Saphenous Vein Harvesting Research Articles

Endoscopic Versus Conventional Vein Harvest Technique: Histological and Immunohistochemical Evaluation of Venous Wall Integrity.

The introduction of endoscopic saphenous vein graft harvesting has been known for two decades. It offers benefits related to decreased rate of donner site complications. Debates related to its safety in terms of trauma to the wall of the venous graft and long-term graft patency have been raised, but few studies had investigated this point. Our aim is to compare the endoscopic saphenous vein harvest and conventional harvest techniques, in terms of the integrity of the wall of the vein graft. A prospective study in which we examined 80 samples of saphenous vein from 80 patients to whom coronary artery bypass grafting was done. Patients randomly were assigned to either technique. Vein samples were taken from patients having the conventional technique (group 1, 40 patients) and from patients having endoscopic vein harvest (group 2, 40 patients). Vein samples were stained with Hematoxylin & Eosin, Masson's trichrome, and immunohistochemical stain for CD 31 and then examined by light microscopy. The degree of intimal staining was graded from 0% to 100%, which is directly related to the degree of intimal preservation (the least injury, the more the staining score) and vein media changes were reported. Patient characteristics were comparable in the groups. Group 1 (conventional group) was better than group 2 (endoscopic group), regarding endothelial integrity and medial changes although it was statistically not significant. Both the conventional and endoscopic techniques are comparable, regarding the intimal preservation of the venous graft.

What is the benefit of venous mapping in saphenous vein harvesting?

What is the benefit of venous mapping in saphenous vein harvesting?

P11: Endoscopic Procurement of Saphenous Vein: a Hydraulic Conductivity and Microscopic Assessment

Background: Endoscopic saphenous vein harvest (ESVH) technique is an alternate and widely used conduit in coronary artery bypass grafting CABG in leu of the internal mammary artery (IMA). Unfortunately, multiple studies have shown low-patency rate in saphenous vein (SV) than IMA and prone to early atherosclerotic changes leading to obstruction. Thus, our goal was to explore the effects of physical distention on the endothelial integrity of SV by using hydraulic conductivity (HC) and scanning electron microscopy (SEM). Method: Saphenous vein conduits were collected intra-operatively from consented patients and procured at 37 °C. Vessel wall filtration rate was determined over 30-minute period at 100 mm Hg pressure and compared with baseline and negative control by using dialysis tubing, and isolated fresh swine carotid arteries. Conduits were stored in saline after harvest. Longitudinal sections of IMAs were fixed and dehydrated in various ethanol concentrations in deionized water for 15-minutes. Samples were then analyzed under SEM imaging. Result: Hydraulic conductivity of ESHV is tenfold higher than the pig carotid and dialysis tubing. Furthermore, SEM analyses of ESHV showed intimal injuries on the luminal surface. Conclusion: ESHV technique may increase the risk of traumatic handling by creating physical gaps in endothelial barrier. Alteration in vascular integrity may impact on permeability of larger molecules enhancing pathologic occlusive state and graft failure.

Efficacy of prophylactic platelet rich plasma (PRP) following open saphenous vein harvesting in cardiac surgery.

Wound infection represents a frequent trouble following open saphenous vein harvesting in cardiac surgery. Platelets' growth factors are crucial for the healing process. Prophylactic platelet rich plasma (PRP) application on leg wound might reduce the incidence of saphenous vein harvest site infections in patients undergoing coronary artery bypass graft surgery (CABG). Between January 2009 and December 2020, 987 consecutive patients underwent CABG using saphenous vein as conduit graft and were retrospectively divided into two groups. All patients had standard surgical leg wound closure and wound care, but treatment group received adjunctive topical application of PRP (no-PRP and PRP group, respectively). The primary outcome was wound infection. Saphenous vein harvest site infection rate was similar between PRP (3.5%) and No-PRP (5.2%) group, p = 0.215. The ASEPSIS score was lower for the PRP group (PRP: 3.6 ± 9.1 vs. No-PRP: 5.3 ± 11.2; p = 0.014). Performing a subgroup analysis, the diabetic patients (PRP-DM) group had a lower rate of infection than control group (No-PRP DM) (2.6% vs. 7.7%, p = 0.026). PRP-DM patients had an inferior ASEPSIS score (PRP-DM: 2.7 ± 8.3 vs. No PRP-DM: 7.5 ± 13.2, p < 0.001). Topical application of autologous PRP on saphenoug vein harvest site might reduce the rate of surgical site infection, with particular benefit among diabetic patients.

