Article    Table of Contents                    Full Text of this article Free    Figures/Tables List  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Nwasokwa, O. N.    Related Articles in PubMed    PubMed Citation    PubMed

ARTICLE

Coronary Artery Bypass Graft Disease

Obi N. Nwasokwa, MD, PhD

1 October 1995 | Volume 123 Issue 7 | Pages 528-533

Purpose: To review saphenous vein graft disease and its prevention and management.

Data Sources: A MEDLINE search of articles published on saphenous vein and arterial bypass grafts.

Study Selection: The reference sections of articles focused the selection of key studies.

Data Extraction: Relevant data representing key findings were noted.

Data Synthesis: The outcome of coronary artery bypass grafting with the saphenous vein graft is unsatisfactory because vein grafts are prone to occlusive disease. By 10 years after surgery, 50% have closed, mainly because of atherosclerosis. With vein graft disease and graft closure, symptoms return. The best way to prevent vein graft disease is to use the internal mammary artery graft. This has become the preferred graft because it is not affected by atherosclerosis. Consequently, it has a much higher patency rate: 90% after more than 10 years. This provides such clinical benefits as decreased occurrence of symptoms, better left ventricular performance, decreased need for reoperation, and prolongation of life. The limited supply of mammary arteries has stimulated interest in identifying alternative arterial grafts.

Conclusions: To prevent vein graft disease, surgeons should bypass diseased coronary arteries with at least one arterial graft and take measures during the surgery to avoid endothelial injury to vein grafts. Treatment with antiplatelet agents decreases the vein graft occlusion rate. When graft atherosclerosis causes symptoms, reoperation will probably prolong life if an old graft to the left anterior descending coronary artery is diseased. Reoperation increases a patient's chance for survival if the surgeon uses at least one arterial graft.

Author and Article Information

From Harris Chasanoff Heart Institute, Long Island Jewish Medical Center, New Hyde Park, New York. For the current author address, see end of text.
Acknowledgment: The author thanks Dr. Hendrick B. Barner for reading the manuscript and making valuable suggestions.
Requests for Reprints: Obi N. Nwasokwa, MD, PhD, Division of Cardiology, Harris Chasanoff Heart Institute, Long Island Jewish Medical Center, New Hyde Park, NY 11042.

This article has been cited by other articles:

				S.-A. Hassantash, B. Bikdeli, S. Kalantarian, M. Sadeghian, and H. Afshar Pathophysiology of Aortocoronary Saphenous Vein Bypass Graft Disease Asian Cardiovasc Thorac Ann, August 1, 2008; 16(4): 331 - 336. [Abstract] [Full Text] [PDF]

				A. Coolong, D. S. Baim, R. E. Kuntz, A. J. O'Malley, S. Marulkar, D. E. Cutlip, J. J. Popma, and L. Mauri Saphenous Vein Graft Stenting and Major Adverse Cardiac Events: A Predictive Model Derived From a Pooled Analysis of 3958 Patients Circulation, February 12, 2008; 117(6): 790 - 797. [Abstract] [Full Text] [PDF]

				R. F. Padera Jr. and F. J. Schoen Pathology of Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 111 - 178. [Full Text]

				E. Gongora and T. M. Sundt III Myocardial Revascularization with Cardiopulmonary Bypass Card. Surg. Adult, January 1, 2008; 3(2008): 599 - 632. [Full Text]

				T. Schachner, G. Laufer, and J. Bonatti In vivo (animal) models of vein graft disease. Eur. J. Cardiothorac. Surg., September 1, 2006; 30(3): 451 - 463. [Abstract] [Full Text] [PDF]

				U. Khanderia, K. A. Townsend, K. Eagle, and R. Prager Statin Initiation Following Coronary Artery Bypass Grafting: Outcome of a Hospital Discharge Protocol Chest, February 1, 2005; 127(2): 455 - 463. [Abstract] [Full Text] [PDF]

