Autologous saphenous vein is the graft material of choice for the bypass of small caliber arteries. This tissue has become widely used for femoral popliteal bypass over the past 25 years and has achieved even greater prominence in recent bypass procedures for coronary artery disease. The initial follow-up studies of venous grafts in the peripheral circuit were concerned with long term patency, and as such they provided performance standards by which substitutes can be judged. Aside from sporadic descriptions of graft pathology these early reports did not establish the incidence and types of pathologic changes which occur in peripheral grafts. When saphenous vein was used to provide vital central organs with blood flow, the follow-up has been more intensive. This has included postoperative evaluation of patency by arteriography and complete histologic examination of graft material obtained at the time of re-exploration or at autopsy. When such an approach is applied to consecutive patients it offers data on the incidence of the distinctive histologic changes which can occur. This comprehensive technique has recently been applied to a consecutive series of patients with peripheral artery bypass. The data from this investigation, in combination with extensive animal experiments, support the contention that distinct pathologic changes may occur in vein grafts whether in the central or peripheral position. Both human and experimental work are combined in the present study in order to establish the characteristics of normal vein, the changes induced by preparation of a vein for grafting, and the alterations that are seen postoperatively. Special attention will is to the features that may be involved in the development of these pathologic changes.
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