1. Compounding
Pharmacies' Potential to
Create Graft Storage
Solutions for Bypass
Surgeries
HTTPS://WWW.IJPC.COM/ABSTRACTS/ABSTRACT.CFM?ABS=4032

2. Author(s): Guth Michael AS
Issue: Sep/Oct 2015 - Volume 19,
Number 5, International Journal of
Pharmaceutical compounding

3.  Abstract: Several studies have addressed the optimal storage conditions for vascular
grafts during bypass surgery. These studies have repeatedly shown that placing vascular
graft conduits in isotonic saline solutions, and to a lesser extent in heparinized autologous
blood, leads to a profound decline in endothelial cell viability. Endothelial damage to vein
grafts can occur at multiple points during a coronary artery bypass graft surgery
procedure: graft harvesting, handling, flushing, storage, anastomosis, and arterialization
(e.g., damage caused by exposure to arterial blood pressure). This damage to endothelial
cells causes the release of pro-inflammatory chemical signals that trigger thrombosis,
intimal hyperplasia, and accelerated graft atherosclerosis, all of which ultimately
contribute to graft failure. Cardiothoracic surgeons performing coronary artery bypass
graft surgery and vascular surgeons performing peripheral artery bypass graft surgery
have attempted to overcome the damage to the vascular grafts by using buffers to
maintain the physiological pH of the storage solution. However, the endothelial layers in
the grafts would benefit from having proper oxygenation and antioxidants added to the
storage solution. Compounding pharmacies can perform a vital role in ensuring the
patency of the vascular grafts by creating compounded flushing and storage solutions
that have an optimal mix of nitric oxide substrates, antioxidants, and other nutrients for
the endothelium. Maintaining structural and functional viability of the endothelia in grafts
by using an appropriate vessel storage medium would lead to improved long-term graft
patency.

4.  Related Keywords: Michael A.S. Guth, PhD, JD, coronary artery
bypass graft, CABG, peripheral artery bypass graft, saphenous
vein harvest, vascular graft, blood vessels, arterial blockage,
cardioplegic solutions, graft flushing and storage solution,
amino acids, Krebs-Henseleit buffer, Krebs-Henseleit solution,
class II medical device, basal salt solutions, irrigation,
transport, cellular osmotic balance, cell metabolism,
formulation, preservation of endothelial cell function, cyclic
guanosine monophosphate, cGMP, nitric oxide substrates,
adenosine triphosphate, ATP, arginine, citrulline malate,
superoxide dismutase, SOD, luteolin, ellagic acid, punicic acid,
punicalagin, angiogenesis, antioxidants
 Related Categories: FORMULATIONS, CARDIOLOGY