CYTOKINETIC STUDY OF AORTOCORONARY BYPASS VEIN GRAFTS IN PLACE FOR LESS THAN 6 MONTHS

To evaluate the initial mechanism involving atherosclerotic changes of the saphenous vein graft implanted for coronary artery revascularization in the early stage, immunocytochemical analysis was performed to determine the cell components and kinetics of saphenous vein grafts. Specimens of saphenous vein grafts were obtained from 7 necropsy patients who died at 4 days to 6 months after surgery. Monoclonal antibodies specific for smooth muscle cells (HHF35) and macrophages (HAM56) were used for analysis of the cell components. Migration of macrophages into the intima and the media was observed on the fourth postoperative day. Intimal thickening was characterized by the proliferation of smooth muscle cells, and scattered macrophages were present in the subendothelial layer 1 month after surgery. At 2 months, intimal thickening became prominent and macrophages were recognized circumferentially throughout the layer. At 5 to 6 months, some of the saphenous vein grafts were almost occluded by severe intimal thickening due to proliferation of the smooth muscle cells. Macrophages were also observed both inside and outside of the internal elastic lamina; these are rarely found in the artery. These results suggest that compared with the arterial graft, cytokinesia of the saphenous vein graft contributes to the development of early graft failure because of its rapidity in progression and severity.