Thirty Years of No-Touch Saphenous Vein Harvesting: A Timely Jubilee Gift

Thirty Years of No-Touch Saphenous Vein Harvesting: A Timely Jubilee Gift

Endoscopic saphenous vein harvest in neurosurgery: Technical note

BackgroundEndoscopic saphenous vein (SV) graft harvesting was introduced in the neurosurgical field as an attractive alternative to open SV graft harvesting. Methods: The left leg was draped, and the subcutaneous vein was identified by ultrasonography. The vein was harvested with use of the endoscopic Vasoview vessel harvesting system. Results: We performed six endoscopic SV graft harvest procedures for extracranial–intracranial bypass and autologous vein patch angioplasty for carotid artery stenosis. Conclusion: A high-quality graft was harvested with a good cosmetic outcome.

The No-Touch Saphenous Vein Harvesting Improves Graft Patency After Off-Pump Coronary Artery Bypass Surgery: A Propensity-Matched Analysis.

IntroductionThis single-center study of propensity-matched data was performed to assess the effect of the no-touch saphenous vein (NTSV) harvesting technique on early- and long-term outcomes of patients after off-pump coronary artery bypass grafting (OPCABG) in China.MethodsA retrospective analysis of 767 patients who underwent OPCABG in the Beijing Anzhen Hospital (June 2017 to October 2021) was performed, and their data entered the conventional saphenous vein (CSV) harvesting technique group or the NTSV group. In-hospital and follow-up outcomes were evaluated by adjusting baseline characteristics using propensity score matching (1:1). Clinical outcomes and postoperative angiographic results were compared.ResultsThe saphenous vein graft patency rates at postoperative three months and one year for the NTSV group vs. CSV group were 99.6% vs. 96.2% (P<0.001) and 97.3% vs. 93.1% (P<0.001), respectively. The two matched groups received a significantly different cumulative incidence function of saphenous vein graft occlusion for the longer follow-up period in Kaplan-Meier curves (χ2=4.330, log-rank P=0.037). No difference in early- and long-term mortality or major adverse cardiac and cerebrovascular events (MACCE) were observed between the groups. The rate of MACCE was not statistically significant different between the groups, but there was a tendency favoring the no-touch technique (9.8% CSV vs. 4.8% NTSV; P=0.067). More patients in the NTSV group developed postoperative leg wound exudation (5.4% vs. 1.2%; P=0.032) and skin numbness (22.2% vs. 8.9%; P=0.001) than in the CSV group.ConclusionThe NTSV is an excellent conduit to be used in OPCABG. There remains a need to reduce leg wound complications.

Skin Closure After No-Touch Saphenous Vein Harvest: Strategies to Minimize Wound Complications.

The no-touch saphenous vein with surrounding pedicle tissue harvesting technique preserved endothelium and vessel wall integrity and demonstrated improved long-term saphenous vein conduit patency that was comparable to internal thoracic artery conduit patency. Despite improved saphenous vein conduit patency rates, there is a possibility that no-touch saphenous vein harvest may increase wound complication rates by increased tissue disruption, including venous and lymphatic channels. Comprehensive strategies to minimize leg wound complications after no-touch saphenous vein harvest are discussed.

