High-Pressure Distention of the Saphenous Vein During Preparation Results in Increased Markers of Inflammation: A Potential Mechanism for Graft Failure

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High-Pressure Distention of the Saphenous Vein During Preparation Results in Increased Markers of Inflammation: A Potential Mechanism for Graft Failure Maseeha S. Khaleel, MD, Tracy A. Dorheim, MD, Michael J. Duryee, MS, Harold E. Durbin, PA-C, Walter D. Bussey, PA-C, Robert P. Garvin, BA, Lynell W. Klassen, MD, Geoffrey M. Thiele, PhD, Daniel R. Anderson, MD, PhD The Annals of Thoracic Surgery Volume 93, Issue 2, Pages 552-558 (February 2012) DOI: 10.1016/j.athoracsur.2011.10.035 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Anatomic location of saphenous vein (SV) segments during specimen harvest. Segment 0 was collected before distention and pressure measurements. Segment 1 was harvested immediately after distention was completed. Segments 2, 3, and 4 were harvested as grafts and were used from the coronary target end. Segment Last was harvested from the vein adjacent to the syringe tip. The Annals of Thoracic Surgery 2012 93, 552-558DOI: (10.1016/j.athoracsur.2011.10.035) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Adhesion molecule expression. Using real-time polymerase chain reaction (RT-PCR), mRNA expression was compared in distended and nondistended SV segments. A significant difference can be seen between segment 0 and segment Last for all adhesion molecules. Furthermore, the difference in expression of PECAM-1 between the intervening segments is significant. Segment Last was exposed to the most amount of pressure for an extended period because of its location next to the syringe tip (*p ≤ 0.001 compared with segment 0; #p ≤ 0.05 compared with segment 0). (B) Upregulation of toll-like receptors (TLRs). Using RT-PCR mRNA expression was compared in distended and nondistended SV segments. A significant difference was observed between segment 0 and segment Last for all biomarkers except CD14. TLR4 expression levels were also significantly elevated between segment 2 and segment Last. Segment Last of vein was exposed to the most amount of pressure for an extended period because of its location next to the syringe tip (*p ≤ 0.001 compared with segment 0; #p ≤ 0.05 compared with segment 0). (C), Upregulation of SRs. Using RT-PCR, mRNA expression was compared in distended and nondistended SV segments. A significant difference can be seen between segment 0 and segment Last for all SRs. Additionally there is a significant difference in fold increase of SR-B1 and CD36 when comparing individual segments. Segment Last of vein was exposed to the most amount of pressure for an extended period because of its location next to the syringe tip (*p ≤ 0.001 compared with segment 0; #p ≤ 0.05 compared with segment 0). (CD 14 = cluster of differentiation 14; CD 36 = cluster of differentiation 36; ICAM = intracellular adhesion molecule; PECAM = platelet endothelial cell adhesion molecule; SR = scavenger receptor; SRA = scavenger receptor A; SRB = scavenger receptor B; SV = saphenous vein; TLR2 = toll-like receptor 2; TLR4 = toll-like receptor 4; VCAM = vascular cell adhesion molecule.) The Annals of Thoracic Surgery 2012 93, 552-558DOI: (10.1016/j.athoracsur.2011.10.035) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Immunohistochemical staining for biomarkers. (A) Immunohistochemical staining of segment 0 and segment Last in human SV for ICAM-1, PECAM-1, TLR2, and SR-A is shown. Staining of segment Last shows increased intensity for all markers at the endothelial border compared with segment 0. (B) Isotype controls were negative for any background staining. Scale bar is 100 mm. (ICAM = intracellular adhesion molecule 1; PECAM-1 = platelet endothelial cell adhesion molecule 1; SR-A = scavenger receptor A; SV = saphenous vein; TLR2 = toll-like receptor 2.) The Annals of Thoracic Surgery 2012 93, 552-558DOI: (10.1016/j.athoracsur.2011.10.035) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions