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   Image          = Heart saphenous coronary grafts.jpg||
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   Caption        = Saphenous vein grafts for coronary arteries|
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{{Saphenous vein graft}}
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{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; Jason C. Choi, M.D.; Xin Yang, M.D.


'''Associate Editor-In-Chief:''' {{CZ}}
==[[Overview]]==


{{Editor Join}}
==[[Saphenous vein graft anatomy|Anatomy]]==


==Overview==
==[[Saphenous Vein Graft Harvesting|Harvesting]]==
==Normal Anatomy==
The great saphenous vein (GSV) originates from where the dorsal vein of the [[first digit]] (the large [[toe]]) merges with the [[dorsal venous arch of the foot]].


After passing anterior to the [[medial malleolus]] (where it often can be visualized and [[Palpation|palpated]]), it runs up the [[medial]] side of the leg. At the [[knee]], it runs over the posterior border of the [[medial epicondyle]] of the [[femur]] bone.
==[[Saphenous Vein Graft Nomenclature|Nomenclature]]==


The great saphenous vein then courses laterally to lie on the anterior surface of the thigh before entering an opening in the [[fascia lata]] called the [[saphenous opening]]. It joins with the [[femoral vein]] in the region of the [[femoral triangle]] at the saphenofemoral junction.
==[[Pathophysiology of Saphenous Vein Graft Disease|Pathophysiology]]==


The '''small saphenous vein''' (also '''lesser saphenous vein''') is originated where the dorsal vein from the [[fifth digit]] (smallest toe) merges with the [[dorsal venous arch of the foot]], which attaches to the [[great saphenous vein]].  It is considered a [[superficial vein]] and is [[subcutaneous]] (just under the skin).    From its origin, it courses around the lateral aspect of the foot (inferior and posterior to the [[lateral malleolus]]) and runs along the posterior aspect of the leg (with the [[sural nerve]]), passes between the heads of the [[gastrocnemius muscle]], and drains into the [[popliteal vein]], approximately at or above the level of the [[knee]] joint.
==[[Assessment of Target Vessels for Saphenous Vein Grafting]]==


==Preparation (Saphenous vein harvesting)==
==Diagnosis and Evaluation of SVG Disease==


===Mini Invasive Technique===
=====[[Symptoms of SVG Occlusion|Symptoms]]=====


===Side Effects of Saphenous Vein Stripping===
=====[[Chest X-Ray in the Patient with Saphenous Vein Grafts|Chest X-Ray]]=====


* Saphenous nerve injury
=====[[CT Angiography in the Assessment of Saphenous Vein Graft Disease|CT]]=====


==Diagnostic & Evaluation Findings==
=====[[Cardiac Catheterization]]=====


===Coronary Angiography===
=====[[Saphenous Vein Graft Pathology|Pathology]]=====


===CT Angiography===
==Saphenous Vein Graft Failure and Patency==


===MR Angiography===
=====[[Definition of Saphenous Vein Graft Failure]]=====


===Pathological Findings===
=====[[Historical Rates of Saphenous Vein Graft Failure]]=====


=====[[Determinants of Sapheous Vein Graft Patency]]=====


=====[[Saphenous vein graft failure as a Surrogate Endpoint in Clinical Trials]]=====


==Saphenous Vein Graft Diseases==
==[[Saphenous vein graft disease treatment|Treatment]]==


===Saphenous Vein Graft Aneurysms===
====[[Saphenous vein graft disease treatment#2011 ACCF/AHA/SCAI Guideline Recommendations: Saphenous vein grafts|2011 ACCF/AHA/SCAI Guideline Recommendations]]====
It is also known as SVGA, aortocoronary saphenous vein graft aneurysms, saphenous vein graft aneurysm disease and saphenous vein graft aneurysmal dilatation.