Saphenous vein graft harvesting site dermatoses among CABG patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Coronary artery bypass grafting (CABG) is a cardiac surgical procedure in which the greater saphenous vein graft is most often used to bypass the narrowed coronary artery segments. The side effects of leg vein harvesting include a variety of cutaneous changes. We report the cutaneous effects at the saphenous vein harvesting sites in 32 patients who underwent CABG. To study the dermatoses occurring at the saphenous vein harvest site post CABG surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A prospective observational study on prevalence of saphenous vein harvesting site dermatoses in patients with CABG attending a tertiary care centre in Kanyakumari, for a period of 6 months from March 2021 to September 2021. The cutaneous changes on and around the saphenous vein (SV) graft donor site were noted in all patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 200 patients underwent CABG during the period of study, out of which 32 patients developed dermatitis at the vein harvesting site. At the donor site, Pruritus was the most common symptom seen in 14 (44%) patients, followed by eczema in 11 (34%) patients, xerosis in 9 (28%), hyperpigmentation in 6 (20%), depigmentation in 2 (3%), anesthesia in 3 (10%), neuralgic pain in 3 (8%), burning sensation in 2 (6%), hypertrophic scar in 3 (10%), and infections in 3 (9%) patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; To minimize the donor site complications following CABG, we recommend proper cutaneous and vascular evaluations, identifying the best graft site, employing meticulous surgical technique, recognizing complications early, and starting treatment without delay.&lt;/p&gt;

A review of the best method of leg wound closure following open harvesting of the long saphenous vein for coronary artery bypass grafting

Uncertainty exists around the optimal method of leg wound closure following open long saphenous vein harvesting in adults undergoing coronary artery bypass graft surgery (CABG). Such is evident from the variety observed in the closure approach utilised. Consequently, a best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘following open long saphenous vein harvesting in adults undergoing CABG, is single-layer leg wound closure superior to multiple-layer closure in terms of post-operative complications encountered? ‘. Altogether 382 papers on Ovid Embase and Ovid Medline, 301 papers on PubMed and 11 papers on the Cochrane database were found using the reported search. From the screened articles, 6 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that the best method of leg closure following open saphenous vein harvesting for CABG is single-layer cutaneous closure. The use of a suction drain to eliminate the dead space should be considered on a case-to-case basis by the lead operating surgeon with the patient's characteristics and their own expertise in mind.

Learning process and results in endoscopic saphenous vein harvesting technique

Background/Aim: Endoscopic saphenous vein graft harvesting (EVH) has been increasingly used in coronary bypass graft (CABG) surgery in recent years due to its cosmetic advantage and reduced morbidity. However, for the successful application of this technique, a learning process is required. In this study, we aimed to compare the results of the experience we obtained in the initial phase and later periods of the EVH technique. Methods: Forty patients who underwent elective CABG between July 2015 and April 2017 were included in this retrospective cohort study. The first 20 patients (Group 1) and the next 20 patients (Group 2), whose saphenous vein graft (SVG) was prepared with the EVH technique were compared. The length and preparation time of SVGs prepared with EVH, local findings such as hematoma, necrosis, wound infection, and healing, demographic data, comorbidity, intraoperative and postoperative data, postoperative intensive care and hospitalization times, cosmetic satisfaction and wearing compression stockings were recorded. Results: While the mean operation time was 201.4 (25.0) minutes in Group 1, it was 184.6 (17.1) minutes in Group 2 (P=0.018). There was no difference in the mean SVG lengths between the groups (P>0.05). While SVG preparation time was 75.3 (26.2) minutes in Group 1, it was 35.4 (6.0) minutes in Group 2 (P<0.001). The number of minor branch injuries in the SVG in Groups 1 and 2 were eight (40%), and two (10%), respectively, and all underwent primary repair (P<0.001). Mean length of hospital stay was similar between the groups (P=0.955). No hematoma, infection or necrosis requiring surgical intervention was observed in the extremity from which the SVG was taken. The use of compression stockings was longer in group 1 than in group 2 for the reduction or complete disappearance of edema (56.4 (23.3) vs 42.0 (19.4) days, P=0.040). No patient in any of the groups required rehospitalization due to infection at the saphenous vein incision site and incision healing problem. According to the satisfaction survey, cosmetic satisfaction was high in both groups (P=0.530). Conclusion: We think that after the completion of the learning process on twenty patients, the EVH technique can be used more widely, with much better results in terms of both patient cosmetic satisfaction and reducing morbidity.

