“No-Touch” versus “Endo” Vein Harvest: Early Patency on Symptom-Directed Catheterization and Harvest Site Complications

Mannion, John D.; Marelli, Daniel; Brandt, Todd; Stallings, Megan; Cirks, Jeffery; Dreifaldt, Mats; Souza, Domingos

doi:10.1097/imi.0000000000000084

Cited by 17 publications

(24 citation statements)

References 26 publications

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“…When considering that EVH SVG's patency is, at best, comparable to OVH's patency, it seems reasonable to assume that NT SVGs will be superior to those prepared by EVH. This has been shown in a recent small, short-term study [72] . Interestingly, The National Institute for Health and Care Excellence (NICE) previous guidance in the United Kingdom advised that EVH should only be used with special arrangements [73] .…”

Section: Endoscopic Vein Harvestingsupporting

confidence: 57%

Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: Structural Observations and Impact on Graft Performance

Samano¹,

Souza²,

Pinheiro³

et al. 2020

Braz J Cardiovasc Surg

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The saphenous vein is the most common conduit used in coronary artery bypass grafting (CABG) yet its failure rate is higher compared to arterial grafts. An improvement in saphenous vein graft performance is therefore a major priority in CABG. No-touch harvesting of the saphenous vein is one of the few interventions that has shown improved patency rates, comparable to that of the left internal thoracic artery. After more than two decades of no-touch research, this technique is now recognized as a Class IIa recommendation in the 2018 European Society of Cardiology and the European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization. In this review, we describe the structural alterations that occur in conventional versus no-touch saphenous vein grafts and how these changes affect graft patency. In addition, we discuss various strategies aimed at repairing saphenous vein grafts prepared at conventional CABG.

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Section: Endoscopic Vein Harvestingsupporting

confidence: 57%

Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: Structural Observations and Impact on Graft Performance

Samano¹,

Souza²,

Pinheiro³

et al. 2020

Braz J Cardiovasc Surg

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“…An ideal situation would be to have a superior conduit combined with minimal risk of harvesting complications. Mannion and colleagues 4 showed in a recent study that NT vein grafts harvested with an open technique had a higher patency rate than did traditionally endoscopically harvested veins, but the NT group did have significantly higher harvest site complications. Our future aim therefore must be to harvest the SV with an endoscopic NT technique or to develop a minimally invasive NT technique.…”

Section: Long-term Patency Versus Leg Woundmentioning

confidence: 99%

Long-term patency versus leg wound healing in coronary artery bypass surgery: Surgical aspects of the no-touch harvesting technique

Souza

Samano

2016

The Journal of Thoracic and Cardiovascular Surgery

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TECHNIQUE Reply to the Editor:We thank Kopjar and colleagues for the constructive and thoughtful comments in their letter. We undoubtedly agree regarding the reluctance of surgeons to adopt the no-touch (NT) harvesting technique, despite considerable evidence supporting its contribution in improving the results of coronary artery bypass grafting. We believe that the main issue for preventing the NT technique from being internationally embraced is that it is a completely new technique for many and that all new surgical techniques require some considerable time for the surgeons to become familiar with and eventually implement them.Furthermore, if the NT technique is not used correctly, as previously described, 1 wound complications may occur more often. There are some aspects that are very important to improving wound healing, such as preoperative ultrasonographic mapping of the saphenous vein (SV). This practice has been shown to reduce the size of the scar and the harvest time, in addition to minimizing unnecessary incisions. 2 Likewise, mapping of the SV allows us to select in advance the segment of the SV most suitable for grafting.We emphasize that it is crucial to follow every aspect of the technique from harvesting to grafting. To be precise, it is not only essential to harvest the vein with a pedicle but also to avoid directly grasping the vein with surgical instruments. In addition, checking for leakage should be performed with the SV connected to the arterial line of the heart-lung machine, instead of with high-pressure distention by syringe.To date, we have operated on more than 3000 patients with the NT harvesting technique, and by implementing this technique as described previously we have managed to reduce wound healing complications considerably. This has also been shown in a recently published study, in which functional wound healing was similar between the NT and conventional harvesting techniques 12 months after surgery. 3 We are convinced that when cardiac surgeons get accustomed to the NT technique, they will appreciate and never abandon it.We would certainly prefer a conduit that performs longer, even if there is a higher risk for wound infection. An ideal situation would be to have a superior conduit combined with minimal risk of harvesting complications. Mannion and colleagues 4 showed in a recent study that NT vein grafts harvested with an open technique had a higher patency rate than did traditionally endoscopically harvested veins, but the NT group did have significantly higher harvest site complications. Our future aim therefore must be to harvest the SV with an endoscopic NT technique or to develop a minimally invasive NT technique. References1. Souza DS, Arbeus M, Botelho Pinheiro B, Filbey D. The no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting surgery. Multimed Man Cardiothoracic Surg. 2009;0731: doi: 10.1510/mmcts.2008.003624. 2. Broughton JD, Asopa S, Goodwin AT, Gildersleeve S. Could routine saphenous vein ultrasound mapping reduce leg wound c...