====Causes of Saphenous Vein Graft Aneurysms====
==Clinical Trials==


* [[Atherosclerosis]]
* [http://clinicaltrials.gov/ct2/show/NCT00054847 Radial Artery Versus Saphenous Vein Grafts in Coronary Artery Bypass Surgery]
* [[Hypertension]]
* [http://clinicaltrials.gov/ct2/show/NCT00453518 The RETRIEVE Study: Use of the FiberNet Embolic Protection System in Saphenous Vein Grafts]
* Mycotic 
* [http://clinicaltrials.gov/ct2/show/NCT00247208 The SOS (Stenting Of Saphenous Vein Grafts) Trial]
* Postoperative [[mediastinitis]]
* [http://clinicaltrials.gov/ct2/show/NCT00283413 Symbiot III: A Prospective Randomized Trial Evaluating the Symbiot Covered Stent System in Saphenous Vein Grafts]
* Previous aneurysms
* [http://clinicaltrials.gov/ct2/show/NCT00766129 Comparison of Safety and Efficacy of Two Different Drug Eluting Stents Implanted Into Saphenous Vein Grafts]
* Torn sutures
* [http://clinicaltrials.gov/ct2/show/NCT00481806 Evaluating the Role of Thrombin in Saphenous Vein Graft Failure After Heart Bypass Surgery]
* [http://clinicaltrials.gov/ct2/show/NCT00260494 Acupuncture and Post-Surgical Wound Healing]
* [http://clinicaltrials.gov/ct2/show/NCT00263263 RRISC Study: Reduction of Restenosis In Saphenous Vein Grafts With Cypher Sirolimus-Eluting Stent.]
* [http://clinicaltrials.gov/ct2/show/NCT00289835 Treatment of Moderate Vein Graft Lesions With Paclitaxel Drug Eluting Stents: The VELETI Trial]
* [http://clinicaltrials.gov/ct2/show/NCT00228423 Trial of Clopidogrel After Surgery for Coronary Artery Disease (CASCADE Trial)]
* [http://clinicaltrials.gov/ct2/show/NCT00187356 Multicentre Radial Artery Patency Study: 5 Year Results]
* [http://clinicaltrials.gov/ct2/show/NCT00595647 Study to Test the Efficacy and Safety of Drug Eluting vs. Bare-Metal Stents for Saphenous Vein Graft Interventions (BASKETSAVAGE)]
* [http://clinicaltrials.gov/ct2/show/NCT00169832 Vein-Coronary Atherosclerosis And Rosiglitazone After Bypass Surgery: The VICTORY Trial]
* [http://clinicaltrials.gov/ct2/show/NCT00159991 Copenhagen Arterial Revascularization Randomized Patency and Outcome Trial (CARRPO)]
* [http://clinicaltrials.gov/ct2/show/NCT00247208 The SOS (Stenting Of Saphenous Vein Grafts) Trial]
* [http://clinicaltrials.gov/ct2/show/NCT00777777 The eSVS (TM) Mesh External Saphenous Vein Support Trial]


==Treatment==
==Related Chapters==
* [[Percutaneous Coronary Intervention (PCI): Basic Principles and Guidelines]]
* [[CABG]]
* [[Hybrid bypass]]
* [[Off-pump coronary artery bypass surgery|Off-pump coronary artery bypass surgery (OPCAB)]]
* [[Minimally invasive direct coronary artery bypass surgery]] ([[MIDCAB]])


===Thrombolysis===
==Guideline Resources==
*[http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions]<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December |pmid=22070837 |doi=10.1016/j.jacc.2011.08.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0 |accessdate=2011-12-08}}</ref>


