A Brief Comment on Vasa Vasorum of Human Saphenous Vein: relevance for Coronary Artery Bypass Surgery

Andrzej Loesch Correspondence Address: Andrzej Loesch, Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London Medical School, Royal Free Campus, Rowland Hill Street, London, United Kingdom - Zip Code: NW3 2PF. E-mail: aloesch@talktalk.net, a.loesch@ucl.ac.uk

PhD DSc

Centre for Rheumatology and Connective Tissue Diseases, University College London Medical School, Royal Free Campus, London, United Kingdom.

https://orcid.org/0000-0002-8051-0099

Michael Richard Dashwood

PhD

Division of Surgery and Interventional Science, University College London Medical School, Royal Free Campus, London, United Kingdom.

Correspondence Address: Andrzej Loesch, Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London Medical School, Royal Free Campus, Rowland Hill Street, London, United Kingdom - Zip Code: NW3 2PF. E-mail: aloesch@talktalk.net, a.loesch@ucl.ac.uk

No conflict of interest.

Figures (4)
Tables (2)

Thumbnail

Fig. 1
Scanning electron microscope (standard procedure) example of possible vasa vasorum/venarum direct openings into the lumen of the host vein - in this case of no-touch human saphenous vein (hSV) for coronary artery bypass grafting. Arrows point to the vasa openings of which one is < 10 µm of diameter, while the other is > 10 µm. Also note that the arrows indicate a possible direction of blood flow - from the vein lumen into the openings of vasa to be then delivered to the vein wall following vein implantation as coronary graft. For more details on the aspects of blood flow in hSV as coronary graft, see Loesch and Dashwood^[¹⁰10 Loesch A, Dashwood MR. Vasa vasorum inside out/outside in communication: a potential role in the patency of saphenous vein coronary artery bypass grafts. J Cell Commun Signal. 2018;12(4):631-43. doi:10.1007/s12079-018-0483-1.
https://doi.org/10.1007/s12079-018-0483-... ^], 2018. SV=saphenous vein

Thumbnail

Fig. 2
Diagrammatically proposed reduction in blood flow in damaged vasa vasorum (medial hypoxia) of human saphenous vein (hSV) harvested for coronary artery bypass grafting. Top panel: no-touch hSV where the adventitia and vasa vasorum are intact; blood flow to the vein wall is restored after graft implantation, oxygen and nutrient supply is maintained. Lower panel: Conventionally harvested hSV where the adventitia has been stripped off or damaged; the vasa vasorum is constricted or occluded, blood flow to the vein wall is reduced releasing hypoxic factors, which are associated with many aspects of graft failure. For more details, see Samano et al.^[²²22 Samano N, Geijer H, Liden M, Fremes S, Bodin L, Souza D. The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: a randomized trial. J Thorac Cardiovasc Surg. 2015;150(4):880-8. doi:10.1016/j.jtcvs.2015.07.027.
https://doi.org/10.1016/j.jtcvs.2015.07.... ^], 2015, and Loesch and Dashwood^[¹⁰10 Loesch A, Dashwood MR. Vasa vasorum inside out/outside in communication: a potential role in the patency of saphenous vein coronary artery bypass grafts. J Cell Commun Signal. 2018;12(4):631-43. doi:10.1007/s12079-018-0483-1.
https://doi.org/10.1007/s12079-018-0483-... ^], 2018. From an Open Access article: Loesch and Dashwood^[¹⁰10 Loesch A, Dashwood MR. Vasa vasorum inside out/outside in communication: a potential role in the patency of saphenous vein coronary artery bypass grafts. J Cell Commun Signal. 2018;12(4):631-43. doi:10.1007/s12079-018-0483-1.
https://doi.org/10.1007/s12079-018-0483-... ^], 2018, which is acknowledged.

Thumbnail

Fig. 3
Diagrammatic representation of a longitudinal section through the vein (may be relevant to human saphenous vein) showing the venal bicuspid valves with their cusps/leaflets closed. Note that the agger is located at the base of valves. Large arrow indicates the main direction (against gravity) of blood movement, while the two small arrows, above valves, indicate a backflow of blood, in particular if valves are damaged in pathological conditions, and where the thickening of agger's structure (usually comprising smooth muscle and elastin) also occurs. For more details about venal valve and agger, see, e.g,. Corcos et al.^[³¹31 Corcos L, De Anna D, Dini M, Macchi C, Ferrari PA, Dini S. Proximal long saphenous vein valves in primary venous insufficiency. J Mal Vasc. 2000;25(1):27-36.^], 2000, and Crotty^[⁸8 Crotty TP. Varicose veins are caused by segmental failures of the vasoregulatory role of the venous microcirculation, mediated by plasma norepinephrine. In: Nelson AE, ed. Varicose Veins: Symptoms, Causes and Treatments. New York: Nova Science Publishers; 2011. Chapter 1:1-58.^], 2011.

Thumbnail

Fig. 4
Confocal microscope image of no-touch human saphenous vein (hSV) (30 µm frozen section) immunolabelled (originally red) for tyrosine hydroxylase (TH; a marker for sympathetic nerves). A fragment of adventitia periphery showing TH-positive perivascular sympathetic nerves at small vasa vasorum blood vessels: two arterioles (ar) and one venule (ve). Bar: 50 µm. Note that a rabbit TH polyclonal antibody (TZ 1010, Affinity, Exeter, United Kingdom) was used at 1:300; goat antirabbit Alexa 568 (Molecular Probes, Oregon, United States of America) was used at 1:600 as a second layer; confocal laser microscope: BioRadiance 2000. For more details on the sympathetic innervation of hSV, see Loesch and Dashwood^[⁵5 Loesch A, Dashwood MR. On the sympathetic innervation of the human greater saphenous vein: relevance to clinical practice. Curr Vasc Pharmacol. 2009;7(1):58-67. doi:10.2174/157016109787354150.
https://doi.org/10.2174/1570161097873541... ^], 2009.

Thumbnail

Abbreviations, acronyms & symbols ar = Arterioles CABG = Coronary artery bypass grafting hSV = Human saphenous vein NA = Noradrenaline NT = No-touch PVAT = Perivascular adipose tissue SV = Saphenous vein ve = Venule

Thumbnail

Authors' roles & responsibilities AL Substantial contributions to the conception or design of the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; ﬁnal approval of the version to be published MRD Substantial contributions to the conception or design of the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; ﬁnal approval of the version to be published

Abbreviations, acronyms & symbols
ar	= Arterioles
CABG	= Coronary artery bypass grafting
hSV	= Human saphenous vein
NA	= Noradrenaline
NT	= No-touch
PVAT	= Perivascular adipose tissue
SV	= Saphenous vein
ve	= Venule

Authors' roles & responsibilities
AL	Substantial contributions to the conception or design of the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; ﬁnal approval of the version to be published
MRD	Substantial contributions to the conception or design of the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; ﬁnal approval of the version to be published

Brasil

Brasil

A Brief Comment on Vasa Vasorum of Human Saphenous Vein: relevance for Coronary Artery Bypass Surgery

Abstract