The effect of storage solutions on endothelial function and saphenous vein graft patency

  • Ismail Bouhout
  • Walid Ben Ali
  • Louis Paul PerraultEmail author
Review Article


Vein graft failure is a complex mechanism that can be triggered immediately after surgical harvesting. Storage solutions have a major role in preventing endothelial cell damage during harvesting. While normal saline is still widely used, buffered solutions seem to better preserve endothelial integrity and function. This review aims to summarize the current literature surrounding vein graft storage solutions.


Vein graft Preservation solution Coronary artery bypass 



No extramural funding was obtained for this work.

Compliance with ethical standards

Conflicts of interest

Louis Paul Perrault discloses a financial relationship with ClearFlow and Somahulation as a member of the scientific committee. All other authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was not necessary for the review article.


  1. 1.
    Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a department of veterans affairs cooperative study. J Am Coll Cardiol. 2004;44:2149–56.CrossRefGoogle Scholar
  2. 2.
    McNeely C, Markwell S, Vassileva C. Trends in patient characteristics and outcomes of coronary artery bypass grafting in the 2000 to 2012 medicare population. Ann Thorac Surg. 2016;102:132–8.CrossRefGoogle Scholar
  3. 3.
    de Vries MR, Simons KH, Jukema JW, Braun J, Quax PH. Vein graft failure: From pathophysiology to clinical outcomes. Nat Rev Cardiol. 2016;13:451–70.CrossRefGoogle Scholar
  4. 4.
    Alexander JH, Hafley G, Harrington RA, et al. Efficacy and safety of edifoligide, an e2f transcription factor decoy, for prevention of vein graft failure following coronary artery bypass graft surgery: PREVENT IV: A randomized controlled trial. JAMA. 2005;294:2446–54.CrossRefGoogle Scholar
  5. 5.
    Harskamp RE, Alexander JH, Schulte PJ, et al. Vein graft preservation solutions, patency, and outcomes after coronary artery bypass graft surgery: Follow-up from the prevent iv randomized clinical trial. JAMA Surg. 2014;149:798–805.CrossRefGoogle Scholar
  6. 6.
    Williams JB, Harskamp RE, Bose S, et al. The preservation and handling of vein grafts in current surgical practice: Findings of a survey among cardiovascular surgeons of top-ranked us hospitals. JAMA Surg. 2015;150:681–3.CrossRefGoogle Scholar
  7. 7.
    Schachner T. Pharmacologic inhibition of vein graft neointimal hyperplasia. J Thorac Cardiovasc Surg. 2006;131:1065–72.CrossRefGoogle Scholar
  8. 8.
    Schlitt A, Pruefer D, Buerke U, et al. Neutrophil adherence to activated saphenous vein and mammary endothelium after graft preparation. Ann Thorac Surg. 2006;81:1262–8.CrossRefGoogle Scholar
  9. 9.
    Weiss DR, Juchem G, Kemkes BM, Gansera B, Nees S. Extensive deendothelialization and thrombogenicity in routinely prepared vein grafts for coronary bypass operations: Facts and remedy. Int J Clin Exp Med. 2009;2:95–113.Google Scholar
  10. 10.
    Shuhaiber JH, Evans AN, Massad MG, Geha AS. Mechanisms and future directions for prevention of vein graft failure in coronary bypass surgery. Eur J Cardiothorac Surg. 2002;22:387–96.CrossRefGoogle Scholar
  11. 11.
    Sur S, Sugimoto JT, Agrawal DK. Coronary artery bypass graft: Why is the saphenous vein prone to intimal hyperplasia? Can J Physiol Pharmacol. 2014;92:531–45.CrossRefGoogle Scholar
  12. 12.
    Lamm P, Juchem G, Milz S, Reichart B. Continuous graft perfusion: Optimizing the quality of saphenous vein grafts. Heart Surg Forum. 2002;5:S355–61.Google Scholar
  13. 13.
    Lopes RD, Hafley GE, Allen KB, et al. Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery. N Engl J Med. 2009;361:235–44.CrossRefGoogle Scholar
  14. 14.
    Owens CD, Gasper WJ, Rahman AS, Conte MS. Vein graft failure. J Vasc Surg. 2015;61:203–16.CrossRefGoogle Scholar
  15. 15.
    Hinokiyama K, Valen G, Tokuno S, Vedin JB, Vaage J. Vein graft harvesting induces inflammation and impairs vessel reactivity. Ann Thorac Surg. 2006;82:1458–64.CrossRefGoogle Scholar
  16. 16.
    Owens CD, Wake N, Conte MS, Gerhard-Herman M, Beckman JA. In vivo human lower extremity saphenous vein bypass grafts manifest flow mediated vasodilation. J Vasc Surg. 2009;50:1063–70.CrossRefGoogle Scholar
  17. 17.
    Loscalzo J. Vascular matrix and vein graft failure. Is the message in the medium? Circulation. 2000;101:221–3.CrossRefGoogle Scholar
  18. 18.
    Taggart DP, Ben Gal Y, Lees B, et al. A randomized trial of external stenting for saphenous vein grafts in coronary artery bypass grafting. Ann Thorac Surg. 2015;99:2039–45.CrossRefGoogle Scholar
  19. 19.
    Kim KB, Hwang HY, Hahn S, Kim JS, Oh SJ. A randomized comparison of the saphenous vein versus right internal thoracic artery as a y-composite graft (save rita) trial: One-year angiographic results and mid-term clinical outcomes. J Thorac Cardiovasc Surg. 2014;148:901–7.CrossRefGoogle Scholar
  20. 20.
    Catinella FP, Cunningham JN Jr, Srungaram RK, et al. The factors influencing early patency of coronary artery bypass vein grafts: Correlation of angiographic and ultrastructural findings. J Thorac Cardiovasc Surg. 1982;83:686–700.Google Scholar
  21. 21.
    Sanchez AM, Wooldridge TA, Boerboom LE, Olinger GN, Almassi GH, Rusch NJ. Comparison of saphenous vein graft relaxation between plasma-lyte solution and normal saline solution. J Thorac Cardiovasc Surg. 1994;107:1445–53.Google Scholar
  22. 22.
    Hickethier T, Dammrich J, Silber RE, Finster S, Elert O. Ultrastructural investigations for reducing endothelial cell damage of vein grafts during CABG-operation and practical consequences. J Cardiovasc Surg (Torino). 1999;40:71–6.Google Scholar
  23. 23.
    Kown MH, Yamaguchi A, Jahncke CL, et al. L-arginine polymers inhibit the development of vein graft neointimal hyperplasia. J Thorac Cardiovasc Surg. 2001;121:971–80.CrossRefGoogle Scholar
  24. 24.
    Biswas KS, Thatte HS, Najjar SF, et al. Multi-photon microscopy in the evaluation of human saphenous vein. J Surg Res. 2001;95:37–43.CrossRefGoogle Scholar
  25. 25.
    Wilbring M, Tugtekin SM, Zatschler B, et al. Even short-time storage in physiological saline solution impairs endothelial vascular function of saphenous vein grafts. Eur J Cardiothorac Surg. 2011;40:811–5.Google Scholar
  26. 26.
    Lawrie GM, Weilbacher DE, Henry PD. Endothelium-dependent relaxation in human saphenous vein grafts. Effects of preparation and clinicopathologic correlations. J Thorac Cardiovasc Surg. 1990;100:612–20.Google Scholar
  27. 27.
    Bush HL Jr, Jakubowski JA, Curl GR, Deykin D, Nabseth DC. The natural history of endothelial structure and function in arterialized vein grafts. J Vasc Surg. 1986;3:204–15.CrossRefGoogle Scholar
  28. 28.
    Chester AH, O'Neil GS, Tadjakarimi S, Borland JA, Yacoub MH. Effect of peri-operative storage solution on the vascular reactivity of the human saphenous vein. Eur J Cardiothorac Surg. 1993;7:399–404.CrossRefGoogle Scholar
  29. 29.
    Cavallari N, Abebe W, Mingoli A, et al. Functional and morphological evaluation of canine veins following preservation in different storage media. J Surg Res. 1997;68:106–15.CrossRefGoogle Scholar
  30. 30.
    Wilbring M, Ebner A, Schoenemann K, et al. Heparinized blood better preserves cellular energy charge and vascular functions of intraoperatively stored saphenous vein grafts in comparison to isotonic sodium-chloride-solution. Clin Hemorheol Microcirc. 2013;55:445–55.Google Scholar
  31. 31.
    Gundry SR, Jones M, Ishihara T, Ferrans VJ. Optimal preparation techniques for human saphenous vein grafts. Surgery. 1980;88:785–94.Google Scholar
  32. 32.
    Santoli E, Di Mattia D, Boldorini R, Mingoli A, Tosoni A, Santoli C. University of wisconsin solution and human saphenous vein graft preservation: Preliminary anatomic report. Eur J Cardiothorac Surg. 1993;7:548–52.CrossRefGoogle Scholar
  33. 33.
    Dumanski A, Sopel M, Pelczar M, Szlapka M, Kustrzycki W, Zabel M. Influence of pressure on the endothelium of the saphenous vein coronary artery bypass graft. In Vivo. 2007;21:785–9.Google Scholar