===PCI===
==Additional Resources==
{{refbegin|2}}
* S. A. Hassantash, B. Bikdeli, S. Kalantarian, M. Sadeghian, and H. Afshar Pathophysiology of Aortocoronary Saphenous Vein Bypass Graft Disease Asian Cardiovasc Thorac Ann, August 1, 2008; 16(4): 331 - 336.
* A. Coolong, D. S. Baim, R. E. Kuntz, A. J. O'Malley, S. Marulkar, D. E. Cutlip, J. J. Popma, and L. Mauri. Saphenous Vein Graft Stenting and Major Adverse Cardiac Events: A Predictive Model Derived From a Pooled Analysis of 3958 Patients. Circulation, February 12, 2008; 117(6): 790 - 797.
* R. F. Padera Jr. and F. J. Schoen. Pathology of Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 111 - 178. 
* E. Gongora and T. M. Sundt III. Myocardial Revascularization with Cardiopulmonary Bypass. Card. Surg. Adult, January 1, 2008; 3(2008): 599 - 632.
* P. Widimsky, Z. Straka, P. Stros, K. Jirasek, J. Dvorak, J. Votava, L. Lisa, T. Budesinsky, M. Kolesar, T. Vanek, et al. One-Year Coronary Bypass Graft Patency: A Randomized Comparison Between Off-Pump and On-Pump Surgery Angiographic Results of the PRAGUE-4 Trial Circulation, November 30, 2004; 110 (22): 3418 - 3423.
* M. A. Hlatky, D. B. Boothroyd, K. A. Melsop, M. M. Brooks, D. B. Mark, B. Pitt, G. S. Reeder, W. J. Rogers, T. J. Ryan, P. L. Whitlow, et al. Medical Costs and Quality of Life 10 to 12 Years After Randomization to Angioplasty or Bypass Surgery for Multivessel Coronary Artery Disease Circulation, October 5, 2004; 110 (14): 1960 - 1966.
* J. G. Lobo Filho, M. C. d. A. Leitao, and A. J. d. V. Forte Studying the lumen in composite Y internal thoracic artery-saphenous vein grafts J. Thorac. Cardiovasc. Surg., September 1, 2004; 128(3): 490 - 491.
* E. McGregor, L. Kempster, R. Wait, M. Gosling, M. J. Dunn, and J. T. Powell. F-actin Capping (CapZ) and Other Contractile Saphenous Vein Smooth Muscle Proteins Are Altered by Hemodynamic Stress: a proteomic approach Mol. Cell. Proteomics, February 1, 2004; 3(2): 115 - 124.
* M. Endo, Y. Tomizawa, and H. Nishida Bilateral Versus Unilateral Internal Mammary Revascularization in Patients with Diabetes Circulation, September 16, 2003; 108(11): 1343 - 1349.
* T. D. Rea, M. Crouthamel, M. S. Eisenberg, L. J. Becker, and A. R. Lima. Temporal Patterns in Long-Term Survival After Resuscitation From Out-of-Hospital Cardiac Arrest Circulation, September 9, 2003; 108(10): 1196 - 1201.
* M. Hilker, T. Langin, U. Hake, F.-X. Schmid, W. Kuroczynski, H.-A. Lehr, H. Oelert, and M. Buerke Gene expression profiling of human stenotic aorto-coronary bypass grafts by cDNA array analysis Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 620 - 625.
* J. L. Sperry, C. B. Deming, C. Bian, P. L. Walinsky, D. A. Kass, F. D. Kolodgie, R. Virmani, A. Y. Kim, and J. J. Rade Wall Tension Is a Potent Negative Regulator of In Vivo Thrombomodulin Expression Circ. Res., January 10, 2003; 92(1): 41 - 47.
* F. J. Schoen and R. F. Padera Jr. Cardiac Surgical Pathology Card. Surg. Adult, January 1, 2003; 2(2003): 119 - 185.
* A. Y. Kim, P. L. Walinsky, F. D. Kolodgie, C. Bian, J. L. Sperry, C. B. Deming, E. A. Peck, J. G. Shake, G. B. Ang, R. H. Sohn, et al. Early Loss of Thrombomodulin Expression Impairs Vein Graft Thromboresistance: Implications for Vein Graft Failure Circ. Res., February 8, 2002; 90(2): 205 - 212.
* K. B. Kim, C. Lim, C. Lee, I.-H. Chae, B.-H. Oh, M.-M. Lee, and Y.-B. Park Off-pump coronary artery bypass may decrease the patency of saphenous vein grafts Ann. Thorac. Surg., September 1, 2001; 72(3): S1033 - 1037.
* Z. Yang, T. Kozai, B. van de Loo, H. Viswambharan, M. Lachat, M. I. Turina, T. Malinski, and T. F. Luscher. HMG-CoA reductase inhibition improves endothelial cell function and inhibits smooth muscle cell proliferation in human saphenous veins J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1691 - 1697.
* H. Hirose, A. Amano, S. Yoshida, A. Takahashi, N. Nagano, and T. Kohmoto Coronary Artery Bypass Grafting in the Elderly Chest, May 1, 2000; 117(5): 1262 - 1270.


=====Bare Metal Stents=====
* D. R. Holmes Jr and P. B. Berger. Percutaneous Revascularization of Occluded Vein Grafts : Is It Still a Temptation to Be Resisted? Circulation, January 12, 1999; 99(1): 8 - 11.
 
=====Drug Eluting Stents=====
* Y. K. Wong, M. Thomas, V. Tsang, P. J. Gallagher, and M. E. Ward. The prevalence of Chlamydia pneumoniae in atherosclerotic and nonatherosclerotic blood vessels of patients attending for redo and first time coronary artery bypass graft surgery. J. Am. Coll. Cardiol., January 1, 1999; 33(1): 152 - 156.
 
===Surgery (Re-do) ===
* F. D. Loop Coronary artery surgery: the end of the beginning Eur. J. Cardiothorac. Surg., December 1, 1998; 14(6): 554 - 571.
 