				P. Widimsky, Z. Straka, P. Stros, K. Jirasek, J. Dvorak, J. Votava, L. Lisa, T. Budesinsky, M. Kolesar, T. Vanek, et al. One-Year Coronary Bypass Graft Patency: A Randomized Comparison Between Off-Pump and On-Pump Surgery Angiographic Results of the PRAGUE-4 Trial Circulation, November 30, 2004; 110(22): 3418 - 3423. [Abstract] [Full Text] [PDF]

				M. A. Hlatky, D. B. Boothroyd, K. A. Melsop, M. M. Brooks, D. B. Mark, B. Pitt, G. S. Reeder, W. J. Rogers, T. J. Ryan, P. L. Whitlow, et al. Medical Costs and Quality of Life 10 to 12 Years After Randomization to Angioplasty or Bypass Surgery for Multivessel Coronary Artery Disease Circulation, October 5, 2004; 110(14): 1960 - 1966. [Abstract] [Full Text] [PDF]

				J. G. Lobo Filho, M. C. d. A. Leitao, and A. J. d. V. Forte Studying the lumen in composite Y internal thoracic artery-saphenous vein grafts J. Thorac. Cardiovasc. Surg., September 1, 2004; 128(3): 490 - 491. [Full Text] [PDF]

				L. Zhang, N. J. Freedman, L. Brian, and K. Peppel Graft-Extrinsic Cells Predominate in Vein Graft Arterialization Arterioscler. Thromb. Vasc. Biol., March 1, 2004; 24(3): 470 - 476. [Abstract] [Full Text]

				E. McGregor, L. Kempster, R. Wait, M. Gosling, M. J. Dunn, and J. T. Powell F-actin Capping (CapZ) and Other Contractile Saphenous Vein Smooth Muscle Proteins Are Altered by Hemodynamic Stress: A PROTEOMIC APPROACH Mol. Cell. Proteomics, February 1, 2004; 3(2): 115 - 124. [Abstract] [Full Text] [PDF]

				M. Endo, Y. Tomizawa, and H. Nishida Bilateral Versus Unilateral Internal Mammary Revascularization in Patients With Diabetes Circulation, September 16, 2003; 108(11): 1343 - 1349. [Abstract] [Full Text] [PDF]

				T. D. Rea, M. Crouthamel, M. S. Eisenberg, L. J. Becker, and A. R. Lima Temporal Patterns in Long-Term Survival After Resuscitation From Out-of-Hospital Cardiac Arrest Circulation, September 9, 2003; 108(10): 1196 - 1201. [Abstract] [Full Text] [PDF]

				M. Hilker, T. Langin, U. Hake, F.-X. Schmid, W. Kuroczynski, H.-A. Lehr, H. Oelert, and M. Buerke Gene expression profiling of human stenotic aorto-coronary bypass grafts by cDNA array analysis Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 620 - 625. [Abstract] [Full Text] [PDF]

				J. L. Sperry, C. B. Deming, C. Bian, P. L. Walinsky, D. A. Kass, F. D. Kolodgie, R. Virmani, A. Y. Kim, and J. J. Rade Wall Tension Is a Potent Negative Regulator of In Vivo Thrombomodulin Expression Circ. Res., January 10, 2003; 92(1): 41 - 47. [Abstract] [Full Text] [PDF]

				F. J. Schoen and R. F. Padera Jr. Cardiac Surgical Pathology Card. Surg. Adult, January 1, 2003; 2(2003): 119 - 185. [Full Text]

				A. Y. Kim, P. L. Walinsky, F. D. Kolodgie, C. Bian, J. L. Sperry, C. B. Deming, E. A. Peck, J. G. Shake, G. B. Ang, R. H. Sohn, et al. Early Loss of Thrombomodulin Expression Impairs Vein Graft Thromboresistance: Implications for Vein Graft Failure Circ. Res., February 8, 2002; 90(2): 205 - 212. [Abstract] [Full Text] [PDF]

				K.-B. Kim, C. Lim, C. Lee, I.-H. Chae, B.-H. Oh, M.-M. Lee, and Y.-B. Park Off-pump coronary artery bypass may decrease the patency of saphenous vein grafts Ann. Thorac. Surg., September 1, 2001; 72(3): S1033 - 1037. [Abstract] [Full Text] [PDF]

