Saphenous Vein Harvesting Technique Research Articles

A histology and immunochemistry study comparing open versus close and open-method endoscopic saphenous vein harvesting.

The introduction of endoscopic saphenous vein harvesting (ESVH) has been reported to reduce wound pain and infection, compared with open saphenous vein harvesting (OSVH) techniques. There are still controversies regarding this technique. The aim of our study is to investigate the endothelial preservation of saphenous vein (SV) grafts harvested by different techniques. Further observations were made for harvesting and closure time, incision length and effect of pressure distension of the veins to the vein endothelium. Prospective observational study of sixty human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin-eosin and Cluster of Differentiation 31 (CD 31) staining. Saphenous vein was harvested endoscopically either by closed CO2 (carbon dioxide) ESVH, open CO2 ESVH or OSVH harvesting technique. Demographic data and intra-operative data were collected. Two saphenous vein samples were collected from each patient to compare differences before and after distension of the veins. Both haematoxylin-eosin and immunohistochemistry slides were imaged by a high-resolution slide scanning system. Open CO2 ESVH group showed the highest number of endothelial detachments. Mean scoring of the immunohistochemistry method using the CD31 antibody was much lower in the open CO2 ESVH group (33.25% ± 28.71, P < 0.0003). This represents a more poorly preserved endothelial cells in the Open CO2 ESVH than the closed CO2 ESVH. Closure time and incision lengths were significantly shorter in both ESVH groups compared to the OSVH group. Significant low scores of immunohistochemistry for samples were seen in distended veins (39.0% ± 30.08, p = 0.004). The OSVH in random sample B, which represents the conduit that will be used, had a far better endothelium preservation and less endothelial detachment when compared to ESVH. We observed more endothelial detachment in the open CO2 ESVH group, due to lack of subcutaneous tissue separation, poor visualization and traction stress across the wall of the saphenous vein. The closed CO2 ESVH group had more endothelial cells preserved, but the OSVH group fared the best with the least number of endothelial cell detachment and a higher score of CD31 antibody. The online version contains supplementary material available at 10.1007/s12055-024-01752-3.

A Novel Technique of No-Touch Endoscopic Saphenous Vein Harvesting.

No-touch saphenous vein harvesting is considered an ideal procedure for harvesting good-quality veins, whereas endoscopic vein harvesting (EVH) is considered ideal for decreasing wound complications. The no-touch EVH (NT-EVH) technique, which was developed in 2018, is one of the best vein-harvesting procedures. We have improved this method in several aspects since our initial experience. Herein, we present the details of this technique.

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

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

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.

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 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.

A Novel Technique of Endoscopic Vein Harvesting With Preserved Perivascular Tissue.

The no-touch saphenous vein harvesting technique is considered to be the ideal procedure to achieve the best quality of vein, whereas the endoscopic vein harvesting (EVH) technique is considered to be ideal for decreasing wound complications. We developed a new technique of EVH with perivascular tissue preservation. This procedure was performed by dissecting the immediate anterior and posterior perivascular connective tissues of the saphenous vein followed by cutting approximately 1 cm laterally from the saphenous vein with the use of a harvester (MAQUET Getinge Group, Getinge AB, Göteborg, Sweden). Histopathological examination revealed preserved perivascular tissue and intimal folding.

Koroner arter bypass grefti için farklı yöntemler kullanılarak alınan safenöz veninin apoptotik indeksinin karşılaştırılması

Amaç: Koroner arter grefti olarak kullanılan safen venin hazırlanmasında farklı cerrahi toplama teknikleri kullanılmaktadır. Bu çalışmanın amacı koroner arter baypas greftlemesi (KABG) için kullanılan safen ven hazırlama işlemlerinden geleneksel yöntem ile “no-touch” tekniği arasında apoptotik indeks açısından farklılığı araştırmaktır. Gereç ve Yöntemler: KABG uygulanan 40 hastada geleneksel ve “no-touch” cerrahi yöntemleri kullanılarak toplanan safen venlerde apopitoz bakılarak prospektif, randomize bir klinik çalışma yapıldı. Toplanan safen ven parçaları paraformaldehitte bekletilerek tespit edildi. Kriyo cihazı ile 5 mikrometre kalınlığında kesitler alındı. Örnekler modifiye TUNEL yöntemi ile işaretlenerek apopitotik hücre ölümleri gösterildi. Doku kesitlerindeki TUNEL (+) ve (-) hücreler Stereo Investigator version 7.5 görüntü işleme yazılımı kullanılarak tarafsız ve eşit 100 çerçeveye optik olarak bölünmüş alanlarda sayıldı. Apoptotik indeks; Hücre / Toplam Hücre oranı kullanılarak hesaplandı. Sonuçlar bağımsız gruplarda t testi ile istatistiksel olarak değerlendirildi. Bulgular: Geleneksel yöntem ile “no-touch” tekniği apoptotik indeksleri karşılaştırıldı. Geleneksel tekniğin uygulandığı grubunun apoptotik indeksi “no-touch” tekniği uygulanan diğer gruba göre anlamlı oranda yüksek bulundu. Mekanik ve yapısal koruma venin etrafını kuşatan yastıkçıklar tarafından sağlanmaktadır. Bu yastıkçıklarda apoptotik hücre ölümünün daha az görülmesi safen vendeki doku hasarının daha az olduğunu gösterir. Sonuç: Safen ven grefti hazırlamasında geleneksel yöntem yerine ‘no-touch’ cerrahi tekniğinin tercih edilmesi ile doku hasarı ve vazospazm oluşumunun azalabileceği ve baypas sonrası greftin açık kalma olasılığının artabileceği sonucuna ulaşıldı.