Saphenous vein harvesting: A touchy subject.

Journal of Cardiac SurgeryVolume 36, Issue 10 p. 3709-3710 COMMENTARY Saphenous vein harvesting: A touchy subject Berhane Worku MD, Berhane Worku MD orcid.org/0000-0003-0135-580X Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USASearch for more papers by this authorMario Gaudino MD, PhD, Corresponding Author Mario Gaudino MD, PhD mfg9004@med.cornell.edu orcid.org/0000-0003-4680-0815 Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA Correspondence Mario Gaudino, Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA. Email: mfg9004@med.cornell.eduSearch for more papers by this author Berhane Worku MD, Berhane Worku MD orcid.org/0000-0003-0135-580X Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USASearch for more papers by this authorMario Gaudino MD, PhD, Corresponding Author Mario Gaudino MD, PhD mfg9004@med.cornell.edu orcid.org/0000-0003-4680-0815 Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA Correspondence Mario Gaudino, Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA. Email: mfg9004@med.cornell.eduSearch for more papers by this author First published: 26 July 2021 https://doi.org/10.1111/jocs.15858Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume36, Issue10October 2021Pages 3709-3710 RelatedInformation

Leg Wound Complications During Hospital Stay When Using Conventional Saphenous Vein Harvest Versus Endoscopic for Coronary Bypass Surgery

Background: Using the endoscope to harvest the saphenous vein as an alternative to conventional method helps in decreasing leg wound related complications. Objective: The aim of the current work was to detect the leg wound problems while using endoscopic vein harvesting versus conventional method during hospital stay. Patients and Methods: Fifty patients underwent coronary bypass surgery divided into two groups randomly, conventional, and endoscopic. Data of the patients were collected perioperatively. Patients were followed up during hospital stay which was 5-7 days in average regarding leg wound complications. Results: Leg wound pain in the postoperative period during hospital stay was significantly higher in the conventional group, leg swelling was lower in endoscopic group, occurrence of hematoma of the leg was higher in endoscopic group. Conclusion: It could be concluded that harvesting the saphenous vein endoscopically is superior to conventional method regarding leg wound complications in addition to its cosmetic advantage.

Laparoscopic hepatobiliary and pancreatic surgery: my trials and current status in Korea.

There has been a dramatic change in surgical care over the past 30 years with the introduction of laparoscopic surgery. It was my great fortune that I could experience laparoscopic surgery during my resident training period. After beginning to work for my hospital in 1995, I tried laparoscopic surgery in many surgical fields, including hepatobiliary and pancreatic (HBP), colon, stomach, and vascular surgery (endoscopic saphenous vein harvesting, endoscopic subfascial perforating vein interruption to treat skin complications in patients with deep vein insufficiency in the lower leg). In Sabiston, Textbook of Surgery, published in 1997, laparoscopic Whipple and major liver resection were not accepted at the time but now are. There are three possible reasons that may explain this shift. The first one is the 30 years of experience using advanced techniques; all of us know that “Seeing is believing,” and “A thousand hearings are not worth one seeing.” Next is the availability of three-dimensional imaging with magnification which enables us to perform difficult surgeries. The last one is the use of good instruments and an advanced surgical platform. In this paper, I would like to share my past and recent trials with advanced HBP laparoscopic surgery, as well as its current status in Korea and future directions.