==Videos==
* Z. G. Zhu, H.-H. Li, and B.-R. Zhang. Expression of Endothelin-1 and Constitutional Nitric Oxide Synthase Messenger RNA in Saphenous Vein Endothelial Cells Exposed to Arterial Flow Shear Stress Ann. Thorac. Surg., November 1, 1997; 64(5): 1333 - 1338.
<youtube v=VbdE6JWdY1s/>
<br clear="left"/>
* A. Y. Kim, P. L. Walinsky, F. D. Kolodgie, C. Bian, J. L. Sperry, C. B. Deming, E. A. Peck, J. G. Shake, G. B. Ang, R. H. Sohn, et al. Early Loss of Thrombomodulin Expression Impairs Vein Graft Thromboresistance: Implications for Vein Graft Failure. Circ. Res., February 8, 2002; 90(2): 205 - 212.
<youtube v=QthyR0bTHzc/>
{{refend}}
<br clear="left"/>
<youtube v=sV-qE2SIkJU/>
<br clear="left"/>


==References==
==References==
{{Reflist}}
{{Reflist|2}}
 
==See Also==
 
==External Links==
 
 
 
{{SIB}}
 


[[Category:Cardiology]]
[[Category:Cardiology]]

Latest revision as of 19:38, 25 October 2012

Saphenous vein graft
Saphenous vein grafts for coronary arteries

Saphenous vein graft Microchapters

Home

Patient Information

Overview

Anatomy

Harvesting

Nomenclature

Pathophysiology

Assessment of Target Vessels for Saphenous Vein Grafting

Diagnosis and Evaluation of SVG Disease

Symptoms

Chest X-Ray

CT

Cardiac Catheterization

Pathology

Saphenous Vein Graft Failure and Patency

Definition of Saphenous Vein Graft Failure

Historical Rates of Saphenous Vein Graft Failure

Determinants of Sapheous Vein Graft Patency

Saphenous vein graft failure as a Surrogate Endpoint in Clinical Trials

Treatment

Treatment

Saphenous vein graft On the Web

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Risk calculators and risk factors for Saphenous vein graft

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Jason C. Choi, M.D.; Xin Yang, M.D.

Overview

Anatomy

Harvesting

Nomenclature

Pathophysiology

Assessment of Target Vessels for Saphenous Vein Grafting

Diagnosis and Evaluation of SVG Disease

Symptoms
Chest X-Ray
CT
Cardiac Catheterization
Pathology

Saphenous Vein Graft Failure and Patency

Definition of Saphenous Vein Graft Failure
Historical Rates of Saphenous Vein Graft Failure
Determinants of Sapheous Vein Graft Patency
Saphenous vein graft failure as a Surrogate Endpoint in Clinical Trials

