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• W2099694663 abstract "It is 37 years since Favarolo’s article1Favarolo R.G. Saphenous vein graft in the surgical treatment of coronary artery disease: operative technique.J Thorac Cardiovasc Surg. 1969; 58: 178-185PubMed Google Scholar introducing the saphenous vein as a bypass graft appeared in the Journal of Thoracic and Cardiovascular Surgery. A novel “no-touch” technique of preparing this vessel has been described,2Souza D. A new “no-touch” preparation technique.Scand J Thorac Cardiovasc Surg. 1996; 30: 41-44Crossref PubMed Scopus (88) Google Scholar and the long-term follow-up study recently reported in the Journal shows that, with this technique, the patency rate of the saphenous vein may be improved to a rate equal to that of the internal thoracic artery.3Souza D.S.R. Johansson B. Bojö L. Karlsson R. Geijer H. Filbey D. et al.Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results from a randomized longitudinal trial.J Thorac Cardiovasc Surg. 2006; 132: 373-378Abstract Full Text Full Text PDF PubMed Scopus (169) Google Scholar Although the saphenous vein is the most commonly used conduit for coronary artery bypass grafting, its patency rate is poor, with 15% to 30% of grafts occluding in the first year and over 50% within 10 years.4Mehta D. Izzat M.B. Bryan A.J. Angelini G.D. Towards the prevention of vein graft failure.Int J Cardiol. 1997; 62: S55-S63Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar Along with many others, as basic research scientists, we are surprised by the degree of damage inflicted on the saphenous vein during conventional bypass surgery. It seems, when harvesting this vessel as a graft, many surgeons are in effect preparing a “tube” or “pipe” (common definitions of conduit) with no regard to its many vital vascular structures. The contribution of tissue damage to graft occlusion has been recognized for some time, and various attempts at reducing surgical trauma have been introduced, ranging from the use of a system of “bent rod of rubber and sutures”5Gottlob R. The preservation of the venous endothelium by “dissecting without touching” and by an atraumatic technique of vascular anastomosis.Minerva Chir. 1977; 32: 693-700PubMed Google Scholar to the use of local vasodilators6Tsui J.C. Dashwood M.R. Recent strategies to reduce vein graft occlusion: a need to limit the effect of vascular damage.Eur J Vasc Endovasc Surg. 2002; 23: 202-208Abstract Full Text PDF PubMed Scopus (51) Google Scholar and the “Souza no-touch technique.”2Souza D. A new “no-touch” preparation technique.Scand J Thorac Cardiovasc Surg. 1996; 30: 41-44Crossref PubMed Scopus (88) Google Scholar In conventional methods of harvesting, the vein is isolated from its surrounding connective tissue, trauma that causes a high proportion of vessels to go into spasm. Although vasodilators may be used to overcome spasm, high-pressure intraluminal distention is mostly used, resulting in damage to the luminal endothelium (Figure 1). This influences endothelium-derived factors, such as nitric oxide, affecting vessel tone, cell proliferation, and thrombus formation.6Tsui J.C. Dashwood M.R. Recent strategies to reduce vein graft occlusion: a need to limit the effect of vascular damage.Eur J Vasc Endovasc Surg. 2002; 23: 202-208Abstract Full Text PDF PubMed Scopus (51) Google Scholar In addition, the width of the vein wall is markedly reduced (Figure 1) and the vascular smooth muscle cells are distorted. Last, the outer vessel wall layer, the adventitia, is generally removed or damaged during harvesting of the vein. This may play an important part in the subsequent processes involved in graft occlusion because the adventitia does not merely provide structural support for the media, but contains the vasa vasorum, a microvascular network responsible for the exchange of gases and supply of nutrients to the vein wall. Clearly, damage to segments of the saphenous vein during harvesting as a graft is inevitable. Although this isolated segment of vein is “disconnected” from its vascular bed, the supply of blood to medial and adventitial structures will be maintained by the retrograde blood flow observed through the vasa vasorum in “no-touch” vein grafts at implantation.3Souza D.S.R. Johansson B. Bojö L. Karlsson R. Geijer H. Filbey D. et al.Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results from a randomized longitudinal trial.J Thorac Cardiovasc Surg. 2006; 132: 373-378Abstract Full Text Full Text PDF PubMed Scopus (169) Google Scholar Furthermore, the connective tissue surrounding the vein when the “Souza no-touch” technique is used may act as a buffer against coronary arterial hemodynamics, “protecting” the graft in very much the same way that has been suggested with the use of experimental external stents.4Mehta D. Izzat M.B. Bryan A.J. Angelini G.D. Towards the prevention of vein graft failure.Int J Cardiol. 1997; 62: S55-S63Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar We propose that damage to the saphenous vein during conventional coronary artery bypass grafting is a major contribution to graft failure and suggest that improved patency may be achieved simply by reducing vascular damage by use of less traumatic harvesting techniques." @default.
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• W2099694663 title "Surgical damage of the saphenous vein and graft patency" @default.
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