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At least 19 recordsLinked to original sources
PubMed1994

Comparative studies on vascular endothelium in vitro. I. Cytokine effects on the expression of adhesion molecules by human umbilical vein, saphenous vein and femoral artery endothelial cells.

Endothelial cells (ECs) are very responsive to proinflammatory cytokines. ECs are stimulated by these substances to increase expression of cell surface adhesion molecules, leading to dramatically altered interactions with leukocytes. In these interactions, E-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) are suggested to play the most important role. Recent evidence has suggested diversity in the responses of ECs from different regions of the vascular system. Human umbilical vein ECs (HUVECs) are the most often used EC culture model, although there are few studies comparing their response with other human EC types from the adult organism. In this study the expression of E-selectin, ICAM-1 and VCAM-1 on cultured human adult ECs from the saphenous vein (HSVECs) and from the femoral artery (HAFECs), as well as HUVECs was studied. Using a cell enzyme immunoassay as well as immunoelectron microscopical methods, we found that both HSVECs and HAFECs respond in a similar way to HUVECs to exogenous stimulation by IL-1 beta, TNF alpha or LPS. IL-1 beta and TNF alpha increased the expression of E-selectin on the cytoplasmic membranes of HUVECs, HSVECs and HAFECs and elicited even similar absolute quantities of this molecule, comparing the different cell types. ICAM-1 and VCAM-1 appeared to be regulated dose dependently by IL-1 beta, independent of the EC type. HUVECs as well as HSVECs and HAFECs gave a reproducible constitutive ICAM-1 expression, whereas E-selectin and VCAM-1 were absent on nonstimulated ECs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Infrainguinal reconstruction with arm vein, lesser saphenous vein, and remnants of greater saphenous vein: a report of 257 cases.

PURPOSE: The purpose of this study was to evaluate the results of infrainguinal reconstructions with arm vein, lesser saphenous vein, and remnants of greater saphenous vein (ectopic vein grafts). METHODS: The records of 222 patients who underwent 257 bypasses were restrospectively reviewed. Most of the grafts were placed for rest pain or tissue loss (88%) and were secondary reconstructions (70%) to the infrapopliteal level (90%). Single-length vein grafts were constructed in 66% of cases, whereas 34% were composite vein grafts. RESULTS: Secondary graft patency was 70%, 52%, and 43% at 1, 3, and 5 years. Single-length grafts had significantly better patency rates at all intervals: 78% versus 56% at 1 year (p = 0.001), 60% versus 39% at 3 years (p = 0.004), and 52% versus 29% at 5 years (p = 0.002). The limb salvage rate was 69% at 5 years. CONCLUSIONS: Ectopic vein grafts with primarily arm vein are an acceptable alternative for infrainguinal reconstruction in the absence of suitable ipsilateral greater saphenous vein.

Adult↗
PubMed1995

[Saphenous vein to saphenous vein bypass grafting in four redo CABG patients].

In four redo CABG patients, new saphenous vein grafts were anastomosed to the angiographically normal part of the old, and partially narrowed or occluded saphenous vein grafts in an end-to-side fashion. Inner surface of the old saphenous vein was confirmed to be smooth and free of atherosclerotic change during anastomosis. Postoperative course was uneventful and angiography demonstrated the good patency of new saphenous vein grafts in all patients. Although this technique is not acceptable if the old saphenous vein graft shows extensive atherosclerotic change, this method may be a useful alternative in case of limited saphenous vein graft disease in terms of less difficulty and operation time.

Aged↗
PubMed1992

Effects of storage solutions on contraction and relaxation of isolated saphenous veins.

Saphenous veins are placed frequently in storage solutions before use as coronary bypass grafts. Controversy remains regarding which solution is optimal for the preservation of endothelium and vascular smooth muscle viability. Thus, this study measured the effect of four different storage solutions on saphenous vein smooth muscle and endothelial cell function. Saphenous vein segments from five baboons were stored for 3 h in one of four storage solutions consisting of physiological salt solution (PSS), University of Wisconsin solution (UWS), normal saline solution (NSS), or autologous whole blood (WB). Following storage, veins were suspended for isometric tension recording in tissue baths filled with PSS. Veins stored in PSS, UWS, and NSS showed similar contractile amplitude and agonist sensitivity to norepinephrine (10(-8) -10(-4) M) and KCl (20-100 mM). However, veins stored in WB contracted 31% less to KCl on average than those stored in the other three solutions (p < 0.05). The direct vascular muscle vasodilator, papaverine (10(-7) -10(-4) M), and the endothelium-dependent dilator, A23187 (10(-5) M), relaxed all vein preparations equally well. These results suggest that after storage in PSS, UWS, and NSS, contractile and relaxant vascular responses are similar in isolated saphenous veins. However, although veins stored in WB show comparable relaxation responses, they demonstrate an impaired vascular contraction immediately after storage. We conclude that storage of veins in blood may immediately modify vascular smooth muscle function.