Saphenous vein harvesting techniques for coronary artery bypass grafting: a systematic review and meta-analysis.

The great saphenous vein (GSV) graft remains a frequently used conduit for coronary artery bypass graft (CABG) surgery. The optimal technique for GSV harvesting has been the subject of on-going controversy. We therefore sought to conduct a systematic review and meta-analysis of all available GSV harvesting techniques in CABG. A systematic search of 12 electronic databases was performed to identify all randomized controlled trials (RCTs) of any GSV harvesting technique, including conventional vein harvesting (CVH), no-touch, standard bridging technique (SBT) and endoscopic vein harvesting (EVH) techniques. We investigated safety and long-term efficacy outcomes. All outcomes were analyzed using the frequentist network meta-analysis. A total of 6480 patients from 34 RCTs were included. For safety outcomes, EVH reduced 91% and 77% risk of wound infection compared to no-touch and CVH, respectively. EVH and SBT also significantly reduced the risk of sensibility disorder and postoperative pain. The techniques were not significantly different regarding long-term efficacy outcomes, including mortality, myocardial infarction and graft patency. For GSV harvesting for CABG, EVH techniques are the most favorable, but in case of using an open technique, no-touch is more recommended than CVH. More effective and safer procedures should be investigated for GSV harvesting in CABG.

Antiatherosclerotic Phenotype of Perivascular Adipose Tissue Surrounding the Saphenous Vein in Coronary Artery Bypass Grafting

BackgroundPerivascular adipose tissue (PVAT) is associated with metabolically driven chronic inflammation called metaflammation, which contributes to vascular function and the pathogenesis of vascular disease. The saphenous vein (SV) is commonly used as an essential conduit in coronary artery bypass grafting, but the long‐term patency of SV grafts is a crucial issue. The use of the novel “no‐touch” technique of SV harvesting together with its surrounding tissue has been reported to result in good long‑term graft patency of SV grafts. Herein, we investigated whether PVAT surrounding the SV (SV‐PVAT) has distinct phenotypes compared with other PVATs of vessels.Methods and ResultsFat pads were sampled from 48 patients (male/female, 32/16; age, 72±8 years) with coronary artery disease who underwent elective coronary artery bypass grafting. Adipocyte size in SV‐PVAT was significantly larger than the sizes in PVATs surrounding the internal thoracic artery, coronary artery, and aorta. SV‐PVAT and PVAT surrounding the internal thoracic artery had smaller extents of fibrosis, decreased gene expression levels of fibrosis‐related markers, and less metaflammation, as indicated by a significantly smaller extent of cluster of differentiation 11c–positive M1 macrophage infiltration, higher gene expression level of adiponectin, and lower gene expression levels of inflammatory cytokines, than did PVATs surrounding the coronary artery and aorta. Expression patterns of adipocyte developmental and pattern‐forming genes were totally different among the PVATs of the vessels.ConclusionsThe phenotype of SV‐PVAT, which may result from inherent differences in adipocytes, is closer to that of PVAT surrounding the internal thoracic artery than that of PVAT surrounding the coronary artery or that of PVAT surrounding the aorta. SV‐PVAT has less metaflammation and consecutive adipose tissue remodeling, which may contribute to high long‐term patency of grafting when the no‐touch technique of SV harvesting is used.

The back-approach technique of endoscopic saphenous vein harvesting in coronary artery bypass grafting.

