Pathophysiology of Saphenous Vein Graft Disease

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Several factors contribute to stenosis of saphenous vein grafts, including intimal hyperplasia, plaque formation, and graft remodeling. Additionally, arterialization of the graft accelerates atherosclerosis. Furthermore, atheroma found in SVGs are more friable (easily break into small pieces) and more prone to thrombus than plaques found in native vessels. Another reason why SVGs are more susceptible to thrombotic occlusion is that they lack side branches[1].

## Contents

* 1 Saphenous Vein Graft Aneurysms
* 1.1 Causes of Saphenous Vein Graft Aneurysms
* 2 Amyloidosis of Saphenous Coronary Bypass Grafts
* 3 Rupture of the Saphenous Vein Coronary Artery Bypass Grafts
* 4 Phlebitis in the Implanted SVG
* 5 Potential for Pre-Operative SVG Failure
* 6 References

### Saphenous Vein Graft Aneurysms[edit | edit source]

It is also known as SVGA, aortocoronary saphenous vein graft aneurysms, saphenous vein graft aneurysm disease and saphenous vein graft aneurysmal dilatation.

##### Causes of Saphenous Vein Graft Aneurysms[edit | edit source]

* Atherosclerosis
* Hypertension
* Mycotic
* Postoperative mediastinitis
* Previous aneurysms
* Torn sutures

### Amyloidosis of Saphenous Coronary Bypass Grafts[edit | edit source]

Amyloid has been associated with accelarated disease in saphenous vein grafts.[2] [3] [4] [5] [6]

### Rupture of the Saphenous Vein Coronary Artery Bypass Grafts[edit | edit source]

Aspergillus species causing a necrotizing vasculitis have been associated with rupture of a saphenous vein grafts.

### Phlebitis in the Implanted SVG[edit | edit source]

Acute postoperative phlebitis is a rare complication of SVG implantation which can be associated with SVG thombosis, and a purulent pericarditis and mediastinitis[7][8].

### Potential for Pre-Operative SVG Failure[edit | edit source]

It should be noted that studies of SVGs that are not implanted show that about 1% of veins are already stenosed by > 50% before implantation[9].

## References[edit | edit source]

1. ↑ Motwani JG, Topol EJ (1998). "Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention". Circulation. 97 (9): 916–31. PMID 9521341. Retrieved 2010-11-09. Unknown parameter `|month=` ignored (help)
2. ↑ Marti MC, Bouchardy B, Cox JN. Aortocoronary bypass with autogenous saphenous vein grafts: histopathological aspects. Virchows Arch Abt A Path Anat 1971; 352: 255–66.
3. ↑ Garrett HE, Dennis EW, DeBakey ME. Aortocoronary bypass with saphenous vein graft. JAMA 1973; 223: 792–4.
4. ↑ Zemva A, Ferluga D, Zorc M, Popovic M, Porenta OV, Radovanovic N. Amyloidosis in saphenous vein aortocoronary bypass grafts. J Cardiovasc Surg 1990; 31: 441–4.
5. ↑ Salerno TA, Wasan SM, Charrette EJ. Prospective analysis of heart biopsies in coronary artery surgery. Ann Thorac Surg 1979; 28: 436–9.
6. ↑ Pelosi F, Capehart J, Roberts WC. Effectiveness of cardiac transplantation for primary (AL) cardiac amyloidosis. Am J Cardiol 1997; 79: 532–5.
7. ↑ Douglas BP, Bulkley BH, Hutchins GM (1979). "Infected saphenous vein coronary artery bypass graft with mycotic aneurysm. Fatal dehiscence of the proximal anastomosis". Chest. 75 (1): 76–7. PMID 311272. Retrieved 2010-11-09. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
8. ↑ Bulkley BH, Hutchins GM (1978). "Acute postoperative graft phlebitis: a rare cause of saphenous vein-coronary artery bypass failure". American Heart Journal. 95 (6): 757–60. PMID 306741. Unknown parameter `|month=` ignored (help); `|access-date=` requires `|url=` (help)
9. ↑ Waller BF, Roberts WC (1985). "Remnant saphenous veins after aortocoronary bypass grafting: analysis of 3,394 centimeters of unused vein from 402 patients". The American Journal of Cardiology. 55 (1): 65–71. PMID 3871302. Retrieved 2010-11-09. Unknown parameter `|month=` ignored (help)

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