Mechanical Factors Associated With the Development of Intimal and Medial Thickening in Vein Grafts Subjected to Arterial Pressure

Arteries exposed to sustained hypertension undergo a moderate degree of intimal thickening and a marked amount of medial thickening. Autogenous veins that are used as bypass grafts undergo similar histological changes. In this study autogenous vein grafts were used as an indirect model of arteries exposed to sustained hypertension. It was hypothesized that it is not pressure per se but rather mechanical changes brought about by exposure to increased pressures that act as a stimulus inducing histological changes. Exposure to arterial pressure increases the following nine mechanical factors: deformation in the circumferential, longitudinal, and radial directions; stresses in each of these three directions; pulsatile deformations and pulsatile stresses; and flow velocity. All of these mechanical changes occur simultaneously. Accordingly, a three-step algorithm was devised to separate each of the nine mechanical factors and correlate them with histological changes. Three sequential experimental studies were performed in 38 dogs following the algorithm. These experiments demonstrated that intimal thickening was best correlated with low flow velocity, a correlate of low shear stress, whereas medial thickening was best correlated with deformation in the circumferential direction.