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The Vasa Vasorum and Associated Endothelial Nitric Oxide Synthase is More Important for Saphenous Vein Than Arterial Bypass Grafts
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Region rebro County, Örebro, Sweden.ORCID iD: 0000-0001-5585-1783
Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
Department of Statistics, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
Department of Rheumatology, Royal Free and University College Medical School, London, UK.
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2013 (English)In: Angiology, ISSN 0003-3197, E-ISSN 1940-1574, Vol. 64, no 4, p. 293-299Article in journal (Refereed) Published
Abstract [en]

No-touch (NT) saphenous vein (SV) grafts are superior to SVs harvested by the conventional technique (CT), with a patency comparable with the internal thoracic artery (ITA). Preservation of the vasa vasorum is implicated in the success of NT harvesting. We compared the vasa vasorum and endothelial nitric oxide synthase (eNOS) in NT SV with ITA and radial artery (RA) grafts. Skeletonized SV (SSV) was also analyzed. The NT SV had a higher number and larger vasa vasorum compared with ITA (P = .0001) and RA (P = .0004) that correlated with eNOS protein. Activity of eNOS in SSV grafts was significantly lower than NT SV grafts (P = 004). Since a high proportion of the vasa vasorum are removed in SSV using the CT, we suggest that preservation of the vasa vasorum and eNOS-derived NO contributes to the high patency for NT as compared with SSV grafts.

Place, publisher, year, edition, pages
2013. Vol. 64, no 4, p. 293-299
Keywords [en]
coronary artery bypass surgery, saphenous vein, internal thoracic artery, radial artery, vasa vasorum, endothelial nitric oxide synthase
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-33267DOI: 10.1177/0003319712443729ISI: 000317008800007OAI: oai:DiVA.org:oru-33267DiVA, id: diva2:690499
Available from: 2014-01-23 Created: 2014-01-23 Last updated: 2018-09-11Bibliographically 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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Dreifaldt, MatsBodin, Lennart

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Dreifaldt, MatsSouza, Domingos S. R.Bodin, Lennart
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