Prevention of venous graft sclerosis with clopidogrel and aspirin combined with a mesh tubing in a dog model of arteriovenous bypass grafting.
OBJECTIVE
to investigate the effect of clopidogrel combined with aspirin or aspirin alone on fibromyointimal hyperplasia (FIMH) in a bypass model with native vein grafts (NVG) and biocompound grafts (BCG).


METHODS
twelve Beagle dogs were randomised into two equal groups. In each animal NVG and a BCG were interposed in the common carotid arteries. Postoperatively, Group 1 received clopidogrel (200 mg/d) and aspirin (100 mg/d) and Group 2 received aspirin (100 mg/d) alone.


METHODS
the BCG was constructed by sheathing the ipsilateral jugular vein with highly flexible metal mesh tubing. After 30 days the grafts were harvested and pressure fixed. FIMH was determined by morphometry.


RESULTS
the average wall thickness of the BCG was significantly lower than that of the NVG in both groups (0.26 (SD)0.02 mm vs 0.47 (SD)0.15 mm, p = 0.04 and 0.28 (SD)0.05 mm vs 0.70 (SD)0.29 mm, p = 0.01, respectively). For BCG treated with aspirin, the wall cross section area was lower (5.0 (SD)0.6 mm(2)vs 9.1 (SD)3.3 mm(2), p = 0.02) and the lumen larger (25.2 (SD)5.9 mm(2)vs 9.7 (SD)3.4 mm(2), p < 0.01) than for the NVG. There was also a difference in the lumen cross section area of the NVG, which was larger after combined therapy with clopidogrel and aspirin (17.9 (SD)7.8 mm(2)vs 9.7 (SD)3.4 mm(2), p = 0.04).


CONCLUSIONS
in this dog model the sheathing of vein grafts effectively prevents FIMH following bypass surgery. Clopidogrel is effective in NVG.
Zurbrügg
H R
HR
Deutsches Herzzentrum Berlin, Department of Cardiac, Thoracic and Vascular Surgery, Berlin, Germany.
Musci
M
M
Sänger
S
S
Gutersohn
A
A
Mülling
C
C
Wellnhofer
E
E
Schaffner
T
T
Hetzer
R
R
D000818:Animals; D001241:Aspirin / Q000008:administration & dosage*; D001807:Blood Vessel Prosthesis; D017536:Carotid Artery, Common / Q000601:surgery*; D000077144:Clopidogrel; D004285:Dogs; D004359:Drug Therapy, Combination; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D007601:Jugular Veins / Q000637:transplantation*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D013988:Ticlopidine / Q000008:administration & dosage* / Q000031:analogs & derivatives
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin