Pharmacology of the Human Saphenous Vein

Edwaldo      E. Joviliano; Renata      Dellalibera-Joviliano; Andrea      Carla Celotto; Verena      K. Capellini; Marcelo      B. Dalio; Carlos      E. Picconato; Paulo      Roberto B. Evora

Abstract

Nowadays, the great saphenous vein is the vascular conduit that is most frequently employed in coronary and peripheral revascularization surgery. It is known that saphenous vein bypass grafts have shorter patency than arterial ones, partly because the wall of the normal saphenous vein has different structural and functional characteristics. The features of this vein can be affected by the large distention pressures it is submitted to during its preparation and insertion into the arterial system. Indeed, a vein graft is subjected to considerable changes in hemodynamic forces upon implantation into the arterial circulation, since it is transplanted from a non-pulsatile, low-pressure, low-flow environment with minimal shear stress to a highpressure system with pulsatile flow, where it undergoes cyclic strain and elevated shear. These changes can be responsible for functional and morphological alterations in the vessel wall, culminating in intima hyperproliferation and atherosclerotic degeneration, which contribute to early graft thrombosis. This review has followed a predetermined strategy for updating information on the human saphenous vein (HSV). Besides presenting the aspects relative to the basic pharmacology, this text also includes surgical aspects concerning HSV harvesting, the possible effects of the major groups of cardiovascular drugs on the HSV, and finally the interference of major cardiovascular diseases in the vascular reactivity of the HSV.

Keywords: Saphenous vein, revascularization, arterial grafts, prostacyclin, oxidative stress, hypertension, diabetes mellitus, anti-thrombotic agents, nitric oxide, serotonin