Animals↗
PubMed1990

Material and structural characterization of human saphenous vein.

Saphenous vein patch rupture after carotid endarterectomy is an infrequent but devastating complication. This study was undertaken to evaluate the material and structural properties of fresh human saphenous veins to understand the causes of this complication. Segments of saphenous veins were obtained from 22 patients from vein harvested during coronary artery bypass surgery. Ninety-three specimens, oriented in both circumferential (n = 45) and longitudinal (n = 48) directions, were prepared from the available vein segments for testing. Specimens were mounted on specially designed grips and then subjected to uniaxial tension testing. For each specimen the following material and structural parameters were determined: vessel diameter, tensile stiffness, failure and ultimate forces, and tensile modulus, failure stress, and strain. The physical properties of specimens evaluated in longitudinal orientations and thus limit the inherent strength of the vein. The physical properties of circumferentially tested vein specimens were negatively correlated to age, female gender, diabetes, and hypertension. The data obtained in this investigation suggest that age, hypertension, as well as diabetes and gender may adversely influence the circumferential tensile strength of human saphenous veins used as patch grafts.

Aged↗
PubMed1992

[Island flap with anastomosis of small saphenous vein to great saphenous vein].

We have devised a small saphenous island flap and successfully used in 6 patients for repairing soft tissue defect of the hell and the sole. After its transference, the small saphenous vein was anastomosed to the large saphenous vein over the ankle in order to obtain the blood supply from the small saphenous vein and blood return through the large saphenous vein. The advantage of this flap is that the vessels are superficial with large caliber so that it is easy to do anastomosis without any influence to the donor area. We believe that this flap can be used to repair soft tissue defect of the leg and foot. In this article, the operative method and advantages and shortcoming are introduced.

Adult↗
PubMed1983

The effects of morphine, nalbuphine, and butorphanol on adrenergic function in canine saphenous veins.

Saphenous vein rings mounted in organ chambers containing Krebs-Ringer solution were used to determine if the venodilator effects of morphine, nalbuphine, and butorphanol are the result of interference with adrenergic neurotransmission or are caused by direct depressant actions on venous smooth muscle cells. Morphine (5 X 10(-5) M and 2 X 10(-4) M) caused a dose-dependent depression of the contractile response to transmural electrical stimulation. H1- and H2- histamine antagonists did not attenuate the inhibitory effect of morphine. Concentrations of morphine and nalbuphine lower than 5 X 10(-5) M had no effect, whereas 5 X 10(-6) M butorphanol significantly depressed the evoked tension response to electrical stimulation. The contractile responses of the veins to exogenous norepinephrine (NE) were not altered by morphine, indicating a presynaptic site of action rather than a direct action on the venous smooth muscle. Transmural electrical stimulation was used to evoke release of endogenous NE. Morphine (5 X 10(-5) M and 2 X 10(-4) M), nalbuphine (2 X 10(-4) M), and butorphanol (4 X 10(-6) M) significantly decreased release of NE. Naloxone did not alter NE release and did not attenuate the inhibition of NE release observed with the opiates, indicating that the effect of morphine on this neuroeffector junction is not mediated by a naloxone-sensitive opiate receptor. Blockade of presynaptic alpha receptors by phenoxybenzamine or phentolamine augments NE release caused by transmural electrical stimulation; morphine inhibited this augmentation. The results of these experiments indicate that high concentrations of morphine may decrease NE release, an effect that may contribute to the venodilation and hypotension observed following administration of high doses of morphine in humans. In the usual analgesic doses, the venodilatory effects of morphine cannot be explained by local action on either NE release or venous smooth muscle contractility.

Adrenergic alpha-Antagonists↗
PubMed2000

A comparative evaluation of polytetrafluoroethylene, umbilical vein, and saphenous vein bypass grafts for femoral-popliteal above-knee revascularization: a prospective randomized Department of Veterans Affairs cooperative study.

