Pedigo Sydney L, Guth Christy M, Hocking Kyle M, Banathy Alex, Li Fan Dong, Cheung-Flynn Joyce, Brophy Colleen M, Guzman Raul J, Komalavilas Padmini
Department of Surgery, Vanderbilt University Medical Center , Nashville, TN , USA.
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA.
Front Surg. 2017 Feb 9;4:6. doi: 10.3389/fsurg.2017.00006. eCollection 2017.
While the pathophysiology and clinical significance of arterial calcifications have been studied extensively, minimal focus has been placed on calcification deposition. In this study, we evaluated the association between calcium deposition in human saphenous vein (HSV), endothelial function, and patient demographic risk factors. Fifty-four HSV segments were collected at the time of coronary artery bypass graft (CABG) surgery. The presence or absence of calcium deposits was visualized using the Von Kossa staining method. Endothelial function was determined by measuring muscle tissue contraction with phenylephrine and relaxation with carbachol in a muscle bath. Additional segments of vein underwent histologic evaluation for preexisting intimal thickness and extracellular matrix (ECM) deposition. Patient demographics data were obtained through our institution's electronic medical record, with patient consent. Calcium was present in 16 of 54 samples (29.6%). Veins with calcium deposits had significantly greater intimal-to-medial thickness ratios ( = 0.0058) and increased extracellular collagen deposition ( = 0.0077). Endothelial relaxation was significantly compromised in calcified veins vs. those without calcium ( = 0.0011). Significant patient risk factors included age ( = 0.001) and preoperative serum creatinine ( = 0.017). Calcified veins can be characterized as having endothelial dysfunction with increased basal intimal thickness and increased ECM deposition. Patient risk factors for calcium deposits in veins were similar to those for arteries, namely, advanced age and kidney disease. Further studies are needed to determine the effect of preexisting vein calcification on short- and long-term graft patency.
虽然动脉钙化的病理生理学和临床意义已得到广泛研究,但对钙化沉积的关注却很少。在本研究中,我们评估了人隐静脉(HSV)中的钙沉积、内皮功能和患者人口统计学风险因素之间的关联。在冠状动脉旁路移植术(CABG)手术时收集了54段HSV。使用冯·科萨染色法观察钙沉积物的有无。通过在肌肉浴中用去氧肾上腺素测量肌肉组织收缩和用卡巴胆碱测量肌肉组织舒张来测定内皮功能。对静脉的其他节段进行组织学评估,以确定其内膜厚度和细胞外基质(ECM)沉积情况。患者人口统计学数据通过我们机构的电子病历获得,并获得了患者的同意。54个样本中有16个(29.6%)存在钙。有钙沉积物的静脉内膜与中膜厚度比显著更高(=0.0058),细胞外胶原沉积增加(=0.0077)。与无钙静脉相比,钙化静脉的内皮舒张功能明显受损(=0.0011)。重要的患者风险因素包括年龄(=0.001)和术前血清肌酐(=0.017)。钙化静脉的特征是内皮功能障碍,基础内膜厚度增加,ECM沉积增加。静脉中钙沉积的患者风险因素与动脉相似,即高龄和肾脏疾病。需要进一步研究以确定预先存在的静脉钙化对移植物短期和长期通畅性的影响。