Use of the No-Touch Saphenous Vein Harvesting Technique via Small Incisions.

There are substantial data in support of improved patency using the no-touch (NT) saphenous vein (SV) harvesting technique. However, wound complications correlated with such are more significant than those associated with the skeletonized technique. To solve this, we introduced the use of the electrothermal bipolar vessel sealing device via small incisions. In this study, a cordless retractor with a built-in LED light source was utilized. The NT-SV graft was harvested with a pedicle of surrounding tissue approximately 5 mm in size and attached to the main trunk. The intima, tunica media, adventitia, and vasa vasorum appeared normal by histological analysis. Our technique combines the potential advantages of a minimally invasive endoscope approach using bipolar electrothermy and the improved patency of a NT-SV.

Long saphenous vein harvesting techniques and their effect on graft patency.

Coronary artery bypass grafting is a key cardiac surgery procedure and is the main treatment for patients with multivessel coronary artery disease. The most frequently used conduit for this procedure is the long saphenous vein (LSV). The technique of harvesting the LSV has evolved over the last 30 years from total open harvesting to endoscopic with minimal access technique. The most important determining factor for success in coronary artery surgery is the graft patency rate. The literature evidence behind each technique has been reported at different levels and there is an ongoing debate about which technique can provide optimum vein patency over the long term. This literature review aims to summarize the current evidence, the implications involved with the use of each technique for harvesting LSV and the patency rate at variable follow-up intervals.

Benefits of Endoscopic Vein Harvesting in Coronary Artery Bypass Grafting

Earlier reports concerning endoscopic vein harvesting have been controversial regarding the patency of the vein graft after coronary artery bypass grafting (CABG). In addition, data on the quality of life are lacking. In this study, we investigated our experience with endoscopic vein harvesting with regard to these end points. The analysis included patients undergoing isolated CABG between 2012 and 2016. Patients were divided in 2 groups stratified by the technique of saphenous vein harvesting: open vs endoscopic. Primary end points were the rate of repeat revascularization and leg wound complications. Secondary end points were the physical and mental quality of life scores of the 36-Item Short Form Health Survey questionnaire. Cox proportional hazard analysis was performed to adjust the end point of repeat revascularization for relevant covariates. The open group included 2123 patients, and the endoscopic group included 883 patients. Overall mortality was not significantly different between the groups (P= .060). Revascularization-free survival was similar between the groups (adjusted hazard ratio, 0.65; 95% confidence interval, 0.42 to 1.02; P= .059). Endoscopic vein harvesting was significantly associated with a decreased hazard for the combined end point of death or repeat revascularization (adjusted hazard ratio, 0.64; 95% confidence interval, 0.46 to 0.90; P= .009). Significantly more leg wound complications were seen in the open group (24 vs 0; P= .002). Postoperative quality of life showed no significant differences between the 2 groups. Apart from the benefits on leg wound complications, endoscopic vein harvesting was comparable to open vein harvesting in the rate of repeat revascularization and quality of life.

Endoscopic saphenous vein harvesting with a non-sealed approach.

Endoscopic saphenous vein harvesting is considered a safe and effective approach for graft procurement during coronary artery bypass graft surgery. As an alternative to open techniques, minimally invasive approaches are associated with superior outcomes in terms of morbidity and patients' discomfort, without affecting graft quality, patency rate, and long-term outcomes. Both sealed and non-sealed systems are available for endoscopic conduit harvesting. Sealed systems require carbon dioxide gas insufflation, which may have a damaging impact on the endothelium. Non-sealed systems do not require carbon dioxide insufflation and thus avoid the potential drawbacks of its use. In this video tutorial, we provide a thorough description of the surgical technique for endoscopic saphenous vein harvesting using a non-sealed approach.

