Vessel Harvesting Research Articles

Endoscopic Radial Artery Harvesting for Coronary Artery Bypass Grafting: The Initial Clinical Experience and Results of the First 50 Patients

The radial artery (RA) is a commonly used arterial conduit in coronary artery bypass grafting (CABG). Traditional open-vessel harvest often leads to postoperative wound complications and cosmetic problems. Endoscopic RA harvesting (ERAH) has been widely used to prevent these problems. The purpose of this study was to assess these problems and graft patency in the first 50 patients who underwent ERAH. Between February 2006 and October 2007, 50 patients underwent ERAH with the VasoView system (Boston Scientific). These patients were compared with 50 patients who underwent the traditional open technique. The mean age was 62.8 years in both groups. All RAs were successfully harvested. No conversion was made from ERAH to the traditional open technique. The mean harvesting time (forearm ischemic time) was 27.4 + or - 6.5 minutes, and the mean length of the RA in the ERAH group was 18.5 cm. Neither wound complications, such as wound infection and skin necrosis, nor severe neurologic complications were recorded. The patency rate was 95.9% (95/99) in the ERAH group and 94% (94/100) in the open group. ERAH can be performed safely, and the early results are satisfactory. Endoscopic vessel harvesting is therefore recommended as the technique of choice for RA harvesting.

Rib-Sparing Internal Mammary Vessel Harvest for Microvascular Breast Reconstruction in 100 Consecutive Cases

Using the internal mammary vessels as recipient vessels in free-flap autologous breast reconstruction has become a common practice. However, these vessels are typically accessed by removing a costochondral segment. The purpose of this study was to describe the authors' rib-sparing technique for accessing the internal mammary vessels that is efficient and reliable and limits chest wall morbidity. The authors analyzed 100 consecutive free-tissue transfers for breast reconstruction in which the internal mammary vessels were accessed using a rib-sparing technique. The data were obtained from a prospectively maintained database and medical records. Of the 100 free-flap reconstructions, 47 used deep inferior epigastric perforator flaps, 45 used muscle-sparing transverse rectus abdominis myocutaneous flaps, six used superficial inferior epigastric artery flaps, and two used superior gluteal artery perforator flaps. No rib cartilage was removed in 66, but a segment of rib cartilage was removed in 34 procedures to optimize the exposure and facilitate anastomosis. After the initial learning curve, however, the internal mammary vessels were used in approximately 90 percent of cases without removal of any rib cartilage. The third intercostal space was used to access the internal mammary vessels two-thirds of the time, and the second intercostal space was used one-third of the time. There were no incidences of complications or morbidity associated with the rib-sparing approach to internal mammary vessel harvest. For most patients, the rib-sparing technique is an efficient and safe approach for exposing the internal mammary vasculature for microvascular breast reconstruction while minimizing chest wall morbidity.

Fleet Restructuring, Rent Generation, and the Design of Individual Fishing Quota Programs: Empirical Evidence from the Pacific Coast Groundfish Fishery

This article characterizes anticipated changes in fleet structure, vessel harvesting activity, and economic performance in the Pacific Coast groundfish fishery under an individual fishing quota management program. Results suggest that the current fleet of 117 vessels will be reduced by roughly 50%-66% to 40—60 vessels, resulting in annual cost savings of $18-$22 million (based on 2004 price and cost estimates). However, cost savings could be significantly less if restrictions on quota trading across vessels are incorporated into the program design. Alternative modes of collecting fees to fund program administration and their impact on fleet size and total fishery value are also studied. We conclude that a program of individual fishing quotas, if carefully designed, can be an attractive alternative for management of the Pacific Coast groundfish fishery.

Fleet Restructuring, Rent Generation, and the Design of Individual Fishing Quota Programs: Empirical Evidence from the Pacific Coast Groundfish Fishery

This article characterizes anticipated changes in fleet structure, vessel harvesting activity, and economic performance in the Pacific Coast groundfish fishery under an individual fishing quota management program. Results suggest that the current fleet of 117 vessels will be reduced by roughly 50%-66% to 40—60 vessels, resulting in annual cost savings of $18-$22 million (based on 2004 price and cost estimates). However, cost savings could be significantly less if restrictions on quota trading across vessels are incorporated into the program design. Alternative modes of collecting fees to fund program administration and their impact on fleet size and total fishery value are also studied. We conclude that a program of individual fishing quotas, if carefully designed, can be an attractive alternative for management of the Pacific Coast groundfish fishery.

Ultrasonic and Nonultrasonic Instrumentation

To compare the efficacy and safety of ultrasonic surgical instrumentation with nonultrasonic traditional surgical techniques in various types of surgery. Electronic searches of MEDLINE, Current Contents, and the Cochrane Library were performed for the period of 1990 to June 1, 2005, using relevant search terms. A manual check of all references in accepted studies was also performed. Only comparative studies (including randomized and nonrandomized control trials) of ultrasonic surgical instrumentation with nonultrasonic instrumentation were accepted. Procedures of interest included the following: colorectal surgery, gynecologic surgery, head and neck surgery, solid organ surgery, vessel harvesting, cholecystectomy, hemorrhoidectomy, mastectomy, and Nissen fundoplication. Two investigators reviewed each study: the first investigator extracted all relevant data, and consensus of each extraction was performed by a second investigator to verify the data. Data were then entered into a database and quality checked for accuracy. Fifty-one primary studies that examined 4902 patients were included in this systematic review, of which 24 were randomized trials and 27 were nonrandomized studies. Comparative meta-analyses for blood loss, surgery time, and hospital length of stay were performed using a random-effects model and stratified by surgery type. Heterogeneity was tested using Q statistics. Statistical significance was defined as P < .05. Meta-analysis of outcomes comparing ultrasonic with conventional nonultrasonic surgical instrumentation demonstrates significant improvement of several perioperative outcomes in procedure-specific settings when ultrasonic instrumentation is used.

