Monocyte adhesion to endothelium is believed to be an initiating event in atherosclerosis both in arteries and in saphenous vein coronary artery bypass grafts. We have developed a method to quantify adhesion of Cr-51-labelled human blood monocytes to saphenous vein. Adhesion to the intimal surface was measured to uniform 6 mm diameter discs, the adventitia of which was embedded in a layer of inert silicone grease. The identity, number and location of bound cells was further defined by scanning electron microscopy. The proportion of monocytes adhering to discs of freshly-isolated vein was 7.1 +/- 1.2% (SE, n = 8), which was equivalent to 500 +/- 80 monocytes/mm2. The percentage of monocytes adhering was independent of the number of monocytes added in the range 5-50 x 10(4). Scanning micrographs showed 80% endothelial coverage with monocytes adhering preferentially but not exclusively to subendothelium. Endothelial removal increased monocyte adhesion by 1.60 +/- 0.15-fold (n = 8, P < 0.01). Vein surgically prepared for use in coronary bypass surgery, had a 50% reduction in endothelial coverage and a small but non significant (1.14 +/- 0.13-fold, n = 8) increase in monocyte adhesion. Treatment of freshly-isolated vein for 4 h at 37-degrees-C with 1-mu-g/ml of E. Coli endotoxin followed by extensive washing did not remove endothelium but increased monocyte adherence by 1.46 +/- 0.18-fold (n = 8, P < 0.05). The proportion of monocytes adhering to veins which had been cultured for 14 days was similar to freshly isolated veins (6.4 +/- 0.8%, n = 7), but in cultured veins, monocytes adhered preferentially to cells with typical endothelial morphology. Endotoxin treatment of cultured freshly-isolated veins increased monocyte adhesion by 1.77 +/- 0.23-fold (n = 8, P < 0.05). The data show that both endothelial activation, and exposure of subendothelium promote monocyte adhesion to human saphenous vein.