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Eur J Cardiothorac Surg 2006;30:567-568
© 2006 Elsevier Science NL

Letter to the Editor

Remodeling of vein grafts after local application of fibrin glue

Innsbruck Medical University, 6020 Innsbruck, Austria

Received 7 May 2006; accepted 1 June 2006.

^_* Tel.: +43 512 5040; fax: +43 512 504 22528. (Email: Thomas.Schachner{at}uibk.ac.at).

Key Words: CABG • Neointima • Intimal hyperplasia • Vein graft

With interest I read the article ‘Differential, time-dependent effects of perivenous application of fibrin glue on medial thickening in porcine saphenous vein grafts’ by Wan et al. [1]. The authors found a significantly reduced intimal area in fibrin glue treated porcine vein grafts at 1 month postoperatively. At 4 months the total wall thickness in the treatment group was significantly increased versus controls. The authors conclude that fibrin glue should be avoided due to these findings. By going through the morphometric data of this study I would like to discuss a positive effect of fibrin glue in this experiment: (1) At 1 month postoperatively there was a significant decrease of neointimal hyperplasia in grafts treated with fibrin glue (maybe by decreasing the radial wall stress?). (2) At 4 months postoperatively the wall thickness was increased in fibrin glue treated grafts. But this increase was due to an increase of medial thickening, whereas in the neointimal thickness no difference was found. Together with the fact that the luminal area was equal in both groups I would discuss this results as ‘arterial remodeling’ of the veins. The increase of wall thickness is an adaption process of the thin venous wall to the arterial blood pressure. If the wall thickening occurs in the media (and not in the neointima!) and does not compromise the luminal area it could be regarded as positive remodeling [2]. Therefore the perivascular use of fibrin glue maybe discussed positive in this study, not negative.

References

1. Wan S, Arifi AA, Chan MCW, Yip JHY, Ng CSH, Chow LTC, Yim APC, Jeremy JY. Differential, time-dependent effects of perivenous application of fibrin glue on medial thickening in porcine saphenous vein grafts. Eur J Cardio-thorac Surg 2006;29:742-747.[Abstract/Free Full Text]
2. Schachner T. Pharmacologic inhibition of vein graft neointimal hyperplasia. J Thorac Cardiovasc Surg 2006;131(5):1065-1072.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thomas Schachner Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schachner, T. Search for Related Content PubMed PubMed Citation Articles by Schachner, T. Related Collections Coronary disease Related Article