Key result
Therapeutic modulation of the immune system represents a potential strategy to prevent vein graft failure by targeting inflammation, intimal hyperplasia, and accelerated atherosclerosis.
Why the study?
Little has changed in the prevention of vein graft failure despite high failure rates, although new insights into innate and adaptive immunity have emerged.
This review highlights the critical role of innate and adaptive immunity in the different phases of vein graft failure and discusses potential immunomodulatory therapeutic strategies to improve graft patency.
Immunomodulation remains hypothesis-generating for vein graft failure; leaves open efficacy in prospective trials.
Obstructive arterial disease is a major cause of morbidity and mortality in the developed world. Venous bypass graft surgery is one of the most frequently used revascularization strategies despite its considerable short and long time failure rate. Due to vessel wall remodeling, inflammation, intimal hyperplasia, and accelerated atherosclerosis, vein grafts may (ultimately) fail to revascularize tissues downstream to occlusive atherosclerotic lesions. In the past decades, little has changed in the prevention of vein graft failure (VGF) although new insights in the role of innate and adaptive immunity in VGF have emerged. In this review, we discuss the pathophysiological mechanisms underlying the development of VGF, emphasizing the role of immune response and associated factors related to VG remodeling and failure. Moreover, we discuss potential therapeutic options that can improve patency based on data from both preclinical studies and the latest clinical trials. This review contributes to the insights in the role of immunomodulation in vein graft failure in humans. We describe the effects of immune cells and related factors in early (thrombosis), intermediate (inward remodeling and intimal hyperplasia), and late (intimal hyperplasia and accelerated atherosclerosis) failure based on both preclinical (mouse) models and clinical data.
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Baganha et al. (2020) conducted a review in Vein graft failure. Immunomodulation was evaluated. Therapeutic modulation of the immune system represents a potential strategy to prevent vein graft failure by targeting inflammation, intimal hyperplasia, and accelerated atherosclerosis.
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