				Z. Yang, T. Kozai, B. van de Loo, H. Viswambharan, M. Lachat, M. I. Turina, T. Malinski, and T. F. Luscher HMG-CoA reductase inhibition improves endothelial cell function and inhibits smooth muscle cell proliferation in human saphenous veins J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1691 - 1697. [Abstract] [Full Text] [PDF]

				H. Hirose, A. Amano, S. Yoshida, A. Takahashi, N. Nagano, and T. Kohmoto Coronary Artery Bypass Grafting in the Elderly Chest, May 1, 2000; 117(5): 1262 - 1270. [Abstract] [Full Text] [PDF]

				P. Dylewicz, S. Bienkowska, L. Szczesniak, T. Rychlewski, I. Przywarska, M. Wilk, and A. Jastrzebski Beneficial Effect of Short-term Endurance Training on Glucose Metabolism During Rehabilitation After Coronary Bypass Surgery* Chest, January 1, 2000; 117(1): 47 - 51. [Abstract] [Full Text] [PDF]

				D P TAGGART The radial artery as a conduit for coronary artery bypass grafting Heart, October 1, 1999; 82(4): 409 - 410. [Full Text] [PDF]

				C. Shi, A. Patel, D. Zhang, H. Wang, P. Carmeliet, G. L. Reed, M.-E. Lee, E. Haber, and N. E. S. Sibinga Plasminogen Is Not Required for Neointima Formation in a Mouse Model of Vein Graft Stenosis Circ. Res., April 30, 1999; 84(8): 883 - 890. [Abstract] [Full Text] [PDF]

				D. R. Holmes Jr and P. B. Berger Percutaneous Revascularization of Occluded Vein Grafts : Is It Still a Temptation to Be Resisted? Circulation, January 12, 1999; 99(1): 8 - 11. [Full Text] [PDF]

				Y.-k. Wong, M. Thomas, V. Tsang, P. J. Gallagher, and M. E. Ward The prevalence of Chlamydia pneumoniae in atherosclerotic and nonatherosclerotic blood vessels of patients attending for redo and first time coronary artery bypass graft surgery J. Am. Coll. Cardiol., January 1, 1999; 33(1): 152 - 156. [Abstract] [Full Text] [PDF]

				F. D. Loop Coronary artery surgery: the end of the beginning Eur. J. Cardiothorac. Surg., December 1, 1998; 14(6): 554 - 571. [Abstract] [Full Text] [PDF]

				Z.-G. Zhu, H.-H. Li, and B.-R. Zhang Expression of Endothelin-1 and Constitutional Nitric Oxide Synthase Messenger RNA in Saphenous Vein Endothelial Cells Exposed to Arterial Flow Shear Stress Ann. Thorac. Surg., November 1, 1997; 64(5): 1333 - 1338. [Abstract] [Full Text]

				J. C. Hornberger, J. H. Best, and L. P. Garrison Jr. Cost-Effectiveness of Repeat Medical Procedures: Kidney Transplantation as an Example Med Decis Making, October 1, 1997; 17(4): 363 - 372. [Abstract] [PDF]

				R. A. Mangiafico, L. S. Malatino, M. Santonocito, R. S. Spada, F. A. Benedetto, and R.A. Mangiafico Plasma Endothelin-1 Release in Normal and Varicose Saphenous Veins Angiology, September 1, 1997; 48(9): 769 - 774. [Abstract] [PDF]

				A. Y. Kim, P. L. Walinsky, F. D. Kolodgie, C. Bian, J. L. Sperry, C. B. Deming, E. A. Peck, J. G. Shake, G. B. Ang, R. H. Sohn, et al. Early Loss of Thrombomodulin Expression Impairs Vein Graft Thromboresistance: Implications for Vein Graft Failure Circ. Res., February 8, 2002; 90(2): 205 - 212. [Abstract] [Full Text] [PDF]