Thomas F. Panetta, MD, Michael L. Marin, MD, Frank J

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Presentation transcript:

Unsuspected preexisting saphenous vein disease: an unrecognized cause of vein bypass failure Thomas F. Panetta, MD, Michael L. Marin, MD, Frank J. Veith, MD, Jamie Goldsmith, RN, Ronald E. Gordon, PhD, Anne M. Jones, BSN, RVT,, Michael L. Schwartz, MD, Sushil K. Gupta, MD, Kurt R. Wengerter, MD Journal of Vascular Surgery Volume 15, Issue 1, Pages 102-112 (January 1992) DOI: 10.1016/0741-5214(92)70018-G Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Cumulative primary patency for infrainguinal arterial bypasses with autogenous saphenous vein. Vein grafts with preexisting venous disease had significantly decreased patency at all time intervals (*p ≤ 0.001). Journal of Vascular Surgery 1992 15, 102-112DOI: (10.1016/0741-5214(92)70018-G) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Light micrographs of saphenous vein remnants from two patients who underwent infrainguinal arterial reconstruction. A, In this section from a normal vein, all layers of the vein wall are identified. B, In this micrograph of a thick-walled vein, the intimal-medial junction is poorly defined. Marked thickening of the intima and media by connective tissue accounts for striking variations in vein wall thickness. I = intima; ML = longitudinal layer of muscle media; MC = circular layer of muscle in media; A = adventitia. (Methylene blue/azure II stain; original magnification × 100.) Journal of Vascular Surgery 1992 15, 102-112DOI: (10.1016/0741-5214(92)70018-G) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Light micrograph of a segment of saphenous vein demonstrates complete luminal occlusion. The obliterated lumen is filled with organized thrombus. (Methylene blue/azure II stain; original magnification × 25.) Journal of Vascular Surgery 1992 15, 102-112DOI: (10.1016/0741-5214(92)70018-G) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 A recanalized saphenous vein segment. A, This vein would irrigate normally and allow passage of a catheter, allowing the recanalized disease to go undetected, although the vein is markedly thickened. B, This section clearly demonstrates the thick wall of the vein composed of abundant connective tissue surrounding several recanalized channels. (Trichrome stain; original magnification × 10.) Journal of Vascular Surgery 1992 15, 102-112DOI: (10.1016/0741-5214(92)70018-G) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 A recanalized saphenous vein. A, Multiple channels (C) that irrigated freely but precluded passage of a valvulotome are seen in association with a laminated thrombus (T). B, Histologic section demonstrates the extensive nature of the recanalization process. The site of attachment of the thrombus to the vein wall is apparent (arrow). (Trichrome stain; original magnification × 10.) Journal of Vascular Surgery 1992 15, 102-112DOI: (10.1016/0741-5214(92)70018-G) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 Calcification in the wall of a saphenous vein. A, Calcification may not be apparent on inspection of the outer surface of this excised segment of the saphenous vein before grafting. A silicone elastomer catheter (arrow) easily passes through the lumen of this remnant segment of saphenous vein. B, Exposing the vein lumen reveals previously unrecognized calcified plaques (arrow). C, Histologic section reveals morphologically discrete intimal plates (arrow) that leech from the section with processing. (Methylene blue/azure II stain; original magnification × 50.) D, This portion, from the segment of the saphenous vein with unsuspected disease, was used for bypass. Because of graft thrombosis, it was recovered 48 hours after bypass grafting. Mural thrombus is adherent to the luminal surface. Vein calcification can be seen (arrow). Journal of Vascular Surgery 1992 15, 102-112DOI: (10.1016/0741-5214(92)70018-G) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions