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{{Infobox_Disease |
{{Infobox_Disease |
   Name          = {{PAGENAME}} |
   Name          = {{PAGENAME}} |
   Image          = |
   Image          = Heart saphenous coronary grafts.jpg||
   Caption        = |
   Caption        = Saphenous vein grafts for coronary arteries|
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   ICD10          = |
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   MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
   MeshID        = |
   MeshID        = |
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{{SI}}
{{Saphenous vein graft}}
{{CMG}}
{{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]]=====


==Saphenous Vein Graft Diseases==
=====[[Cardiac Catheterization]]=====


===Venospastic Phenomena of Saphenous Vein Bypass Grafts===
=====[[Saphenous Vein Graft Pathology|Pathology]]=====


===Saphenous Vein Graft Aneurysms===
==Saphenous Vein Graft Failure and Patency==


It is also known as SVGA, aortocoronary saphenous vein graft aneurysms, saphenous vein graft aneurysm disease and saphenous vein graft aneurysmal dilatation.
=====[[Definition of Saphenous Vein Graft Failure]]=====


=====Causes of Saphenous Vein Graft Aneurysms=====
=====[[Historical Rates of Saphenous Vein Graft Failure]]=====


* [[Atherosclerosis]]
=====[[Determinants of Sapheous Vein Graft Patency]]=====
* [[Hypertension]]
* Mycotic 
* Postoperative [[mediastinitis]]
* Previous aneurysms
* Torn sutures


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


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


===Amyloidosis of Saphenous Coronary Bypass Grafts <small> <ref>Marti MC, Bouchardy B, Cox JN. Aortocoronary bypass with autogenous saphenous vein grafts: histopathological aspects. Virchows Arch Abt A Path Anat 1971; 352: 255–66.</ref> <ref>Garrett HE, Dennis EW, DeBakey ME. Aortocoronary bypass with saphenous vein graft. JAMA 1973; 223: 792–4.</ref> <ref>Zemva A, Ferluga D, Zorc M, Popovic M, Porenta OV, Radovanovic N. Amyloidosis in saphenous vein aortocoronary bypass grafts. J Cardiovasc Surg 1990; 31: 441–4.</ref> <ref>Salerno TA, Wasan SM, Charrette EJ. Prospective analysis of heart biopsies in coronary artery surgery. Ann Thorac Surg 1979; 28: 436–9.</ref> <ref>Pelosi F, Capehart J, Roberts WC. Effectiveness of cardiac transplantation for primary (AL) cardiac amyloidosis. Am J Cardiol 1997; 79: 532–5.</ref> </small>===
====[[Saphenous vein graft disease treatment#2011 ACCF/AHA/SCAI Guideline Recommendations: Saphenous vein grafts|2011 ACCF/AHA/SCAI Guideline Recommendations]]====
 
===Rupture of the Saphenous Vein Coronary Artery Bypass Grafts===
 
* Aspergillus species necrotizing [[vasculitis]]
 
==Diagnostic & Evaluation Findings==
 
===Chest X-Ray===
 
[http://www.radswiki.net Images courtesy of RadsWiki]
 
<gallery>
Image:CABG-clips-001.jpg|Median sternotomy wires and CABG clips
Image:CABG-clips-002.jpg|Lateral graphy: Median sternotomy wires and CABG clips
</gallery>
 
===Coronary Angiography===
 
===CT Angiography===
 
===MR Angiography===
 
===Postmortem Angiography===
 
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
 
<gallery>
Image:Postmortem angiography saphenous vein graft 001.jpg
Image:Postmortem angiography saphenous vein graft 002.jpg
</gallery>
 
===Pathological Findings===
 
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
 
<gallery perRow="3">
Image:Saphenous vein graft 001.jpg|Saphenous vein coronary bypass graft: Gross, natural color, external view of heart with thrombosed veins
Image:Saphenous vein graft 002.jpg|Saphenous vein coronary bypass graft: Thrombosis, Acute: Gross, fixed tissue but well shown cross sections of bypass graft and anastomotic site with thrombosis. 61 yo male, with and acute infarct treated with streptokinase and two days later had bypass. Died 5 days post op. Two veins are thrombosed
Image:Saphenous vein graft 003.jpg|Myocardial Infarct Acute Reflow Type: Gross, fixed tissue but good color. A very enlarged heart with moderate LV dilation and high anterior wall hemorrhagic infarct. Initially treated with streptokinase and two days later had saphenous vein grafts. Both grafts are thrombosed. He died after 5 days
Image:Saphenous vein graft 004.jpg|
Image:Saphenous vein graft 005.jpg|
Image:Saphenous vein graft 006.jpg|
Image:Saphenous vein graft 007.jpg|
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Image:Saphenous vein graft 030.jpg|
Image:Saphenous vein graft 031.jpg|
Image:Saphenous vein graft 032.jpg|
</gallery>
 
==Treatment==
 
===Thrombolysis===
 
===PCI===
 
=====Plain Old Balloon Angioplasty (POBA)=====
 
=====Bare Metal Stents=====
 
=====Drug Eluting Stents=====
 
=====Excimer Laser Coronary Angioplasty (ELCA) of Saphenous Vein Grafts=====
 
At the end of 80's <ref>Litvack F, Grundfest WS, Goldenberg T, et al. Percutaneous excimer laser angioplasty of aortocoronary saphenous vein grafts. J Am CoIlCardiol 1989; 14:803-8.</ref>, ELCA was introduced and thought to be particularly suitable for saphenous vein grafts that were otherwise difficult to treat with balloon angioplasty alone.<ref>Bittl JA, Sanborn TA, Tcheng JE, et al. Clinical success, complications and restenosis rates with excimer laser coronary angioplasty. Am J Cardiol 1992; 70: 1533-9. </ref>
 
===Surgery (Re-do) ===
 
==Videos==
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<br clear="left"/>
<youtube v=QthyR0bTHzc/>
<br clear="left"/>
<youtube v=sV-qE2SIkJU/>
<br clear="left"/>


==Clinical Trials==
==Clinical Trials==
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* [http://clinicaltrials.gov/ct2/show/NCT00777777 The eSVS (TM) Mesh External Saphenous Vein Support Trial]
* [http://clinicaltrials.gov/ct2/show/NCT00777777 The eSVS (TM) Mesh External Saphenous Vein Support Trial]


==References==
==Related Chapters==
{{Reflist|2}}
* [[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]])
 
==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>


==Additional Resources==
==Additional Resources==
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{{refend}}
{{refend}}


==See Also==
==References==
 
{{Reflist|2}}
==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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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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