Effects of dipyridamole and methylprednisolone on intimal thickening in vein grafts

Fibrous intimal proliferation severe enough to produce occlusion has been observed in vein segments used for aorta-coronary bypass grafts. In an attempt to improve graft patency and decrease intimal fibrous thickening, animals with vein grafts were treated with dipyridamole or methylprednisolone for 8 to 12 weeks. Femoral vein segments were used to bypass the femoral artery in 36 dogs. Thirty-four of these grafts were patent at 8 weeks, with no statistically significant differences between control and drug treatment groups. Intimal thickness measurements were taken at three different points along the graft: proximal (upstream end), middle, and distal (downstream end). Dogs treated with methylprednisolone had significantly less intimal thickening (214 versus 125 μ, p < 0.05) than did control animals in the middle of the veins, but there was no difference in thickness measurements at the proximal and distal ends. Dipyridamole-treated animals did not differ from control dogs. Although these data show decreasing intimal thickening in the middle of grafts with methylprednisolone therapy, the intimal thickness was still considerably greater than normal. The lack of response near the anastomotic sites suggests that clinical application of either agent to improve long-term patency is unwarranted.