Treatment

2011 ACCF/AHA/SCAI Guideline Recommendations

Clinical Trials

Related Chapters

Guideline Resources

Additional Resources

  • S. A. Hassantash, B. Bikdeli, S. Kalantarian, M. Sadeghian, and H. Afshar Pathophysiology of Aortocoronary Saphenous Vein Bypass Graft Disease Asian Cardiovasc Thorac Ann, August 1, 2008; 16(4): 331 - 336.
  • A. Coolong, D. S. Baim, R. E. Kuntz, A. J. O'Malley, S. Marulkar, D. E. Cutlip, J. J. Popma, and L. Mauri. Saphenous Vein Graft Stenting and Major Adverse Cardiac Events: A Predictive Model Derived From a Pooled Analysis of 3958 Patients. Circulation, February 12, 2008; 117(6): 790 - 797.
  • R. F. Padera Jr. and F. J. Schoen. Pathology of Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 111 - 178.
  • E. Gongora and T. M. Sundt III. Myocardial Revascularization with Cardiopulmonary Bypass. Card. Surg. Adult, January 1, 2008; 3(2008): 599 - 632.
  • P. Widimsky, Z. Straka, P. Stros, K. Jirasek, J. Dvorak, J. Votava, L. Lisa, T. Budesinsky, M. Kolesar, T. Vanek, et al. One-Year Coronary Bypass Graft Patency: A Randomized Comparison Between Off-Pump and On-Pump Surgery Angiographic Results of the PRAGUE-4 Trial Circulation, November 30, 2004; 110 (22): 3418 - 3423.
  • M. A. Hlatky, D. B. Boothroyd, K. A. Melsop, M. M. Brooks, D. B. Mark, B. Pitt, G. S. Reeder, W. J. Rogers, T. J. Ryan, P. L. Whitlow, et al. Medical Costs and Quality of Life 10 to 12 Years After Randomization to Angioplasty or Bypass Surgery for Multivessel Coronary Artery Disease Circulation, October 5, 2004; 110 (14): 1960 - 1966.
  • J. G. Lobo Filho, M. C. d. A. Leitao, and A. J. d. V. Forte Studying the lumen in composite Y internal thoracic artery-saphenous vein grafts J. Thorac. Cardiovasc. Surg., September 1, 2004; 128(3): 490 - 491.
  • E. McGregor, L. Kempster, R. Wait, M. Gosling, M. J. Dunn, and J. T. Powell. F-actin Capping (CapZ) and Other Contractile Saphenous Vein Smooth Muscle Proteins Are Altered by Hemodynamic Stress: a proteomic approach Mol. Cell. Proteomics, February 1, 2004; 3(2): 115 - 124.
  • M. Endo, Y. Tomizawa, and H. Nishida Bilateral Versus Unilateral Internal Mammary Revascularization in Patients with Diabetes Circulation, September 16, 2003; 108(11): 1343 - 1349.
  • T. D. Rea, M. Crouthamel, M. S. Eisenberg, L. J. Becker, and A. R. Lima. Temporal Patterns in Long-Term Survival After Resuscitation From Out-of-Hospital Cardiac Arrest Circulation, September 9, 2003; 108(10): 1196 - 1201.
  • M. Hilker, T. Langin, U. Hake, F.-X. Schmid, W. Kuroczynski, H.-A. Lehr, H. Oelert, and M. Buerke Gene expression profiling of human stenotic aorto-coronary bypass grafts by cDNA array analysis Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 620 - 625.
  • J. L. Sperry, C. B. Deming, C. Bian, P. L. Walinsky, D. A. Kass, F. D. Kolodgie, R. Virmani, A. Y. Kim, and J. J. Rade Wall Tension Is a Potent Negative Regulator of In Vivo Thrombomodulin Expression Circ. Res., January 10, 2003; 92(1): 41 - 47.
  • F. J. Schoen and R. F. Padera Jr. Cardiac Surgical Pathology Card. Surg. Adult, January 1, 2003; 2(2003): 119 - 185.
  • A. Y. Kim, P. L. Walinsky, F. D. Kolodgie, C. Bian, J. L. Sperry, C. B. Deming, E. A. Peck, J. G. Shake, G. B. Ang, R. H. Sohn, et al. Early Loss of Thrombomodulin Expression Impairs Vein Graft Thromboresistance: Implications for Vein Graft Failure Circ. Res., February 8, 2002; 90(2): 205 - 212.
  • K. B. Kim, C. Lim, C. Lee, I.-H. Chae, B.-H. Oh, M.-M. Lee, and Y.-B. Park Off-pump coronary artery bypass may decrease the patency of saphenous vein grafts Ann. Thorac. Surg., September 1, 2001; 72(3): S1033 - 1037.
  • Z. Yang, T. Kozai, B. van de Loo, H. Viswambharan, M. Lachat, M. I. Turina, T. Malinski, and T. F. Luscher. HMG-CoA reductase inhibition improves endothelial cell function and inhibits smooth muscle cell proliferation in human saphenous veins J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1691 - 1697.
  • H. Hirose, A. Amano, S. Yoshida, A. Takahashi, N. Nagano, and T. Kohmoto Coronary Artery Bypass Grafting in the Elderly Chest, May 1, 2000; 117(5): 1262 - 1270.
  • D. R. Holmes Jr and P. B. Berger. Percutaneous Revascularization of Occluded Vein Grafts : Is It Still a Temptation to Be Resisted? Circulation, January 12, 1999; 99(1): 8 - 11.
  • Y. K. Wong, M. Thomas, V. Tsang, P. J. Gallagher, and M. E. Ward. The prevalence of Chlamydia pneumoniae in atherosclerotic and nonatherosclerotic blood vessels of patients attending for redo and first time coronary artery bypass graft surgery. J. Am. Coll. Cardiol., January 1, 1999; 33(1): 152 - 156.
  • F. D. Loop Coronary artery surgery: the end of the beginning Eur. J. Cardiothorac. Surg., December 1, 1998; 14(6): 554 - 571.
  • Z. G. Zhu, H.-H. Li, and B.-R. Zhang. Expression of Endothelin-1 and Constitutional Nitric Oxide Synthase Messenger RNA in Saphenous Vein Endothelial Cells Exposed to Arterial Flow Shear Stress Ann. Thorac. Surg., November 1, 1997; 64(5): 1333 - 1338.
  • A. Y. Kim, P. L. Walinsky, F. D. Kolodgie, C. Bian, J. L. Sperry, C. B. Deming, E. A. Peck, J. G. Shake, G. B. Ang, R. H. Sohn, et al. Early Loss of Thrombomodulin Expression Impairs Vein Graft Thromboresistance: Implications for Vein Graft Failure. Circ. Res., February 8, 2002; 90(2): 205 - 212.

References

  1. ↑ Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions". Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)

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