Surgical Aspects of No-Touch Saphenous Vein Graft Harvesting in CABG: Clinical and Angiographic Follow-Up at 3 Months

Abstract

With more than 800,000 coronary artery bypass grafting (CABG) operations annually worldwide and the saphenous vein being the most common conduit used, there is no question that improving saphenous vein graft patency is one of the most important tasks in CABG. This video describes the no-touch harvesting procedure of the saphenous vein on an 80-year old man with hypertension, hyperlipidemia and a previous myocardial infarction with percutaneous coronary intervention to the right coronary artery. He was complaining of exertional chest pain and was diagnosed with stable angina pectoris. The coronary angiography showed advanced three vessel disease with significant stenoses in the left anterior descending (LAD) artery, two marginal arteries (MAs) and the posterior descending artery (PDA), in addition to an occluded diagonal artery (DA). The patient received a triple sequential no-touch vein graft to the PDA and two MAs together with a double sequential no-touch vein graft to the DA and LAD. A vein graft was used to bypass the LAD due to the age of the patient and the low degree of stenosis in the LAD. The no-touch harvesting technique is described in detail in the film with complete narration. A follow-up of this patient was performed at three months both clinically and with a computed tomography angiography (CTA). No angina pectoris symptoms were reported by the patient and the wounds in the chest and lower limb were completely healed. The CTA showed patent no-touch saphenous vein grafts to all the distal anastomoses.

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

“…Over two decades ago, the 'no-touch' (NT) technique of harvesting SV was introduced [13] . Using an atraumatic method, the vein is removed with a pedicle of surrounding tissue and with minimal vascular damage [14] . Subsequently, a randomized trial comparing C SVG and NT SVG has shown that the latter is superior in terms of patency rates and left ventricular ejection fraction at 1.5, 8.5, and 16 years postoperatively [15][16][17][18] , as seen in Table 1 from Samano et al [17] , 2015.…”

Saphenous veins in coronary artery bypass grafting need external support

“…Avoiding direct contact with the vessel prevents spasm and the need for manual distension. 25 Side-branches are ligated and divided at the same distance from the SV. After removal, the SV is stored in heparinized blood.…”

“…Hence, there is no need for distension and endothelial damage is minimized. 25 , 26 , 37 – 39 An additional beneficial effect of preserved outer layers of the SV is the protection conferred on the luminal endothelium once inserted as a graft and subjected to arterial hemodynamics. A study comparing sections of CT versus NT harvested SVs showed marked differences in endothelial integrity.…”

Quality of Life After Percutaneous Coronary Intervention in No-Touch Saphenous Vein Grafts is Significantly Better Than in Conventional Vein Grafts

“…No results have yet been reported regarding PCI of a saphenous vein harvested with the no-touch (NT) [ 14 ] technique or treated in any other way during the primary CABG operation. The no-touch technique differs from the conventional (C) technique in that it causes less endothelium damage during the harvesting procedure [ 15 - 17 ] , and leads to reduced neo-intimal hyperplasia and subsequent atherosclerosis in the long term [ 18 - 20 ] . Our group has previously investigated HRQoL in CABG patients who had received a no-touch vein graft [ 11 ] , but that study did not compare the no-touch technique with the conventional technique.…”