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Mechanisms of Venous Graft Failure

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Coronary Graft Failure

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Abstract

Venous graft failure is a complex pathology of surgical revascularization that comprises many physiopathologic mechanisms, some of them still unclear until the present moment. Arterialization of the venous graft produces structural modifications in the graft wall, including all anatomic layers: intima, media, and adventitia. Of these, the most important aspect of graft dysfunction is intimal destructuration by various mechanisms: endothelial cell separation and cell loss, intimal edema, exposed basement membrane, subendothelial collagen and elastin, intimal tears and flaps, fibrointimal hyperplasia, neointimal hyperplasia, and thrombus formation. Some of these pathogenic processes are exacerbated while others are diminished, but, overall, they lead to graft restenosis. Intimal edema extends toward the superjacent layer, producing myocite necrosis, fibrosis, and eventually aneurysm formation. Adventitial ischemia produced by graft harvesting determines vasa vasorum loss and vein sclerosis. Under these circumstances, neoangiogenesis occurs without oxygenation importance criteria, which leads to augmentation of neointimal hyperplasia and intimal and medial fibrosis. Therefore, graft restenosis is a complex process with many pathologic mechanisms, in general without sequentiality, but which taken together lead toward what is designated as “venous graft disease.”

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Author information

Authors and Affiliations

  1. Department of Cardiology, “Vasile Cândea” Army’s Center for Cardiology, Bucharest, Romania

    Gabriel Cristian MD, PhD, FESC

  2. Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

    Ana-Maria Vintila MD, PhD

  3. Department of Internal Medicine and Cardiology, Coltea Clinical Hospital, Bucharest, Romania

    Ana-Maria Vintila MD, PhD

  4. Department of Gastroenterology, Central Military University Emergency Hospital “Dr. Carol Davila”, Bucharest, Romania

    Florentina Ionita-Radu MD, PhD

  5. Department of Cardiology, Centrul Clinic de Urgenta de Boli Cardiovasculare “Acad. Vasile Candea”, Bucharest, Romania

    Ileana Hantulie MD, PhD

  6. Department of Cardiology, “Fundacion Jimenez Diaz” Hospital, Universidad Autonoma de Madrid, Madrid, Spain

    Ana-Maria Ioan

  7. Department of Cardiology, “Acad. Vasile Cândea” Army’s Center for Cardiology, Bucharest, Romania

    Dragos Savoiu MD, PhD

  8. Department of Cardiology, Buzau Regional Hospital, Buzau, Romania

    Nicoleta Sava MD

Authors
  1. Gabriel Cristian MD, PhD, FESC
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  2. Ana-Maria Vintila MD, PhD
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  3. Florentina Ionita-Radu MD, PhD
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  4. Ileana Hantulie MD, PhD
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  5. Ana-Maria Ioan
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  6. Dragos Savoiu MD, PhD
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  7. Nicoleta Sava MD
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Corresponding author

Correspondence to Ana-Maria Ioan .

Editor information

Editors and Affiliations

  1. Cardiology, Army's Center for Cardiovascular Di, Bucharest, Romania

    Ion C. Ţintoiu

  2. Department of Surgery, Chinese University of Hong Kong, Sha Tin, Hong Kong

    Malcolm John Underwood

  3. University Fribourg, Hospital HFR Fribourg, Fribourg, Fribourg, Switzerland

    Stephane Pierre Cook

  4. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan

    Hironori Kitabata

  5. University Medical Center, Texas Tech Univ. Health Science Center, EL PASO, Texas, USA

    Aamer Abbas

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Cristian, G. et al. (2016). Mechanisms of Venous Graft Failure. In: Ţintoiu, I., Underwood, M., Cook, S., Kitabata, H., Abbas, A. (eds) Coronary Graft Failure. Springer, Cham. https://doi.org/10.1007/978-3-319-26515-5_24

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  • DOI: https://doi.org/10.1007/978-3-319-26515-5_24

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