"No-touch" Technique using Saphenous Vein Harvested with its Surrounding Tissue for Coronary Artery Bypass Grafting Maintains an Intact Endothelium

Souza, Domingos; Christofferson, Rolf; Bomfim, Vollmer; Filbey, Derek

doi:10.1080/14017439950141362

Cited by 59 publications

(14 citation statements)

References 21 publications

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“…While some authors report such a termination [33, 34] others deny it [4] or report that VV terminate in main tributaries [15]. We could not find a direct opening of venae vasorum into the lumen of HGSV as in all our specimens injected via the external iliac artery (India ink injections) or via the VV arterial feeders (Mercox resin injection) no injection material was found in the HGSV lumen.…”

Section: Discussionmentioning

confidence: 41%

Architectonic Arrangement of the Vasa Vasorum of the Human Great Saphenous Vein

Kachlík¹,

Báča²,

Stingl³

et al. 2007

J Vasc Res

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Objective: The detailed spatial arrangement of the vasa vasorum (VV) of the human great saphenous vein (HGSV) was demonstrated in qualitative and quantitative terms. Materials and Methods: Segments of the HGSV taken from cadavers 12–24 h post mortem and from patients undergoing aortocoronary bypassing were studied by light microscopy of India-ink-injected specimens and by scanning electron microscopy of vascular corrosion casts. Results: Arterial feeders were found to approach the HGSV from nearby arteries every 15 mm forming a rich capillary network within the adventitia and the outer two thirds of the media in normal HGSV, while in HGSV with intimal hyperplasia capillary meshes extended into the inner layers of the media. Within the media, capillary meshes ran circularly. Postcapillary venules drained centrifugally towards the adventitial venous vessels which finally formed venous drainers running adjacent to the arterial feeders. Three-dimensional morphometry of vascular corrosion casts of VV revealed that diameters of (i) arterial VV ranged from 11.6 to 36.6 µm, (ii) capillary VV from 4.7 to 11.6 µm and (iii) venous VV ranged from 11.6 to 200.3 µm. Conclusions: The 3D network of VV suggests these layers are metabolically highly active and therefore require a continuous blood supply. We conclude, therefore, that the VV network must be preserved during in situ bypassing.

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Section: Discussionmentioning

confidence: 41%

Architectonic Arrangement of the Vasa Vasorum of the Human Great Saphenous Vein

Kachlík¹,

Báča²,

Stingl³

et al. 2007

J Vasc Res

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“…A number of factors may contribute to the beneficial results using no-touch-harvested veins. For example, since spasm is not encountered using this technique, high-pressure saline distension is not required and, unlike conventionally prepared veins, the luminal endothelium remains intact [15, 16]. Also, the effects of arterial haemodynamics are reduced through the buffering capacity of the vein’s surrounding cushion of tissue, where it may act as an ‘external biological stent’ [17, 18].…”

Section: Discussionmentioning

confidence: 99%

Does Periadventitial Fat-Derived Nitric Oxide Play a Role in Improved Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Surgery?

Dashwood¹,

Dooley²,

et al. 2007

J Vasc Res

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Background/Aims: The saphenous vein is commonly used for coronary artery bypass surgery but its patency is poor. Vascular damage occurs during conventional surgery. However, patency improves when the graft is harvested with minimal surgical trauma, partly due to preservation of vascular endothelial nitric oxide synthase (eNOS) and tissue sources of nitric oxide (NO), a factor possessing both dilatory and anti-proliferative properties. Apart from these grafts exhibiting an intact luminal endothelium they are harvested complete with a surrounding cushion of tissue, much of which is fat. Methods: Immunostaining for eNOS was performed on vein graft sections and reverse-transcriptase polymerase chain reaction and Western blotting were used to identify eNOS mRNA and protein. NO synthase activity was measured using the citrulline assay. Results: Immunohistochemistry identified eNOS staining of vein graft segments, including dense staining of the cushion of perivascular fat and associated structures surrounding the vein. eNOS protein was confirmed in both the vein and surrounding fat by Western blot analysis. Using the citrulline assay, the perivascular fat and underlying vein possessed comparable NO synthase activity. Conclusions: Our observations suggest that perivascular fat-derived NO plays a beneficial role in saphenous veins harvested atraumatically and used as grafts in patients undergoing coronary artery bypass surgery.

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“…The return of palmar blush within 5-10 seconds is considered positive (normal) modified Allen’s test (6). All grafts (SV, RA and IMA) were harvested using ‘no-touch’ technique along with their pedicles as previously explained (7). No vasodilatory agent was applied before placement of the graft into the Krebs solution.…”

Section: Methodsmentioning

confidence: 99%

Comparison of endothelial function of coronary artery bypass grafts in diabetic and nondiabetic patients: Which graft offers the best?

Gür

Gür²,

Gürkan³

et al. 2015

Anatol J Cardiol

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Objective:Diabetes associated endothelial dysfunction, which determines both long and short term graft patency, is not uniform in all coronary artery bypass surgery (CABG) grafts. Herein this study, we aimed to investigate the degree of endothelial dysfunction in diabetic radial artery (RA), internal mammarian artery (IMA) and saphenous vein (SV) grafts in vitro tissue bath system.Methods:This is a prospective experimental study. Fifteen diabetic and 15 non-diabetic patients were included to the study. A total number of 96 graft samples were collected; 16 graft samples for each graft type from both diabetic and non-diabetic patients. Arterial grafts were harvested with pedicles and SV grafts were harvested by ‘no touch’ technique. Vasodilatation response of vascular rings to carbachol, which induces nitric oxide (NO) mediated vasodilatation, was designated as the measure of endothelial function.Results:The IMA grafts had the most prominent NO mediated vasodilatation in both diabetic and non-diabetic patients, concluding a better preserved endothelial function than SV and RA. The ‘no-touch’ SV and RA grafts had similar vasodilatation responses in non-diabetic patients. In diabetic patients, on the other hand, RA grafts exhibited the least vasodilatation response (ie. worst endothelial function), even less vasodilatation than ‘no touch’ SV grafts (p<0.0001).Conclusion:Deteriorated function of RA grafts in diabetic patients, even worse than SV grafts made evident by this study, encourages the use of ‘no touch’ technique as the method of SV harvesting and more meticulous imaging of RA before its use as a graft in diabetic patients.

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"No-touch" Technique using Saphenous Vein Harvested with its Surrounding Tissue for Coronary Artery Bypass Grafting Maintains an Intact Endothelium

Cited by 59 publications

References 21 publications

Architectonic Arrangement of the Vasa Vasorum of the Human Great Saphenous Vein

Architectonic Arrangement of the Vasa Vasorum of the Human Great Saphenous Vein

Does Periadventitial Fat-Derived Nitric Oxide Play a Role in Improved Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Surgery?

Comparison of endothelial function of coronary artery bypass grafts in diabetic and nondiabetic patients: Which graft offers the best?

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