One of the concerns during endoscopic saphenous vein harvesting (EVH) in coronary artery bypass grafting (CABG) is injury to the vein or its branches. The cutting edge of bipolar electrocautery scissors, used to divide the side branches of the saphenous vein, can cause vascular injury leading to reduced graft patency. We have developed a novel back-approach technique using a C-ring to divide the wide side branches of the saphenous vein during EVH. The aim of the study was to describe the technique and assess early outcomes of EVH using this technique. The back-approach technique is as follows: (a) insert the C-ring near the target branch, (b) push the C-ring over the proximal aspect of the target branch, (c) twist the C-ring forward to capture the target branch, and (d) cut the target branch by bipolar electrocautery. We investigated 169 patients, including 35 women (mean age 70.1 ± 8.9years), who underwent CABG at our hospital, using a novel EVH technique. The patients were categorized as those who underwent EVH (EVH group, n = 44) or open vein harvesting (OVH) (OVH group, n = 125). This method involves the creation of a small incision (2cm), sufficient saphenous vein dissection near the skin incision, adequate dissection to separate the vein from the surrounding tissues, and the back-approach technique with C-ring to divide the side branch of the saphenous vein. The primary endpoint was the graft patency rate, and the secondary endpoints were leg wound complications and length of hospitalization. No significant intergroup difference was observed in early patency of saphenous vein graft patency (OVH vs. EVH = 94.7 vs. 95.6%, p = 0.763). The incidence of lower extremity wound lymphorrhea was significantly lesser (OVH: EVH = 16.0: 0.0%, p = 0.005) and the length of hospitalization was also significantly shorter in the EVH group (OVH vs. EVH = 24.2 ± 9.8 vs. 19.0 ± 5.3days, p = 0.001). EVH, using the back-approach technique, showed satisfactory short-term results; therefore, this technique performed with C-ring might be effective for vein harvesting during EVH.

SUCCESSFUL MULTI-VESSEL CORONARY ARTERY BYPASS GRAFT IN A PATIENT WITH KAWASAKI DISEASE AND BILATERAL GIANT CORONARY ARTERY ANEURYSMS WITH INTRACORONARY THROMBUS BURDEN CAUSING A MYOCARDIAL INFARCTION: A CASE REPORT

SESSION TITLE: Medical Student/Resident Cardiothoracic Surgery Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Kawasaki Disease (KD) is a small to medium sized vessel vasculitis which usually occurs in children aged from 6 months to 5 years old [1]. A complication of KD is coronary artery aneurysms (CAA) which can pose a risk of thrombosis and progressive stenosis with the development of ischemic heart disease, myocardial infarction, and sudden cardiac death [2,3]. The following case report presents a young male with KD and giant CAA undergoing multi-vessel coronary artery bypass graft (CABG) surgery following a myocardial infarction. Consent for presentation was obtained from patient’s parents. CASE PRESENTATION: A 17 yo Caucasian male with known KD presented to the ED with new onset chest pain. Initial EKG showed T-wave inversions in aVL, V4-V6 leads. Laboratory analysis included a serum troponin of 54 ng/L and INR of 1.6. Initial therapy included aspirin and a heparin infusion. Echocardiogram demonstrated a dilated aortic root. Repeat EKG consistent with a lateral STEMI. Emergent coronary angiography remarkable for possible dissection of left main coronary artery vs intracoronary thrombus. Coronary CTA obtained which confirmed extensive thrombus burden in LM and RCA as well as 100% occlusion of LAD and distal portion of RCA. Admitted to the CVICU and started on infusions of altepase, heparin, and abiciximab. Two-vessel CABG surgery performed on hospital day #6 with internal mammary artery grafts to RCA and LAD. Discharged on post-op day #4/hospital day #10 on aspirin, statin, beta-blocker, and apixaban. DISCUSSION: KD associated giant coronary artery aneurysms (GCAA) are a serious complication associated with acute myocardial infarction. GCAA are defined as an internal diameter of >8mm. With GCAA >8mm, regression is less likely and often leads to myocardial ischemia or infarction with an increased mortality rate [2]. In a study of CABG vs PCI in KD patients, CABG patients were more likely to have complete revascularization and required less re-intervention then PCI patients [3]. Arterial graft usage (internal thoracic artery) in CABG showed improved graft patency, long-term life expectancy, and growth potential compared to saphenous vein harvesting [3]. CONCLUSIONS: Seventeen-year-old male with Kawasaki Disease and giant coronary artery aneurysms presents with a lateral STEMI secondary to intracoronary thrombus burden. Coronary angiography and Coronary CTA demonstrated enlargement of both known aneurysms and intracoronary thrombus inducing total occlusion of LAD and distal RCA requiring multi-vessel CABG surgery. Reference #1: 1: CME “Rare Refractory Kawasaki Dz in an Adolescent Boy with Cardiac and Diffuse Coronary artery involvement” Reference #2: 2: Lin MT, Sun LC, Wu ET, Wang JK, Lue HC, Wu MH (2015) Acute and late coronary outcomes in 1073 patients with Kawasaki disease with and without intravenous-immunoglobin therapy. Arch Dis Child 100(6):542-547 Reference #3: 3: Dionne A, Bakloul M, Manlhiot C, et al. Coronary artery bypass grafting and percutaneous coronary intervention after Kawasaki disease: the Pediatric Canadian series. Pediatric cardiology. 2017;38(1):36-43. DISCLOSURES: No relevant relationships by Matthew Ellison, source=Web Response No relevant relationships by Kevin McKillion, source=Web Response No relevant relationships by Patrick McKillion, source=Web Response

