Biological Regeneration in Vascular Grafts

  • Ch. R. H. Wildevuur
Part of the NATO ASI Series book series (volume 166)


Mammarian arteries are preferable for coronary artery bypass grafting. However vein grafts are more commonly used because multiple grafts are frequently needed. Arterial grafts are preferred because the patency rate is 93%. Vein grafts have only 45% patency after seven years (Lytle, 1985). This disturbing result using vein grafts in a large population of patients is likely related to damage of the vein walls, caused by the high pressures to which the veins are subjected, during harvesting and implantation. This leads to endothelial desquamation and an inflammatory reaction in the distended wall. A sequence of biological responses is evoked. A deposition of a platelet/fibrin layer occurs and then endothelial and smooth muscle cells are stimulated to restore the defect. Optimally this biological response of regeneration results in re-endothelialization and in smooth muscle cell proliferation, commonly named arterialization of the graft. However vein grafts frequently occlude early, because of thrombosis, or later due to excessive smooth muscle cell proliferation. Thus distension of a vein graft by the arterial pressure damages the vein wall, which affects patency, but also stimulates a biological mechanism of adaptation of the vein graft to the arterial pressure, i.e. arterialization. Ideally damage of the vein graft should be prevented but the mechanism to adapt to the higher pressure should be preserved.


Smooth Muscle Cell Vein Graft Patency Rate Vascular Graft Biological Regeneration 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Lytle, B.W., Floyd, D.L., Cosgrove, D.M., Ratliff, N.B., Easley, K., and Taylor, P.C., 1985, Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J. Thorac. Cardiovasc..Surg., 89: 248.PubMedGoogle Scholar
  2. Wildevuur, Ch.R.H., Lei, van der B., and Schakenraad, J.M., 1985, Basic aspects of the regeneration of small-calibre neoarteries in biodegradable vascular grafts in rats, Biomaterials, 8: 418.CrossRefGoogle Scholar
  3. Buul van-Wortelboer, M.F., Brinkman, H.J.M., Dingemans, K.P., Groot de, P.G., Aken, van W.G., and Mourik van, J.A., 1986, Reconstruction of the vascular wall in vitro. A novel model to study interactions between endothelial and smooth muscle cells, Exp. Cell Res., 162: 151.PubMedCrossRefGoogle Scholar
  4. Dewey, C.F., 1984, Effects of fluid flow on living vascular cells, J. Biomech. Eng., 106: 31.PubMedCrossRefGoogle Scholar
  5. Yue, X., Lei van der, B., Schakenraad, J.H., Oene van, G.H., and Wildevuur, Ch.R.H., 1988, Smooth muscle cell seeding in biodegradable grafts in rats. A new method to enhance the process of arterial-wall regeneration, Surgery, 103 (2): 206.PubMedGoogle Scholar

Copyright information

© Plenum Press, New York 1989

Authors and Affiliations

  • Ch. R. H. Wildevuur
    • 1
  1. 1.Department of Cardiopulmonary Surgery, Research DivisionUniversity Hospital GroningenThe Netherlands

Personalised recommendations