ENDOTHELIAL-CELL INJURY IN CARDIOVASCULAR-SURGERY - THE INTIMAL HYPERPLASTIC RESPONSE

Arteries and veins respond to injury by a healing process that include s the development of a neointima. This response to injury is implicate d as the primary cause of failure after arterial reconstruction. Becau se it is an integrator and transmitter of blood flow variations, infla mmation, and growth stimuli, the endothelium is a potent regulator of long-term arterial wall mass changes. The contribution of the endothel ium to intimal development depends on the type of arterial conduit. In arteries, the growth of the intima stops when the endothelium has reg rown. In synthetic grafts, the endothelium stabilizes intimal growth. Hence, the mere presence of endothelial cells can influence intimal ch anges in arterial conduits. Understanding endothelial biology should h elp us define methods to prevent cell proliferation, extracellular mat rix accumulation, intimal hyperplasia, and vessel narrowing. (C) 1997 by The Society of Thoracic Surgeons.