Early biomechanical changes in lower extremity vein grafts-distinct temporal phases of remodeling and wall stiffness

Christopher D. Owens, Nicole Wake, Jeffrey G. Jacot, Marie Gerhard-Herman, Peter Gaccione, Michael Belkin, Mark A. Creager, Michael S. Conte

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


Background: The geometric and biomechanical changes that contribute to vein graft remodeling are not well established. We sought to measure patterns of adaptation in lower extremity vein grafts and assess their correlation with clinical outcomes. Methods: We conducted a prospective, longitudinal study of patients undergoing infrainguinal reconstruction with autogenous conduit. In addition to standard duplex surveillance, lumen diameter (of a defined index segment of the conduit) and pulse wave velocity (PWV) were assessed by ultrasound imaging at surgery and at 1, 3, and 6 months postoperatively. Graft dimensions and wall stiffness were correlated with clinical outcomes. Results: There were 92 patients and 96 limbs in this study. On average, vein graft lumen diameter increased during the first month of implantation from 0.37 ± .01 cm to 0.45 ± 0.02 cm (mean ± SEM; P = .002), representing a relative change of +21.6% (median ± 14%; range, -31 to +67%) during this period. Of the entire cohort, 72% of grafts demonstrated appreciable dilation of the index segment during the first month. Index segment lumen diameter did not change appreciably beyond 1 month, with the notable exception of arm vein conduits, which showed continued tendency to dilate. PWV increased during the first 6 months (17.2 ± 1.2 m/s to 23.2 ± 2.4 m/s; P = .008), reflecting a nearly 40% increase in conduit stiffness (2.0 ± .6 Mdynes/cm to 3.3 ± .8 Mdynes/cm, P = .01). The greatest relative increase (25%) in PWV occurred from months 1 to 3. Loss of primary patency occurred in 24 cases (19 revisions, 5 occlusions), with a mean reintervention time of 7.6 months. Grafts that demonstrated early positive remodeling (lumen dilatation) had a trend of increased primary patency (P = .08, log rank). Among the grafts that failed, a trend was noted toward greater wall stiffness at 1 month, 2.7 vs 1.5 Mdynes (P = .08). Conclusion: Vein graft remodeling appears to involve at least two distinct temporal phases. Outward remodeling of the lumen occurs early, and wall stiffness changes occur in a more delayed fashion. Early outward remodeling may be important for successful vein graft adaptation.

Original languageEnglish (US)
Pages (from-to)740-746
Number of pages7
JournalJournal of Vascular Surgery
Issue number4
StatePublished - Oct 2006
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Early biomechanical changes in lower extremity vein grafts-distinct temporal phases of remodeling and wall stiffness'. Together they form a unique fingerprint.

Cite this