  34. 34.
    Tsakok M, Montgomery-Taylor S, Tsakok T. Storage of saphenous vein grafts prior to coronary artery bypass grafting: Is autologous whole blood more effective than saline in preserving graft function? Interact Cardiovasc Thorac Surg. 2012;15:720–5.CrossRefGoogle Scholar
  35. 35.
    Wise ES, Hocking KM, Cheung-Flynn J, Brophy CM. Balanced, ph-buffered preservation solutions improved physiologic response in human saphenous vein graft. Arterioscler Thromb Vasc Biol. 2014;34:A322.Google Scholar
  36. 36.
    Bas M, Luther B, Knopf A, Suvorava T, Kojda G. Preservation of endothelial and smooth muscle function of human saphenous vein transplants. Exp Clin Transplant. 2016;14:86–92.Google Scholar
  37. 37.
    Schaeffer U, Strohschneider T, Pilch H, et al. Influence of several solutions used in bypass surgery on the perrmeability of the endothelium of carotid arteries in new zealand rabbits. Thorac Cardiovasc Surg. 1999;47:240–3.CrossRefGoogle Scholar
  38. 38.
    Garbe S, Zatschler B, Muller B, et al. Preservation of human artery function following prolonged cold storage with a new solution. J Vasc Surg. 2011;53:1063–70.CrossRefGoogle Scholar
  39. 39.
    Veres G, Hegedus P, Barnucz E, et al. Tiprotec preserves endothelial function in a rat model. J Surg Res. 2016;200:346–55.CrossRefGoogle Scholar
  40. 40.
    Wilbring M, Tugtekin SM, Zatschler B, et al. Preservation of endothelial vascular function of saphenous vein grafts after long-time storage with a recently developed potassium-chloride and n-acetylhistidine enriched storage solution. Thorac Cardiovasc Surg. 2013;61:656–62.Google Scholar
  41. 41.
    He GW, Rosenfeldt FL, Angus JA. Pharmacological relaxation of the saphenous vein during harvesting for coronary artery bypass grafting. Ann Thorac Surg. 1993;55:1210–7.CrossRefGoogle Scholar
  42. 42.
    Wise ES, Hocking KM, Luo W, et al. Traditional graft preparation decreases physiologic responses, diminishes viscoelasticity, and reduces cellular viability of the conduit: A porcine saphenous vein model. Vasc Med. 2016;21:413–21.CrossRefGoogle Scholar
  43. 43.
    Thatte HS, Biswas KS, Najjar SF, et al. Multi-photon microscopic evaluation of saphenous vein endothelium and its preservation with a new solution, GALA. Ann Thorac Surg. 2003;75:1145–52.CrossRefGoogle Scholar
  44. 44.
    Thatte HS, Khuri SF. The coronary artery bypass conduit: I. Intraoperative endothelial injury and its implication on graft patency. Ann Thorac Surg. 2001;72:S2245–52.CrossRefGoogle Scholar
  45. 45.
    Bhardwaj S, Roy H, Yla-Herttuala S. Gene therapy to prevent occlusion of venous bypass grafts. Expert Rev Cardiovasc Ther. 2008;6:641–52.CrossRefGoogle Scholar
  46. 46.
    Chandiwal A, Balasubramanian V, Baldwin ZK, Conte MS, Schwartz LB. Gene therapy for the extension of vein graft patency: A review. Vasc Endovascular Surg. 2005;39:1–14.CrossRefGoogle Scholar
  47. 47.
    Alexander JH, Ferguson TB Jr, Joseph DM, et al. The project of ex-vivo vein graft engineering via transfection iv (prevent iv) trial: Study rationale, design, and baseline patient characteristics. Am Heart J. 2005;150:643–9.CrossRefGoogle Scholar
  48. 48.
    Stahli BE, Gebhard C, Duchatelle V, et al. Effects of the P-selectin antagonist inclacumab on myocardial damage after percutaneous coronary intervention according to timing of infusion: Insights from the SELECT-ACS trial. J Am Heart Assoc. 2016;5.pii:e004255.Google Scholar
  49. 49.
    Nakao A, Huang CS, Stolz DB, et al. Ex vivo carbon monoxide delivery inhibits intimal hyperplasia in arterialized vein grafts. Cardiovasc Res. 2011;89:457–63.CrossRefGoogle Scholar

Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2018

Authors and Affiliations

  • Ismail Bouhout
    • 1
  • Walid Ben Ali
    • 1
  • Louis Paul Perrault
    • 1
    Email author
  1. 1.Department of Cardiovascular SurgeryMontreal Heart InstituteMontrealCanada

Personalised recommendations