Tension-Free Management of Surgical Wound in Paramalleolar Bypass.

Objective: In paramalleolar bypass for critical limb-threatening ischemia (CLTI), excessive skin tension may occur for the closure of surgical wounds around the ankle. Furthermore, these surgical incisions are often proximal to infectious ischemic ulcers. Wound dehiscence caused by skin tension and surgical site infection carries a risk of graft exposure, anastomotic disruption, or graft insufficiency.Patients and Methods: Tension-free wound management was adopted in eight patients who underwent paramalleolar bypass for CLTI. Tension-free closure was adopted for surgical incisions for distal anastomotic site of the paramalleolar bypass, whereas the incisions for saphenous vein harvest were left open. A relief incision was made as needed. The opened incisions were covered with artificial dermis.Results: All surgical incisions and ischemic wounds healed successfully within 1.8 months after bypass. Two postoperative graft stenoses occurred, which were rescued by additional endovascular intervention. Secondary graft patency, wound healing, and limb salvage rates were 100% during an average follow-up period of 30 months.Conclusion: Tension-free wound closure using artificial dermis was effective in selected cases of paramalleolar bypass for CLTI.

The Usefulness of Professional Foot and Wound Care on Post-Saphenectomy Surgical Site Complications in Patients Undergoing Coronary Artery Bypass Grafting

ABSTRACT Background: Venous vessel removal during coronary artery bypass grafting may cause undesired problems such as pain and skin infection in the surgical site. Objective: To investigate the usefulness of professional foot and wound care on the healing of saphenectomy surgical site in patients undergoing coronary artery bypass grafting (CABG). Methods: The present prospective study was conducted among 574 patients (&gt;18 years) undergoing CABG with great saphenous vein harvesting, between May 2017 and May 2018. The patients were randomly divided into two groups based on the foot care into professional foot care group (PFCG) and the standard foot care group (SFCG) with 287 patients each. Postoperative surgical site complications were assessed on the first, second, third, fourth day, 1 week and 1 month interval. Results: The Mean age of patients in PFCG and SFCG groups was 59.71 ±9.9 and 60.34 ±11.22, respectively. Rate of Postoperative complications decreased on the follow up examinations in PFCG group as compared to SFCG group. A significant difference in the incidence of complications was observed on the fourth day (p=0.004) and after 1 month (p=0.029) of surgery between 2 groups. No significant correlation was determined between the length of the removed saphenous vein, number of arteries anastomosed and the post-saphenectomy complication rate at the first, second, third, and fourth days, at the first week, and first month in both groups except in PFCG where significant association was noted on the third postoperative day. Conclusion: Postoperative limb care by professional foot specialist decreases the postoperative complications in the surgical site.