Analysis of Balloon Dilatation of Human Vein Graft Stenoses

Michael L. Marin, Frank J. Veith, Ronald E. Gordon, Thomas F. Panetta, Clifford Sales, Ross T. Lyon, Steven P. Rivers, Kurt R. Wengerter, William D. Suggs, Luis A. Sanchez, Curtis W. Bakal, Jacob Cynamon

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Controversy continues as to whether percutaneous transluminal angioplasty (PTA) or surgical revision is the ideal modality for the treatment of failing grafts. This prompted a histopathologic analysis of failing human vein graft segments subjected to ex vivo balloon dilatation to define variables responsible for the discrepant results. Fifteen vein graft lesions from 14 patients with failing infrainguinal bypasses were recovered after surgical excision. Each graft lesion was focal and uniform in length (2.1 ± 0.3 cm). Rings sectioned from adjacent regions of each vein graft lesion before and after balloon inflation were processed for histologic study, photomicrography, and image analysis. Angioplasty balloon size was selected on the basis of preoperative arteriograms. Graft lesions were divided into three groups based on lesion thickness and the degree of fibrosis and cellularity seen on sections stained with Masson's trichrome. The luminal area before angioplasty was not significantly different for the three groups (p >0.2). Vein grafts with thick intimas (group 1) had significantly less luminal dilatation after angioplasty as compared with less thick intimal lesions (groups 2 and 3; p< 0.001). Those lesions with varying degrees of cellularity (groups 2 and 3) showed no significant differences in luminal diameter after angioplasty. However, the cellular lesions in group 2 consistently formed multiple intimal flaps that could produce PTA failures even with good luminal restoration. The varying histology of vein graft lesions and associated differences in intimal thickness and cellularity may be responsible for the inconsistent results following PTA. Estimates of wall thickness before angioplasty, particularly in the intimal area, may be helpful in evaluating which lesions might benefit most from PTA.

Original languageEnglish (US)
Pages (from-to)2-7
Number of pages6
JournalAnnals of Vascular Surgery
Volume7
Issue number1
DOIs
StatePublished - Jan 1 1993
Externally publishedYes

Fingerprint

Angioplasty
Dilatation
Veins
Pathologic Constriction
Tunica Intima
Transplants
Photomicrography
Balloon Angioplasty
Economic Inflation
Reoperation
Histology
Fibrosis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Marin, M. L., Veith, F. J., Gordon, R. E., Panetta, T. F., Sales, C., Lyon, R. T., ... Cynamon, J. (1993). Analysis of Balloon Dilatation of Human Vein Graft Stenoses. Annals of Vascular Surgery, 7(1), 2-7. https://doi.org/10.1007/BF02042652
Marin, Michael L. ; Veith, Frank J. ; Gordon, Ronald E. ; Panetta, Thomas F. ; Sales, Clifford ; Lyon, Ross T. ; Rivers, Steven P. ; Wengerter, Kurt R. ; Suggs, William D. ; Sanchez, Luis A. ; Bakal, Curtis W. ; Cynamon, Jacob. / Analysis of Balloon Dilatation of Human Vein Graft Stenoses. In: Annals of Vascular Surgery. 1993 ; Vol. 7, No. 1. pp. 2-7.
@article{a6492698d63e4110a92f114b2f34c9ad,
title = "Analysis of Balloon Dilatation of Human Vein Graft Stenoses",
abstract = "Controversy continues as to whether percutaneous transluminal angioplasty (PTA) or surgical revision is the ideal modality for the treatment of failing grafts. This prompted a histopathologic analysis of failing human vein graft segments subjected to ex vivo balloon dilatation to define variables responsible for the discrepant results. Fifteen vein graft lesions from 14 patients with failing infrainguinal bypasses were recovered after surgical excision. Each graft lesion was focal and uniform in length (2.1 ± 0.3 cm). Rings sectioned from adjacent regions of each vein graft lesion before and after balloon inflation were processed for histologic study, photomicrography, and image analysis. Angioplasty balloon size was selected on the basis of preoperative arteriograms. Graft lesions were divided into three groups based on lesion thickness and the degree of fibrosis and cellularity seen on sections stained with Masson's trichrome. The luminal area before angioplasty was not significantly different for the three groups (p >0.2). Vein grafts with thick intimas (group 1) had significantly less luminal dilatation after angioplasty as compared with less thick intimal lesions (groups 2 and 3; p< 0.001). Those lesions with varying degrees of cellularity (groups 2 and 3) showed no significant differences in luminal diameter after angioplasty. However, the cellular lesions in group 2 consistently formed multiple intimal flaps that could produce PTA failures even with good luminal restoration. The varying histology of vein graft lesions and associated differences in intimal thickness and cellularity may be responsible for the inconsistent results following PTA. Estimates of wall thickness before angioplasty, particularly in the intimal area, may be helpful in evaluating which lesions might benefit most from PTA.",
author = "Marin, {Michael L.} and Veith, {Frank J.} and Gordon, {Ronald E.} and Panetta, {Thomas F.} and Clifford Sales and Lyon, {Ross T.} and Rivers, {Steven P.} and Wengerter, {Kurt R.} and Suggs, {William D.} and Sanchez, {Luis A.} and Bakal, {Curtis W.} and Jacob Cynamon",
year = "1993",
month = "1",
day = "1",
doi = "10.1007/BF02042652",
language = "English (US)",
volume = "7",
pages = "2--7",
journal = "Annals of Vascular Surgery",
issn = "0890-5096",
publisher = "Elsevier Inc.",
number = "1",