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“…The survey was sent to all OT nurses and surgeons, since it was not possible to select only those who performed CABG. The study-specific questionnaires were based on both existing research [1,2,8,9,11,[14][15][16][17][18] and the authors' own clinical experience as OT nurses, a nurse, and a cardiothoracic surgeon.…”

Section: Questionnairesmentioning

confidence: 99%

“…The surgical techniques used for harvesting the SV and closing the wound also play an important role in wound complications [8,9]. The open harvest technique, which uses a longitudinal skin incision over the vein, might facilitate the occurrence of wound complications.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative routines and surgical techniques for saphenous vein harvesting in CABG surgery: a national cross-sectional study in Sweden

Larsson

Nyman

Friberg

et al. 2020

J Cardiothorac Surg

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Background: The saphenous vein is the most commonly used conduit for coronary artery bypass grafting (CABG). Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2 to 20%. Patients' risk factors, perioperative hygiene routines, and surgical technique play important roles in wound complications. Here we describe the perioperative routines and surgical methods of Swedish operating theatre (OT) nurses and cardiac surgeons. Methods: A national cross-sectional survey with descriptive design was conducted to evaluate perioperative hygiene routines and surgical methods associated with saphenous vein harvesting in CABG. A web-based questionnaire was sent to OT nurses and cardiac surgeons at all eight hospitals performing CABG surgery in Sweden. Results: Responses were received from all hospitals. The total response rate was 62/119 (52%) among OT nurses and 56/111 (50%) among surgeons. Chlorhexidine 5 mg/mL in 70% ethanol was used at all eight hospitals. The OT nurses almost always (96.8%) performed the preoperative skin disinfection, usually for three to 5 minutes. Chlorhexidine was also commonly used before dressing the wound. Conventional technique was used by 78.6% of the surgeons, "no-touch" by 30.4%, and both techniques by 9%. None of the surgeons used endoscopic vein harvesting. Type of suture and technique used for closing the wound differed markedly between the centres. Conclusions: In this article we present insights into the hygiene routines and surgical methods currently used by OT nurses and cardiac surgeons in Sweden. The results indicate both similarities and differences between the centres. Local traditions might be the most important factors in determining which procedures are employed in the OT. There is a lack of evidence-based hygiene routines and surgical methods.

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“No-Touch” versus “Endo” Vein Harvest: Early Patency on Symptom-Directed Catheterization and Harvest Site Complications

Cited by 17 publications

References 26 publications

Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: Structural Observations and Impact on Graft Performance

Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: Structural Observations and Impact on Graft Performance

Long-term patency versus leg wound healing in coronary artery bypass surgery: Surgical aspects of the no-touch harvesting technique

Perioperative routines and surgical techniques for saphenous vein harvesting in CABG surgery: a national cross-sectional study in Sweden

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