous vein. Eur J Vasc Surg 7:518–522PubMedCrossRefGoogle Scholar
  37. 37.
    Onorati F, Santarpino G, Lerose MA, Impiombato B, Mastroroberto P, Renzulli A (2008) Intraoperative behavior of arterial grafts in the elderly and the young: a flowmetric systematic analysis. Heart Vessels 23:316–324PubMedCrossRefGoogle Scholar
  38. 38.
    Ji Q, Mei Y, Wang X, Feng J, Cai J, Sun Y, Dewei W, Wang C, Chi L (2011) Short-term effects of double-layer autologous vein graft on restraint of excessive distension and alleviation of neointimal hyperplasia in a porcine saphenous vein graft model. Heart Vessels 26:190–195PubMedCrossRefGoogle Scholar
  39. 39.
    Sepehripoura AH, Jarral OA, Shipolini AR, McCormack DJ (2011) Does a ‘no-touch’ technique result in better vein patency? Interact Cardiovasc Thorac Surg 13:626–630CrossRefGoogle Scholar

Copyright information

© Springer 2012

Authors and Affiliations

  • Necla Ozturk
    • 1
  • Nehir Sucu
    • 2
  • Ulku Comelekoglu
    • 3
    Email author
  • Banu Coskun Yilmaz
    • 4
  • Barlas Naim Aytacoglu
    • 2
  • Ozden Vezir
    • 2
  1. 1.Department of Biophysics, Faculty of MedicineHacettepe UniversityAnkaraTurkey
  2. 2.Department of Cardiovascular Surgery, Faculty of MedicineMersin UniversityMersinTurkey
  3. 3.Department of Biophysics, Faculty of MedicineMersin UniversityMersinTurkey
  4. 4.Department of Histology and Embryology, Faculty of MedicineMersin UniversityMersinTurkey

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