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High early patency of saphenous vein graft for coronary artery bypass harvested with surrounding tissue
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
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2001 In: Ann Thorac Surg, no 71, 797-800 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
2001. no 71, 797-800 p.
Identifiers
URN: urn:nbn:se:uu:diva-89622OAI: oai:DiVA.org:uu-89622DiVA: diva2:161266
Available from: 2002-02-22 Created: 2002-02-22Bibliographically approved
In thesis
1. Harvesting of Saphenous Vein for Coronary Artery Bypass Grafting: An Improved Technique that Maintains Vein Wall Integrity and Provides a High Early Patency Rate
Open this publication in new window or tab >>Harvesting of Saphenous Vein for Coronary Artery Bypass Grafting: An Improved Technique that Maintains Vein Wall Integrity and Provides a High Early Patency Rate
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The primary aim of this thesis was to modify saphenous vein (SV) harvesting technique and evaluate its clinical importance. A new "no touch" (NT) technique of SV preparation was developed where the vein is harvested with a pedicle of surrounding tissue, which protects the vein from spasm therefore obviating the need for distension.

Firstly, a prospective randomised study in 156 patients who underwent coronary artery bypass grafting was done to compare this new "no touch" technique to two others, the conventional (C) and the intermediate (I) techniques. A morphological study of the endothelium showed an endothelial integrity of 97% in NT vessels while about half of endothelial surface of veins harvested by the other two techniques was devoid of endothelium. At angiographic follow up, the patency for NT was 95.4%, 88.9% for grafts in group C and 86.2% for grafts in group I. A statistically significant difference in patency rate was found between the NT group and group C (p=0.025) and the poorest result was observed in group I.

Secondly, the immunohistochemistry assessment using CD31-antibody confirmed a better-preserved endothelium for NT vessels. Putative NOS was identified by NADPH-diaphorase histochemistry and autoradiographic localization of [3H] L-nitroarginine (NOARG) binding. NADPH staining was almost continuous on the luminal aspect and was also present in the intact adventitia of NT vessels, which was markedly reduced in conventionally harvested veins. Autoradiographic analysis of specific NOARG binding showed greater binding in the no-touch vessels, confirming the histochemistry results. All three NOS isoforms were identified in the media of SV grafts. In NT, NOS I was abundant in adventitial nerves; NOS II was found in adventitial vasa vasorum and NOS III was associated with endothelial cells lining both the vessel lumen and microvessels within the adventitia.

In conclusion, this study demonstrated that the endothelial integrity and NOS activity are better maintained when using the no-touch technique for vein graft harvesting. The vasorelaxant and thromboresistent activities of NO may be responsible for the reduced venospasm and improved early patency rates observed. Furthermore, the mechanical properties provided by the cushion of surrounding tissue in grafts harvested by NT technique may contribute to the observed high patency rate.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2002. 49 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1121
Keyword
Surgery, Saphenous vein, coronary bypass, endothelium, nitric oxide, patency rate, Kirurgi
National Category
Surgery
Research subject
Thoracic and Cardivascular Suregery
Identifiers
urn:nbn:se:uu:diva-1655 (URN)91-554-5232-9 (ISBN)
Public defence
2002-03-15, Robergsalen, ingång 40, 4 tr, UAS, Uppsala, 13:15
Opponent
Available from: 2002-02-22 Created: 2002-02-22Bibliographically approved

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