}

Marin, ML, Veith, FJ, Gordon, RE, Panetta, TF, Sales, C, Lyon, RT, Rivers, SP, Wengerter, KR, Suggs, WD, Sanchez, LA, Bakal, CW & Cynamon, J 1993, 'Analysis of Balloon Dilatation of Human Vein Graft Stenoses', Annals of Vascular Surgery, vol. 7, no. 1, pp. 2-7. https://doi.org/10.1007/BF02042652

Analysis of Balloon Dilatation of Human Vein Graft Stenoses. / Marin, Michael L.; Veith, Frank J.; Gordon, Ronald E.; Panetta, Thomas F.; Sales, Clifford; Lyon, Ross T.; Rivers, Steven P.; Wengerter, Kurt R.; Suggs, William D.; Sanchez, Luis A.; Bakal, Curtis W.; Cynamon, Jacob.

In: Annals of Vascular Surgery, Vol. 7, No. 1, 01.01.1993, p. 2-7.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Analysis of Balloon Dilatation of Human Vein Graft Stenoses

AU - Marin, Michael L.

AU - Veith, Frank J.

AU - Gordon, Ronald E.

AU - Panetta, Thomas F.

AU - Sales, Clifford

AU - Lyon, Ross T.

AU - Rivers, Steven P.

AU - Wengerter, Kurt R.

AU - Suggs, William D.

AU - Sanchez, Luis A.

AU - Bakal, Curtis W.

AU - Cynamon, Jacob

PY - 1993/1/1

Y1 - 1993/1/1

N2 - Controversy continues as to whether percutaneous transluminal angioplasty (PTA) or surgical revision is the ideal modality for the treatment of failing grafts. This prompted a histopathologic analysis of failing human vein graft segments subjected to ex vivo balloon dilatation to define variables responsible for the discrepant results. Fifteen vein graft lesions from 14 patients with failing infrainguinal bypasses were recovered after surgical excision. Each graft lesion was focal and uniform in length (2.1 ± 0.3 cm). Rings sectioned from adjacent regions of each vein graft lesion before and after balloon inflation were processed for histologic study, photomicrography, and image analysis. Angioplasty balloon size was selected on the basis of preoperative arteriograms. Graft lesions were divided into three groups based on lesion thickness and the degree of fibrosis and cellularity seen on sections stained with Masson's trichrome. The luminal area before angioplasty was not significantly different for the three groups (p >0.2). Vein grafts with thick intimas (group 1) had significantly less luminal dilatation after angioplasty as compared with less thick intimal lesions (groups 2 and 3; p< 0.001). Those lesions with varying degrees of cellularity (groups 2 and 3) showed no significant differences in luminal diameter after angioplasty. However, the cellular lesions in group 2 consistently formed multiple intimal flaps that could produce PTA failures even with good luminal restoration. The varying histology of vein graft lesions and associated differences in intimal thickness and cellularity may be responsible for the inconsistent results following PTA. Estimates of wall thickness before angioplasty, particularly in the intimal area, may be helpful in evaluating which lesions might benefit most from PTA.

AB - Controversy continues as to whether percutaneous transluminal angioplasty (PTA) or surgical revision is the ideal modality for the treatment of failing grafts. This prompted a histopathologic analysis of failing human vein graft segments subjected to ex vivo balloon dilatation to define variables responsible for the discrepant results. Fifteen vein graft lesions from 14 patients with failing infrainguinal bypasses were recovered after surgical excision. Each graft lesion was focal and uniform in length (2.1 ± 0.3 cm). Rings sectioned from adjacent regions of each vein graft lesion before and after balloon inflation were processed for histologic study, photomicrography, and image analysis. Angioplasty balloon size was selected on the basis of preoperative arteriograms. Graft lesions were divided into three groups based on lesion thickness and the degree of fibrosis and cellularity seen on sections stained with Masson's trichrome. The luminal area before angioplasty was not significantly different for the three groups (p >0.2). Vein grafts with thick intimas (group 1) had significantly less luminal dilatation after angioplasty as compared with less thick intimal lesions (groups 2 and 3; p< 0.001). Those lesions with varying degrees of cellularity (groups 2 and 3) showed no significant differences in luminal diameter after angioplasty. However, the cellular lesions in group 2 consistently formed multiple intimal flaps that could produce PTA failures even with good luminal restoration. The varying histology of vein graft lesions and associated differences in intimal thickness and cellularity may be responsible for the inconsistent results following PTA. Estimates of wall thickness before angioplasty, particularly in the intimal area, may be helpful in evaluating which lesions might benefit most from PTA.

UR - http://www.scopus.com/inward/record.url?scp=0027295033&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027295033&partnerID=8YFLogxK

U2 - 10.1007/BF02042652

DO - 10.1007/BF02042652

M3 - Article

C2 - 8518114

AN - SCOPUS:0027295033

VL - 7

SP - 2

EP - 7

JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

SN - 0890-5096

IS - 1

ER -