Vein graft harvesting induces inflammation and impairs vessel reactivity.
BACKGROUND
Saphenous veins are often used for coronary artery bypass grafting (CABG), but loss of patency is a problem. The surgical procedure may contribute to graft injury. Our aim was to study the impact of surgical handling of saphenous veins on graft inflammation and vascular function.


METHODS
Biopsy samples of saphenous veins were taken from 9 patients undergoing elective CABG at the start of vein harvesting (open technique) and after the last proximal anastomosis was sutured. Messenger RNA was extracted and amplified with semiquantitative reverse transcription polymerase chain reaction. Gene expression of proinflammatory cytokines (tumor necrosis factor-alpha, interleukin-1beta), leukocyte adhesion molecules (E-selectin, intercellular adhesion molecule-1), and vasoactive substances (endothelin-1, inducible and endothelial nitric oxide synthase) was investigated. Translocation of nuclear factor-kappaB (NFkappaB) was evaluated with electrophoretic mobility shift assay. Immunostaining for von Willebrand factor was performed to evaluate loss of endothelium, and in vitro vein reactivity to phenylephrine and endothelin-1 was studied.


RESULTS
Gene expression of cytokines and leukocyte adhesion molecules increased after graft harvesting and storage, whereas vasoactive substances did not change. Nuclear translocation of NFkappaB occurred after surgical handling, concurrent with partial loss of endothelium and impaired contractile function.


CONCLUSIONS
Standard surgical handling of vein grafts induces NFkappaB-driven inflammation in the vessel wall and impairs vascular function. This may potentially contribute to both early and late graft occlusion.
Hinokiyama
Kazuhiro
K
Crafoord Laboratory, Karolinska Hospital, Stockholm, Sweden.
Valen
Guro
G
Tokuno
Shinichi
S
Vedin
Jenny Bäcklund
JB
Vaage
Jarle
J
D001706:Biopsy; D015815:Cell Adhesion Molecules / Q000276:immunology; D001026:Coronary Artery Bypass / Q000379:methods; D016207:Cytokines / Q000276:immunology; D005260:Female; D015870:Gene Expression / Q000276:immunology; D006083:Graft Occlusion, Vascular / Q000276:immunology; D006801:Humans; D007249:Inflammation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D016328:NF-kappa B / Q000276:immunology; D052250:Nitric Oxide Synthase Type III / Q000276:immunology; D012501:Saphenous Vein / Q000276:immunology* / Q000473:pathology / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*; D014654:Vascular Patency / Q000276:immunology; D014661:Vasoconstriction / Q000276:immunology; D014664:Vasodilation / Q000276:immunology
D015815:Cell Adhesion Molecules; D016207:Cytokines; D016328:NF-kappa B; C496314:NOS3 protein, human; D052250:Nitric Oxide Synthase Type III