Short-term clinical safety and efficacy of No-touch great saphenous vein harvesting technique for off-pump coronary artery bypass grafting

Objective: To evaluated early clinical outcomes of saphenous vein grafts harvested with a No-touch technique in off-pump coronary artery bypass graft (OPCABG) surgery. Methods: A total of 124 patients with three-vessel disease undergoing OPCABG by No-touch technique between June and November 2017 in Beijing An Zhen Hospital were respectively reviewed. Results: The average age of patients was (60.7±10.3) years, and 80 cases (64.5%) were male, with the average body mass index (BMI)of (25.4±2.5) kg/m(2,) the mean preoperative left ventricular ejection fraction (LVEF) of (58.0±7.0%). The operative time was (4.0±0.4) hours, and 16 cases (12.9%) were harvested for whole vein grafts. The number of vein grafts and venous anastomoses was 144 and 284, respectively. There were 16 cases of single bridge NTSVG-LAD, 4 cases of single bridge NTSVG-D, 99 cases of sequential bridge NTSVG-OM-PDA, 5 cases of sequential bridge NTSVG-OM-PLV, 4 cases of sequential bridge NTSVG-OM-RCA, 16 cases of sequential bridge NTSVG-D-OM-PDA. The mean flow volume of No-touch vein grafts was (51.9±2.4) ml/min. There was no death case in hospital. Postoperative re-exploration for hemorrhage of anastomosis happened in 1 case (0.8%), which was caused by pericardial tamponade due to insufficiency of hemostasis in internal mammary bed. There were 1 case of bad wound healing of lower extremity incision (0.8%). A total of 124 cases were followed up after operation, and the follow-up rate was 100%. There was one all-cause death (0.8%) 27 days after the operation. Conclusion: The short-term clinical observation of the application of No-touch great saphenous vein harvesting technique for OPCABG is safe and effective.

No-touch technique of saphenous vein harvesting for coronary artery bypass grafting gives promise patency rate comparable to that of the left internal thoracic artery

The paper presents review of the literature in terms of the advantages of no-touch great saphenous vein (GSV) harvesting technique and its impact on long-term GSV patency for coronary artery bypass grafting compared to conventional method of vein harvesting. Presented detailed pathophysiological mechanisms of venous graft failure, using conventional GSV harvesting.&#x0D; Purpose. Analysis of literature data for the optimal choice of additional vascular shunt used for coronary bypass grafting in multi – vessel coronary artery disease, based on patency rate.&#x0D; Conclusion. No-touch technique of GSV harvesting provides better structural, functional, and mechanical protection of the vein wall. Perfecting the technique of this harvesting method and long-term follow up in patients with no-touch GSV grafts may reveal a graft patency comparable to that of LITA.

Proximal first: a beneficial strategy for no-touch saphenous vein graft.

In the mid-1990s, a novel saphenous vein harvesting technique, in which the vein is harvested with its surrounding tissue without manual distention, was introduced. This no-touch technique provides an excellent long-term patency; however, graft twisting and kinking should be given attention. To fully bring out the benefit of the no-touch method while reducing the risk of twisting and kinking, we have modified the anastomosis strategy. Our simple modified strategy involved a proximal anastomosis prior to the distal anastomosis. This strategy was successfully used in 16 patients.

'No-touch' technique for great saphenous vein harvesting

'No-touch' technique for great saphenous vein harvesting

Bridging saphenous vein harvesting versus conventional techniques in patients undergoing coronary artery bypass grafting in Suez Canal university hospital

BackgroundIschemic heart disease (IHD) is a common cause of death, which encourages us to improve continuously the techniques adopted for coronary artery bypass grafting (CABG). Still the most commonly used graft is saphenous vein harvested by different techniques. MethodsThis prospective randomized study included 60 patients with IHD in need of CABG classified into two equal groups: group A (saphenous vein harvesting with conventional technique) and group B (saphenous vein harvesting with lens assisted bridging technique [LABT]). We compared the two groups in terms of preoperative, intraoperative and postoperative data then we statistically analysed the findings. ResultsOur study showed that LABT had significantly less pain, less infection, more cosmetic, less hospital stay with more patient satisfaction and without any additional costs. ConclusionsOur study showed that lens assisted bridging vein harvesting was a good substitute for conventional technique.

Lens assisted after Duplex mapping, Bridging technique of saphenous vein harvesting. (A new technique in saphenous vein harvesting, best substitute for endoscopic vein harvesting)

Lens assisted after Duplex mapping, Bridging technique of saphenous vein harvesting. (A new technique in saphenous vein harvesting, best substitute for endoscopic vein harvesting)