PURPOSE: Currently, the choice of a vascular prosthesis for a femoral-popliteal above-knee arterial bypass graft is left to the surgeon's preference, because the available information on comparative evaluations is inconclusive. The Department of Veterans Affairs (VA) Cooperative Study 141 was established to identify whether improved patency exists with different bypass graft materials for patients with femoral-popliteal above-knee bypass grafts. METHODS: Between June 1983 and June 1988, 752 patients at 20 VA medical centers were randomized to receive either an externally supported polytetrafluoroethylene (PTFE; N = 265), human umbilical vein (HUV; N = 261), or saphenous vein (SV; N = 226) for an above-knee femoral-popliteal bypass graft. The indication for the bypass grafting operation was limb salvage in 67.5% of the patients. Patients were observed every 3 months for the first year and every 6 months thereafter. All patients were instructed to take aspirin (650 mg) daily for the duration of the study.Doppler-derived ankle-brachial indices (ABIs) were determined preoperatively and serially postoperatively. A bypass graft was considered to be patent when the Doppler-derived postoperative ABI remained significantly improved (more than 0.15 units higher than their preoperative value) and additional objective information, such as angiograms or operations, did not contradict these observations. Patency failure also included bypass grafts that were removed because of an infection or aneurysmal degeneration. Patency rates were compared by using the Kaplan-Meier life table analysis. RESULTS: The cumulative assisted primary patency rates were statistically similar among the different conduit types at 2 years (SV, 81%; HUV, 70%; PTFE, 69%). After 5 years, above-knee SV bypass grafts had a significantly (P </=.01) better patency rate (73%) than HUV bypass grafts (53%), which had a significantly (P </=.01) better patency rate than PTFE bypass grafts (39%). Limb salvage was slightly worse with PTFE conduits. The number of bypass graft thromboses and major amputations within the first 30 days was highest in the HUV group. CONCLUSION: The overall results of this prospective randomized study suggest that the SV should be considered as the bypass graft of choice for femoral-popliteal above-knee reconstruction and that, when a prosthetic bypass graft is used, an HUV should also be considered as an alternative choice to PTFE.

Anastomosis, Surgical↗
PubMed2003

Comparison of superficial femoral vein and saphenous vein as conduits for mesenteric arterial bypass.

PURPOSE: Gangrenous bowel, intraabdominal sepsis, and previous failed mesenteric bypass are indications for use of an autogenous conduit for mesenteric arterial reconstruction. Saphenous vein (SV) is often used as the autogenous conduit of choice, but it may be prone to graft stenosis or occlusion. Recent experience with superficial femoral vein (SFV) suggests that it is an excellent alternative conduit for major arterial reconstruction. The purpose of this study was to compare the outcomes of SV and SFV for mesenteric arterial bypass. METHODS: During a 7-year period, 26 patients underwent 43 mesenteric arterial bypass procedures with autogenous conduit. SV was used for 23 bypasses (53%), and SFV was used for 20 bypasses (47%). Indications for revascularization included chronic mesenteric ischemia (n = 15; 58%), acute mesenteric ischemia (n = 9; 35%), and mycotic aneurysm of the paravisceral aorta (n = 2; 7%). Three patients (11%) underwent revascularization with SV grafts and two patients (8%) with SFV grafts after previous failed mesenteric bypass. RESULTS: The 30-day mortality rate was 15%. Three deaths occurred after SV bypass for acute mesenteric ischemia, and one death occurred after a SFV bypass for a ruptured paravisceral mycotic aneurysm. Twenty-two surviving patients were followed for a mean of 31 +/- 6 months. Three of 11 patients (27%) who survived after SV bypass had recurrent mesenteric ischemia develop (acute, n = 1; chronic, n = 2) from graft thrombosis at a mean interval of 32 +/- 22 months after surgery. No patient had recurrent symptoms develop after SFV bypass. One of the three patients with SV graft failure died of acute mesenteric ischemia, and the other two patients underwent successful bypass with SFV. Symptomatic graft failure was significantly more likely to occur in patients receiving SV grafts compared with SFV grafts (P <.05). CONCLUSION: SFV yields acceptable clinical outcomes for mesenteric arterial bypass compared with SV. SFV is a viable alternative to SV when autogenous conduit is indicated for mesenteric arterial reconstruction.

Adult↗
PubMed2004

Correlation of duplex ultrasound scanning-derived valve closure time and clinical classification in patients with small saphenous vein reflux: Is lesser saphenous vein truly lesser?

