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Department of Pathology, Montreal Heart Institute, Quebec, Canada.
In 72% of 143 patients undergoing a second coronary bypass grafting, mural or occlusive late thrombosis was observed histologically in 69% of 173 resected grafts. Late thrombosis was particularly prevalent in atherosclerotic grafts (80.2% vs. 40.4% in nonatherosclerotic grafts) and was always noted in 16 grafts with aneurysmal dilation. Multivariate analysis of risk factors contributing to late thrombosis indicated that graft atherosclerosis and smoking after graft surgery played important roles. Univariate analysis also showed significantly higher ratios of serum total cholesterol/HDL cholesterol and of serum LDL cholesterol/HDL cholesterol in patients whose grafts were affected by late thrombosis. To prevent late thrombosis of saphenous vein aortocoronary grafts, it appears reasonable that decreasing the ratios of total cholesterol/HDL cholesterol and of LDL cholesterol/HDL cholesterol, refraining from smoking, and controlling other risk factors for atherosclerosis should be advised.
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