Grants We Funded

Abstract
Venous conduits are used for coronary artery bypass grafts (CABG), peripheral arterial disease and microsurgical reconstruction of the extremities. Saphenous vein grafts (SVG) are the conduits most commonly used for CABG, but they have poor long term patency rates compared to arterial grafts. Whereas 90% of internal mammary artery grafts are patent after 10 years, only ~50% of SVG remain patent. This is due to accelerated atherosclerosis of the grafts. Suboptimal outcomes of venous grafts for arterial reconstruction have also been published in plastic and vascular surgery. Accelerated atherosclerosis begins as intimal hyperplasia (IH), which is a consequence of intimal injury, from: surgical trauma; and most importantly, over-stretching of the vein graft as it is exposed to arterial pressure. Therefore, IH can be prevented if the stretch is limited. This has been validated by placing cumbersome external sheaths around vein grafts. Photochemical Tissue Passivation (PTP) is a technology developed in our institution that crosslinks surface collagen by a light activated process. The tissue is coated with a photosensitizing dye that is activated by a laser; resulting in collagen cross-linking along the surface of the tissue, which stiffens it. We have shown that PTP can significantly increase the elasticity modulus of porcine veins (i.e. make them stiffer). For in-vivo testing, we have modeled IH by making an interposition graft in the femoral artery of a rat using epigastric vein. Preliminary data shows histologic evidence of intimal hyperplasia by two weeks within the untreated vein graft. We believe that by treating the venous graft with PTP prior to its connection into the arterial system, we can diminish the intimal injury caused by stretch and prevent intimal hyperplasia. This could greatly improve the long term patency rates of the hundreds of thousands of venous grafts used yearly in the U.S. for CABG, peripheral arterial disease, and microsurgical procedures.

Biography
Dr. Salinas attended the University of Miami in Coral Gables, Florida, where he graduated Magna Cum Laude with a degree in Biomedical Engineering in 2004. In 2009, Dr. Salinas graduated from The Mount Sinai School of Medicine in New York, NY. In residency, he continued to work on clinical outcomes research, publishing two first author papers and an invited clinical review and awarding him best resident presentation at the New England Society of Colorectal Surgeons in 2011. During residency, Dr. Salinas joined Dr. William G. Austen Jr. for a two year, full-time research fellowship at the Massachusetts General Hospital. For this endeavor, he was awarded the V.H. Kazanjian Research Fellowship by Harvard Medical School. While in the laboratory, he worked on a novel approach for prevention of vein graft intimal hyperplasia and several clinical outcomes project. This year, Dr. Salinas applied and matched into the Harvard Combined Plastic Surgery Residency, which he will begin on July 1st, 2014.