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Vasa vasorum of the failed aorto-coronary venous grafts

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Abstract

Purpose

This study was designed to investigate the distribution of vasa vasorum in walls of failed aorto-coronary venous grafts.

Methods

Fifty-one diseased venous grafts harvested from 39 patients underwent qualitative histological evaluation. The morphology of the grade of the pathological changes and the extent of the vascularisation were examined, and related to the length of the interval between the primary surgery and the explantation. The obtained results were placed into five groups, substantially differing one from the other in morphology and vascularisation.

Results

The intervals between grafts implantation and explantation ranged from 1 day to 35 years. The onset of arterialization of the graft media was observed on average at 1 month after bypass implantation. During this same time period massive intimal hyperplasia and atherosclerosis occurred. Vasa vasorum proliferation from the adventitia to the outer layers of the media was first apparent between 7 and 24 months after implantation. Proliferation of the vasa vasorum throughout the entire atherosclerotic media and hyperplastic intima continued for a much longer time interval.

Conclusion

No correlation between neoangiogenesis and age, sex or type of bypassed coronary branch was proven. Regarding the given findings, the authors believe that changes in hemodynamic conditions and endothelial trauma are primarily responsible for the development of graft disease and that vasa vasorum proliferation is only a secondary reaction to the structural changes of the graft wall. To what extent the frequently present pre-existing intimal hyperplasia of venous bypass grafts play in the development of graft disease remains questionable.

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Acknowledgements

The authors thank Adam Whitley, M.D. for language corrections of the article. The study was supported by Charles University, Prague (PRVOUK P38 and PROGRES Q41).

Author information

Authors and Affiliations

  1. Department of Anatomy, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic

    Josef Stingl, David Kachlik & Matej Patzelt

  2. Centre of Scientific Information, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic

    Vladimir Musil

  3. Cardiovascular Surgery Department, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21, Prague 4, Czech Republic

    Jan Pirk

  4. Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and Teaching Hospital Královské Vinohrady, Srobarova 50, 100 34, Prague 10, Czech Republic

    Zbynek Straka

  5. Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 150 06, Prague 5, Czech Republic

    Marek Setina

  6. Department of Pathology, Third Faculty of Medicine, Charles University and Teaching Hospital Královské Vinohrady, Srobarova 50, 100 34, Prague 10, Czech Republic

    Josef Sach

Authors
  1. Josef Stingl
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  2. Vladimir Musil
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  3. Jan Pirk
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  4. Zbynek Straka
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  5. Marek Setina
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  6. Josef Sach
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  7. David Kachlik
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  8. Matej Patzelt
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Contributions

JS (Stingl): Project development, Data collection and Management, Data analysis, Manuscript writing. VM: Data Collection, Data analysis, Manuscript writing. JP: Data Collection. ZS: Data Collection. MS: Data Collection. JS (Sach): Data analysis, Manuscript Editing. DK: Data analysis, Manuscript Editing. MP: Data analysis, Manuscript Editing.

Corresponding author

Correspondence to Vladimir Musil.

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Conflict of interest

The authors declare that they have no competing interests.

Additional information

Deceased: Zbynek Straka.

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Stingl, J., Musil, V., Pirk, J. et al. Vasa vasorum of the failed aorto-coronary venous grafts. Surg Radiol Anat 40, 769–778 (2018). https://doi.org/10.1007/s00276-018-2036-y

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  • DOI: https://doi.org/10.1007/s00276-018-2036-y

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