Abstract
Saphenous vein grafts (SV) used in coronary artery bypass grafting have a limited life and vein occlusion may be the final adverse effect. Efforts to develop new techniques to harvest the saphenous vein may improve the viability of the graft. Twenty patients were randomly divided into two groups with the objective of evaluating the vascular endothelium. The No Touch (NT) technique consists in removing the saphenous vein with perivascular tissue. The conventional technique consists in harvesting with "in situ" removal of the perivascular tissue. The standard saphenous vein harvesting procedure used bridged incisions. Characteristics of the vein were considered. Evaluation of the endothelium was achieved by electron microscopy and histologic analysis using hematoxylin eosin staining. The Picrosirius and Masson Trichrome methods were used to analyze subendothelial collagen. Electron microscopy demonstrated that the NT Group had larger non-denudated endothelial areas as well as a smaller number of degraded cells. Histological analysis showed the form and integrity of the saphenous vein layers. A larger amount of collagen fibers were identified in the NT Group. The NT technique better preserves the saphenous vein endothelium suggesting a more viable graft in the long term.
Highlights
Atherosclerotic artery disease is the most common cause of morbidity and mortality in industrialized nations
This study aims, by means of histological and ultrastructural studies, to reinforce the evidence that the so-called “No-touch” technique of saphenous vein (SV) harvesting is better the traditional methods
The electronic microscopic analysis of the surgical samples demonstrated that the “No-touch” Group had larger areas of endothelium without denudation, as well as a smaller number of cells degraded in the handling process (Figures 3 to 6)
Summary
Atherosclerotic artery disease is the most common cause of morbidity and mortality in industrialized nations. More than one million people die annually from coronary artery disease [1]. Coronary artery bypass grafting (CABG) is one of the most frequent procedures performed worldwide, with, over the last three decades since the first direct CABG, many advances being introduced principally in respect to the concepts concerning atherosclerosis, technology and surgical technique. One of the key elements to long-term success of CABG is the choice of the ideal graft. Analyses, such as the state of native coronary arteries, the co-morbidities, the clinical presentation and the possibility of flow steal are all important in the choice of the graft to be employed. The most commonly used grafts are the left internal thoracic artery (LITA) (mammary); the right internal thoracic artery (RITA); the radial artery (RA); gastroepiploic artery (GA); inferior epigastric artery (IEA) and the great saphenous vein (SV) [2]
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