Intraoperative endothelial damage is associated with increased risk of stenoses in infrainguinal vein grafts.
OBJECTIVE
Saphenous vein injury is believed to predispose to vein graft stenoses. The aims of this study were to assess the endothelial injury associated with infrainguinal vein bypass surgery by serial measurements of serum thrombomodulin concentration as well as by platelet scintigraphy, and to relate these findings with the postoperative development of stenoses.


METHODS
In 35 patients undergoing vein bypass surgery serum thrombomodulin concentration was measured pre- and postoperatively. Autologous 111-indium labelled platelets were administered into the common femoral artery immediately after restoration of flow in the graft and scintigraphic images were obtained 4 and/or 24 h later.


RESULTS
Serum thrombomodulin increased markedly from median 17 ng/ml preoperatively to 32 ng/ml 1 day after surgery (p =0.00002). Platelet scintigraphy revealed a total of 62 focal activity accumulations, the majority being located in the anastomotic regions. Among the 30 patients with grafts remaining patent at 30 days stenoses occurred in nine (16%) of 55 regions with scintigraphic platelet accumulations as compared to only four (4%) of 94 regions without platelet accumulations (p =0.03).


CONCLUSIONS
The very high predictive value of a negative platelet scintigraphy (96%) strongly suggests that localised perioperative endothelial injury is an important pathogenetic factor in the development of vein graft stenoses.
Nielsen
T G
TG
Department of NuclearDepartment of Vascular Surgery Medicine and Clinical Physiology, Rigshospitalet, Copenhagen, Denmark
Hesse
B
B
Boehme
M W
MW
Schroeder
T V
TV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001792:Blood Platelets / Q000000981:diagnostic imaging*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D018180:Thrombomodulin / Q000097:blood*; D014680:Veins / Q000503:physiopathology / Q000637:transplantation*
D015415:Biomarkers; D018180:Thrombomodulin