OBJECTIVE: We recently identified small saphenous vein (SSV) reflux as a significant risk factor for ulcer recurrence in patients with severe chronic venous insufficiency (CVI) undergoing perforator vein ligation. In this study we examined the role of SSV reflux in patients across the spectrum of CVI. METHODS: From March 15, 1997, to December 24, 2002, clinical and duplex ultrasound (US) scanning data from all valve closure time studies performed in our vascular laboratory were prospectively recorded. Valve closure time in the deep and superficial leg veins was assessed with the rapid cuff deflation technique; reflux time greater than 0.5 seconds was considered abnormal. SSV reflux was correlated with the CEAP classification system and eventual surgical procedure. Data were analyzed with Pearson chi(2) analysis. RESULTS: We analyzed 722 limbs in 422 patients, 265 (63%) female patients and 157 (37%) male patients, with a mean age of 48 +/- 12.8 years (range, 16-85 years). In the entire cohort the cause was congenital (Ec) in 5 patients, primary (Ep) in 606 patients, and secondary (Es) in 112 patients. SSV reflux was present in 206 limbs (28.5%) evaluated. Among limbs with SSV reflux, Ec = 4 (2%), Ep = 162 (79%), and Es = 40 (19%). SSV reflux did not correlate with gender, side, or age. The prevalence of SSV reflux increases with increasing severity of clinical class: C1-C3, 25.8% versus C4-C6, 36.1% (P =.006). SSV reflux is highly associated with deep venous reflux, 35.2% of femoral vein reflux (P =.015), 35.8% of femoral vein plus popliteal vein reflux (P =.001), and 40.5% of isolated popliteal vein reflux (P <.001). Great saphenous vein (GSV) reflux was identified in 483 (67%) limbs studied with valve closure time, whereas SSV reflux was present in 206 (28%) limbs. In this cohort, 127 GSV or SSV surgical procedures were performed subsequent to valve closure time examination. Among these operations 107 (84%) were GSV procedures, and only 20 (16%) were SSV procedures. CONCLUSION: SSV reflux is most common in patients demonstrating severe sequelae of CVI, such as lipodermatosclerosis or ulceration. The increasing prevalence of SSV reflux in more severe clinical classes and the strong association of SSV reflux and deep venous reflux suggest that SSV may have a significant role in CVI. Our data further show that, in our institution, a GSV with reflux is more than twice as likely to be surgically corrected as an SSV with reflux. It is time for the SSV to assume greater importance in the treatment of lower extremity venous disease. Future improvements in surgical techniques for access and visualization of the SSV may facilitate this method.

Cohort Studies↗
PubMed1996

Recurrent varicose veins after short saphenous vein surgery: a duplex ultrasound study.

Recurrent venous reflux in the popliteal fossa of patients with recurrent varicose veins following short saphenous vein surgery was assessed in 70 limbs using a duplex scanner. Incompetence of the short saphenous vein was found to be the main source (61%) of venous reflux in the popliteal fossa (43/70). The recurrence or persistence of the short saphenous vein was subdivided into four types: an intact saphenopopliteal junction, as well as an intact short saphenous vein in 20 limbs (type I): varicosities in the popliteal fossa communicating with a short saphenous vein stump in 11 limbs (type II); a residual short saphenous vein communicating with the popliteal vein via a tortuous recurrent vein in eight limbs (type III); and a segment of residual short saphenous vein with no communication with the popliteal vein in four limbs (type IV). Incompetence of a gastrocnemius vein was involved in 24 cases (34%), an incompetent popliteal area vein in one (1.4%), popliteal vein incompetence in 15 (21%), and popliteal fossa varicosities communicating with the long saphenous system in two (3%). Of 12 limbs tested pre- and postoperatively, a high termination of the short saphenous vein was demonstrated in four of seven residual incompetent short saphenous veins. Duplex scanning is recommended to assess recurrent venous reflux in the popliteal fossa. It can be used to determine the level of an incompetent saphenopopliteal junction and the level of the termination of any other incompetent vein in the management of varicose veins recurring after a short saphenous vein operation.

Follow-Up Studies↗
PubMedDate not supplied

[Incompetence of the external saphenous vein with progressive repercussions on the internal saphenous vein. Cure by stripping of the external saphenous vein alone].

Voluminous dilatation of the arch of the external saphenous, developing after effort. Progressive dilatation of the whole of the external saphenous and the veins communicating with the internal saphenous, followed by progressive dilatation of the internal saphenous, from the malleolus up to the knee. After ligation of the arch and stripping of the external saphenous, the internal saphenous reverted spontaneously to its normal size in a few months.

