Rapidly progressive atherosclerosis in aortocoronary saphenous vein grafts. Possible immune-mediated disease.

One hundred fifteen aortocoronary saphenous vein grafts from 100 consecutive reoperations were examined. Ninety-nine percent of the grafts contained diffuse concentric intimal fibroplasia. Forty-six percent of the grafts were atherosclerotic. The atherosclerosis was typically rapid in development, concentric, diffuse, without a fibrous cap, with numerous foam cells and inflammatory cells, including multinucleate giant cells, with erosion of the media by the inflammatory reaction. The histologic features of the grafts were similar to those reported in experimental models of immune-mediated atherosclerosis. On this basis we propose that aortocoronary saphenous vein graft atherosclerosis, and possibly intimal fibroplasia, may be an immune-mediated disease.