Cardiovascular Journal of Africa: Vol 27 No 3 (May/June 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 3, May/June 2016 AFRICA 159
Administration of perivascular cyanoacrylate for the
prevention of cellular damage in saphenous vein grafts:
an experimental model
Nail Kahraman, Gunduz Yumun, Arif Gücü, Kadir Kağan Özsin, Temmuz Taner, Ebru Şener,
Mehmet Tuğrul Göncü
Abstract
Objective: The saphenous vein is the most commonly used
graft in coronary artery bypass surgery, since no suitable
arterial graft is available. However, the frequency of late graft
failure is a cause for research into graft protection. The objec-
tive of this study was to investigate the effect of synthetic
adhesive cyanoacrylate administration on the saphenous vein
graft for preventing vascular damage due to internal pressure
on the graft.
Methods: In this study we enrolled 20 volunteer subjects who
had undergone coronary artery bypass surgery and who had
excess saphenous vein grafts. Perivascular cyanoacrylate was
administered to one of two saphenous vein grafts explanted
from each patient. The other saphenous vein graft from each
patient was not treated and was used as the control. A model
of the arterial system was created using a saphenous vein
cardiopulmonary bypass system. Circulation was maintained
at 120 mmHg for 45 minutes. Afterwards, the grafts were
subjected to histopathological examination.
Results: The cyanoacrylate group of grafts did not develop
severe vascular damage compared with many instances of
moderate and severe damage due to compression in the
control group of grafts (p = 0.003).
Conclusion: Perivascular administration of cyanoacrylate
appeared to be successful in the prevention of early saphen-
ous vein graft injury. No in vivo study has been performed to
date to assess endothelial damage in the saphenous vein, in
order to demonstrate the long-term effect of cyanoacrylate.
Further investigations are needed in this regard.
Keywords: cyanoacrylate, saphenous vein graft, vascular damage,
arterial pressure
Submitted 13/2/15, accepted 4/10/15
Published online 28/10/15
Cardiovasc J Afr 2015; 26: 159–163
DOI: 10.5830/CVJA-2015-078
Coronary artery bypass surgery (CABG) in coronary artery
disease affords a longer lifespan for patients and higher patency
rates of grafts than with percutaneous procedures.1,2 At present,
the saphenous vein is the most commonly used graft, as no
suitable arterial graft can be prepared for all vessels.
At the end of 10-year follow-up studies, it was reported
that up to 40% of the saphenous vein grafts had undergone
occlusion.3,4 Stenosis in up to half of the patent vessels is a
significant negative factor with regard to long-term results
after CABG. Therefore, a wide range of investigations has been
conducted to investigate protection of saphenous vein grafts.
Increases in pulsatile flow and wall tension occur in venous
grafts exposed to post-operative arterial pressure. Therefore
injuries develop in the wall layers of the blood vessels, particularly
the endothelium. Consequently, proliferation and migration of
cells, vascular smooth muscle hyperplasia, and the formation of
myofibroblasts, as well as neo-intimal development occur. 5-7
Numerous studies have been performed involving the use
of rigid and elastic supports or fibrin glue for the outside of
the venous grafts in order to reduce the stress on them.8-11 The
objective of this study was to investigate the protective effect of
perivascular cyanoacrylate administration against saphenous
vein damage due to blood pressure in patients after CABG.
Methods
The study included 20 of the patients who underwent on-pump
CABG operations between 2011 and 2012 in our clinic, who
agreed to participate in the study, and who had sufficient
saphenous vein grafts for use in this study. Two graft samples
were taken from each patient to ensure standardisation between
the groups. Then each patient’s two grafts were divided into two
groups, one with and one without perivascular cyanoacrylate
application, to ensure each group had 20 grafts.
Patients who had undergone off-pump surgery, those who had
had an emergency operation, those with insufficient saphenous
vein grafts, those who did not agree to participate, those with
known malignancies, and those with haematological problems
were excluded from the study.
An arterial system model was created using redundant
saphenous vein grafts in a cardiopulmonary bypass system
(CPB). A device with two 3-cm-long saphenous vein grafts
was created during CPB using a new line from the arterial
Bursa Yuksek Ihtisas Education and Research Hospital,
Bursa, Turkey
Nail Kahraman, MD
Namik Kemal University, Tekirdag, Turkey
Gunduz Yumun, MD,
Department of Cardiovascular Surgery, Bursa Yuksek
Ihtisas Education and Research Hospital, Bursa, Turkey
Arif Gücü, MD
Kadir Kağan Özsin, MD
Temmuz Taner, MD
Mehmet Tuğrul Göncü, MD
Department of Pathology, Erzurum Education and
Research Hospital, Erzurum, Turkey
Ebru Şener, MD