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The ‘‘no-touch’’ harvesting technique for vein grafts in coronary artery bypass surgery preserves an intact vasa vasorum
Departments of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0001-5585-1783
Departments of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden.
Departments of Inflammation, UCL Medical School, London, United Kingdom.
UCL Medical School, London, United Kingdom.
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2011 (English)In: The Internet Journal of Thoracic and Cardiovascular Surgery, ISSN 1524-0274, Vol. 141, no 1, p. 145-150Article in journal (Refereed) Published
Abstract [en]

Objectives: Our objective was to evaluate the impact of vein graft harvesting technique on structure and function of vasa vasorum.

Methods: Paired segments of great saphenous veins harvested either with conventional harvesting technique or no-touch technique were obtained from 9 consecutive patients undergoing coronary artery bypass grafting. Quantitative measurements, using immunohistochemistry and morphometry, were performed. Ultrastructural analyses of vasa vasorum were performed with electron microscopy. Video footage of superficial vasa vasorum in an implanted saphenous vein graft harvested with the no-touch technique was captured during a coronary bypass operation and is presented for online viewing.

Results: The total area of vasa vasorum in vein grafts harvested with the conventional technique was significantly reduced both in the media (P¼.007) and in the adventitia (P¼.014) compared with vein grafts harvested with the no-touch technique. Ultrastructural findings indicated that the no-touch technique preserved an intact vasa vasorum whereas the conventional technique did not. Video footage showed retrograde flow in the vasa vasorum in vein graft harvested with the no-touch technique.

Conclusions: These findings showthat the no-touch technique for saphenous vein graft harvesting for coronary bypass grafting preserves an intact vasa vasorum. This could represent one of the mechanisms underlying the improved patency of saphenous vein grafts harvested with this technique.

Place, publisher, year, edition, pages
New York, USA: Elsevier, 2011. Vol. 141, no 1, p. 145-150
National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-33266DOI: 10.1016/j.jtcvs.2010.02.005ISI: 000285407500026PubMedID: 20381817Scopus ID: 2-s2.0-78650266270OAI: oai:DiVA.org:oru-33266DiVA, id: diva2:690493
Available from: 2014-01-23 Created: 2014-01-23 Last updated: 2018-05-05Bibliographically approved
In thesis
1. Conduits in coronary artery bypass grafting surgery: Saphenous vein, radial and internal thoracic arteries
Open this publication in new window or tab >>Conduits in coronary artery bypass grafting surgery: Saphenous vein, radial and internal thoracic arteries
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A novel technique for saphenous vein (SV) graft harvesting, the No-touch technique (NT), has been developed at the Dept. of Cardiovascular surgery, Örebro University hospital. With NT the SV is harvested with a pedicle of surrounding tissue. This avoids graft spasm and eliminates the need for distension. The surrounding tissue acts as a structural support and is a rich source of vaso-dilating agents. A randomized controlled trial (RCT) has shown a significantly higher patency rate for NT SV grafts compared to SV grafts harvested with conventional technique (CT). This thesis evaluates some of the properties of the surrounding tissue and compares patency rates between NT SV and radial artery (RA) grafts and patency rates for internal thoracic artery (ITA) grafts harvested with and without surrounding tissue. Paper I investigated vasa vasorum (VV) in SV grafts and showed that the NT preserves an intact VV whereas CT does not. This could be one of the mechanisms underlying the improved patency for NT SV grafts. Paper II evaluated VV and associated nitric oxide (NO) in SV and arterial grafts. SV grafts showed a higher number and larger VV, which correlated with NO production, compared to arterial grafts. NT SV grafts showed higher activity for e-NOS compared to CT SV grafts. Paper III is a RCT comparing patency rates between NT SV and RA grafts, three years after surgery, showing a significantly higher patency rate for NT SV grafts. Paper IV is a RCT comparing patency rates for ITA graft harvested with and without surrounding tissue and did not show any difference between graft preparations. In conclusion, the NT for SV graft harvesting preserves an intact vasa vasorum and associated NO production. NT SV grafts show a higher patency rate than RA grafts. Harvesting of ITA with or without surrounding tissue does not affect patency rate. 

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2013. p. 65
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 93
Keywords
Cardiac surgery, Coronary artery bypass, Saphenous vein, Radial artery, Internal thoracic artery, Vasa vasorum, Nitric oxide, Graft patency
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-33265 (URN)978-91-7668-960-8 (ISBN)
Public defence
2013-10-11, Wilandersalen, Universitetssjukhuset, Örebro, Södra Grev Rosengatan, 703 62 Örebro, 13:15 (Swedish)
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Available from: 2014-01-23 Created: 2014-01-23 Last updated: 2017-10-17Bibliographically approved

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