Role of procurement-related injury in early saphenous vein graft failure after coronary artery bypass surgery

Abstract

Saphenous vein graft thrombosis after coronary artery bypass graft surgery is a poorly understood problem that lessens the benefits of this procedure. Recent studies highlight the importance of injury sustained at the time of saphenous vein graft procurement in the pathogenesis of acute graft thrombosis. In particular, damage to the graft endothelium that occurs secondary to ex vivo pressure distention, a common practice during vein harvest, leads to a loss of antithrombotic factors and increased activity of subendothelial prothrombotic factors. The prothrombotic potential of damaged grafts is further exacerbated by an ischemic storage interval and subsequent exposure to arterial flow conditions after grafting. A clearer understanding of the mechanisms by which endothelial disruption leads to acute saphenous vein graft thrombosis may result in interventions for improving our procurement techniques, interrupting the downstream effects of the damaged saphenous vein graft and/or discriminating damage that is beyond an acceptable threshold of thrombotic risk.