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2% inward remodeling (P = .020; Fig 5). At implantation, the two femoral subgroups did not differ regarding animal weights (29.4 �� 6.3 vs 30.6 �� 0.8 kg; P > .9), the ID, or flow-conditions of the run-off suprapopliteal arteries (3.04 �� 0.26 vs 3.30 �� 0.36 mm; P > .5), nor were there any signs of luminal irregularities. Distinct neointimal proliferation EX 527 manufacturer and a 2.4 to 3.1 times increase in media thickness, together with an increase in adventitial collagen, led to a distinct thickening of the vein graft wall from 214 �� 67 to 797 �� 382 ��m (3.7 times; P = .002) for the femoral and from 208 �� 69 to 1062 �� 79 ��m; (5.2 times; P Vatalanib (PTK787) 2HCl effect of downstream disease into account, distinct site-specific remodeling trends emerged for coronary and femoral vein grafts: ? All coronary grafts showed a subintimal diameter constriction of 42% compared with most femoral grafts showing a subintimal diameter expansion of 31%. The correlation of these remodeling trends at termination with vessel dimensions and shear forces at implantation made accurate measurements of vessel dimensions a sine qua non. Because the functional effect of flow dynamics at implantation were related to pathomorphologic changes at explantation, two different assessment modes for vessel dimensions were applied at the two intervals, potentially raising concerns regarding direct comparability. Although minor intermeasurement deviations have been previously reported,13 diameter measurements showed virtually no differences between ultrasound imaging and angiography14 and ultrasound imaging and macromorphology,12 as applied in the current study. Moreover, by using M-mode, we were able to determine systolic vessel dimensions at implantation buy Docetaxel corresponding with perfusion-fixed dimensions at explantation that represented vessels arrested in systole. By relating downstream remodeling to initial hemodynamic forces, we could confirm size mismatch between vein grafts and their target arteries as an over-riding determinant. Merely on the basis of size difference between the target arteries��otherwise presuming identical inflow and outflow conditions��coronary grafts would experience a fourfold to ninefold lower blood flow than femoropopliteal bypass grafts. However, native coronary arteries are perfused during both cardiac cycles with a moderate systolic and a predominant diastolic component, often showing an early systolic reverse flow.15 Femoral arteries, in contrast, experience predominantly systolic flow and a relatively high peripheral resistance.