Background Recent studies have suggested that endoscopic vein harvest (EVH) compromises graft patency. To test whether the learning curve for EVH alters conduit integrity owing to increased trauma compared with an open harvest, we analyzed the quality and early patency of conduits procured by technicians with varying EVH experience. Methods During coronary artery bypass grafting, veins were harvested open (n = 10) or by EVH (n = 85) performed by experienced (>900 cases, >30/month) versus novice <100 cases, <3/month) technicians. Harvested conduits were imaged intraoperatively using optical coherence tomography and on day 5 to assess graft patency using computed tomographic angiography. Results Conduits from experienced (n = 55) versus novice (n = 30) harvesters had similar lengths (33 versus 34 cm) and harvest times (32.4 versus 31.8 minutes). Conduit injury was noted in both EVH groups with similar distribution among disruption of the adventitia (62%), intimal tears at branch points (23%), and intimal or medial dissections (15%), but the incidence of these injuries was less with experienced harvesters and rare in veins procured with an open technique. Overall, the rate of graft attrition was similar between the two EVH groups (6.45% versus 4.34% of grafts; p = 0.552). However, vein grafts with at least 4 intimal or medial dissections showed significantly worse patency (67% versus 96% patency; p = 0.05). Conclusions High-resolution imaging confirmed that technicians inexperienced with EVH are more likely to cause intimal and deep vessel injury to the saphenous vein graft, which increases graft failure risk. Endoscopic vein harvest remains the most common technique for conduit harvest, making efforts to better monitor the learning curve an important public health issue.
Background: Rotator cuff disease is one of the most common condition afflicting shoulder joint. It includes spectrum from minimal bursal/articular inflammation of tendons to severe degenerative cuff tear/arthropathy. With advent in arthroscopic techniques, most RC tears are nowadays treated arthroscopically than open, miniopen or nonoperative management. The purpose of this prospective study is to assess results of arthroscopic repair of rotator cuff tear using UCLA (University of California at Los Angeles) and ASES (American Shoulder and Elbow Surgeons) shoulder scoring systems. Methods: 25 patients operated arthroscopically by single senior arthroscopic surgeon at Civil hospital, Ahmedabad, over a period of 30 months (Dec 2012 to June 2015) were followed for minimum of 12 months duration and included in study. Outcome measures used are preoperative and postoperative UCLA and ASES scores. A proforma was prepared to collect and analyse data using descriptive and inferential statistical methods. Results: In our study, we have measured UCLA and ASES scores over 12 months period. Our study shows improved functional outcome from UCLApresentation-12.2 and ASESpresentation-30.8 to UCLA12 months-30.64 and ASES12 months-77.43. Evident from our study, there is no significant gender difference in terms of incidence and postoperative functional outcome. Maximum incidence is seen in age group-41-50 years with etiological inclination towards precedent trauma. Conclusion: Arthroscopic repair of rotator cuff tear offers excellent functional outcome; with minimal morbidity. Improvement in pain, range of motion and strength of cuff tendons can be achieved only by meticulous repair techniques, adequate subacromial decompression, and strict rehabilitation programme.
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