The Role of TGF- Signaling in Saphenous Vein Graft Failure after Peripheral Arterial Disease Bypass Surgery

Saphenous vein bypass grafting is an effective technique used to treat peripheral arterial disease (PAD). However, restenosis is the major clinical challenge for the graft vessel among people with PAD postoperation. We hypothesize that there is a common culprit behind arterial occlusion and graft restenosis. To investigate this hypothesis, we found TGF-beta, a gene specifically upregulated in PAD arteries, by bioinformatics analysis. TGF-beta has a wide range of biological activities and plays an important role in vascular remodeling. We discuss the molecular pathway of TGF-beta and elucidate its mechanism in vascular remodeling and intimal hyperplasia, including EMT, extracellular matrix deposition, and fibrosis, which are the important pathways contributing to stenosis. Additionally, we present a case report of a patient with graft restenosis linked to the TGF-beta pathway. Finally, we discuss the potential applications of targeting the TGF-beta pathway in the clinic to improve the long-term patency of vein grafts.