Humans↗
PubMed2001

Prospective comparison of arm veins and greater saphenous veins as infrageniculate bypass grafts.

OBJECTIVES: to compare arm and saphenous veins for infrageniculate bypass grafting. DESIGN: prospective non-randomised study. MATERIALS: two hundred patients, of which 197 had ischaemic tissue loss or rest pain. METHODS: two hundred and eleven infrageniculate vein bypass procedures using 176 greater saphenous veins and 35 arm veins. RESULTS: the cumulative primary graft patency rate at 1-month and 2 years was 80% and 61% for saphenous vein and 89% and 42% for arm vein. The corresponding rates for secondary patency were 84.5% and 68%, and 91% and 57%, respectively. These results corresponded to a relative risk of secondary failure of 1.53 (95% CI 0.71, 3.31) for arm vein grafts. In subgroup analyses, this estimate was 0.93 and 2.1 for primary vs secondary bypasses and 0.38 and 2.06 for single-vein vs spliced-vein bypasses. Among arm veins, cephalic vein grafts performed better than basilic vein grafts. Early mortality was 14% for arm vein and 10% for saphenous vein. CONCLUSION: in the setting of infrageniculate bypass grafting, arm vein grafts are not equivalent to greater saphenous vein grafts, but contribute importantly to a policy of using autologous veins. The possibility of equivalence remains for the arm vein graft that uses a cephalic vein or is a primary procedure.

Aged↗
PubMedDate not supplied

Errors in the differential diagnosis of incompetence of the popliteal vein and short saphenous vein by Doppler ultrasound.

Doppler Ultrasound is now routinely used to demonstrate valvular reflux in the venous system. Incompetence detected at the back of the knee is located either in the short saphenous vein or in the popliteal vein. Whether the incompetence is in the deep or superficial venous system can be differentiated by digital compression over the short saphenous vein in the upper calf; if reflux is abolished then the incompetence is assumed to be in the superficial vein but if it is not prevented it must be in the popliteal vein. Sometimes the reflux is not controlled when the deep system is normal. This has been shown to be due to variations in the anatomy of the short saphenous vein and especially the pattern of its termination. Examples with venography are given, showing that in the presence of incompetence at the sapheno-popliteal junction there may be no reflux in the short saphenous vein; instead the proximal tributaries are involved and reflux in these veins is not controlled by pressure over the short saphenous vein. This explains the false positive diagnosis of valvular incompetence in the popliteal vein.

Adult↗
PubMed1978

The short saphenous vein: an alternative to the long saphenous vein for aortocoronary bypass.

The long saphenous vein and internal mammary artery are considered at present to be the best grafts available for coronary artery bypass. Patients who have had bilateral long saphenous vein stripping and who require multiple aortocoronary bypass grafts present a challenge to the cardiac surgeon. The short saphenous vein appears to be a suitable alterative.

Coronary Artery Bypass↗
PubMed1987

The healing characteristics of autogenous saphenous vein used in the reconstruction of previously implanted arterial saphenous vein grafts.

Aortocoronary saphenous vein grafts with early isolated stenoses pose the technical problem of how to deal with these grafts at reoperation. The advisability of using a portion of old graft when reconstructing these grafts was examined. An experimental model was devised in which the anatomical and pathological interfaces between fresh vein and previously inserted vein were studied. Superficial femoral artery from the thigh of 15 dogs was replaced by reversed autogenous saphenous vein. Four months later, the animals were divided into two groups. Group 1 consisted of 8 animals that underwent transection and reimplantation of the middle 4 cm of the vein graft in exactly the same position in which it had been. In Group 2, the 7 animals had the middle 4 cm of the graft replaced with newly harvested reversed saphenous vein. Six months after initial vein graft implantation, the animals were studied. No critical stenoses were seen in the grafts. Pathological study of Group 1 grafts revealed fibrous graft disease of uniform severity throughout the graft, thereby demonstrating that new anastomoses in an old graft do not affect graft disease. Group 2 grafts revealed that the severity of disease in the new interposed segment of the vein graft was less than in the old retained portions of the graft. No untoward reaction causing acceleration of graft disease occurred between old and new vein. Operations using undiseased portions of old vein grafts should be considered a viable option in repeat coronary revascularization for early stenoses.

Animals↗