Endoscopic harvesting of the radial artery for neurovascular bypass

The radial artery is a common conduit used for high-flow bypasses. Until now the radial artery has been harvested using a long incision in the forearm that follows the course of the artery. The authors present an endoscopic technique that has been used during coronary bypass surgery but is not yet widespread in the neurosurgical arena. From October 2006 to October 2007, the authors used the radial artery as a graft in 6 patients during the treatment of complex cerebral aneurysms. The artery was harvested via an endoscopic technique. The radial artery was exposed distally at the wrist. Using the VasoView vessel harvesting system, the endoscope was inserted into the arm. The radial artery was dissected from its surrounding tissues endoscopically. With direct current energy via the HemoPro device, the side branches were coagulated and cut. The artery was transected at the wrist, then retrieved through a counterincision at the proximal forearm. There were no neurological or bleeding complications in the hand or forearm. Endoscopic harvesting of the radial artery is feasible, faster, and produces a more aesthetically pleasing result than standard open harvesting. The learning curve associated with the endoscope can be overcome by practice on cadavers and by collaboration with a cardiac surgical team.

Tissue Welding Forceps Usage in Superficial Parotidectomy: A Clinical Assessment

Tissue welding forceps (TWF) have been used effectively in a number of surgical procedures including blood vessel harvesting and tonsillectomy. Our objective was to assess the safety and efficacy of TWF usage in superficial parotidectomy. We performed a retrospective review of 25 patients between November 2002 and July 2006 who underwent superficial parotidectomy using TWF. The inpatient and outpatient records were reviewed for diagnosis, operative times, estimated blood loss, and postoperative facial paresis. Only one of the 25 patients (4%) who underwent superficial parotidectomy using TWF had transient postoperative facial weakness and no procedure had blood loss of greater than 150 cc. This initial evaluation suggests that use of TWF is safe in superficial parotidectomy and may help reduce the development of postoperative facial paresis.

Simultaneous endoscopic radial artery and great saphenous vein harvesting for redo coronary artery bypass grafting. A report of two cases

An ageing population and increase in patient co-morbidities are forcing cardiac surgeons to meticulously consider the benefits and risks of respective conduits and their harvesting techniques. Two cases of simultaneous endoscopic radial artery and great saphenous vein harvesting, for redo coronary artery bypass grafting, are presented. A shortage of venous conduits after previous bypass grafting, as well as the presentation of several risk factors of wound-healing complications, favoured simultaneous utilisation of both endoscopic techniques. Endoscopic vessel harvesting together with the pre-harvesting duplex study is able to gain not only high-quality conduits but also minimize the risk of wound-healing and neurological disturbances associated the saphenous vein and radial artery harvesting.

Endoscopic harvest of saphenous vein: a lesson learned from 1,348 cases

Endoscopic harvest of saphenous vein is a relatively new technique developed to minimize the wound and postoperative complications. This technique has gained patients' acceptance and become popular in cardiac surgical practices. Because most centers have limited experience with this approach, the authors summarize the clinical profiles of patients undergoing endoscopic vessel harvest (EVH). Between March 2001 and August 2006, 1,348 patients (945 men and 403 women) with a mean age of 67.2 years (range, 28-89 years) underwent EVH of saphenous vein for coronary artery bypass surgery, peripheral artery reconstruction, and miscellaneous conditions. The EVH technique was performed using the Vasoview system (Guidant, Menlo Park, CA, USA) under the assistance of carbon dioxide (CO(2)) insufflation. Technical success was achieved in 98.6% of the cases. Two saphenous veins were discarded because of obvious vein injury. The mean harvest time was 45 min: 68 min for the first 50 cases and 23 min for the last 200 cases. Nearly all the patients (98%) had saphenous vein harvested only from the thighs, whereas only 1.5% of the patients had saphenous vein harvested from the legs. Postoperative wound complications were experienced by 61 patients including 25 tract hematomas, 19 wound dehiscences or poor healing, 16 wound infections, and 1 overlying skin necrosis. Overall, 13 subsequent revisions were required for these complications. Detectable air embolisms occurred for 143 patients and numbness in the saphenous nerve territory for 169 patients. The findings showed EVH of saphenous vein to be a valid alternative to open saphenectomy, providing excellent surgical results. Therefore, EVH should be considered as the standard of care for saphenous vein harvest.

'El Niño' Effects and Biomass Endogeneity in a Harvest Function: The Chilean Jack Mackerel Fishery

The main goal of this paper consists in estimating the input parameters of an annual harvest function for the Chilean jack mackerel stock; particularly, the effects of biomass on catch. One of the main problems faced is that the biomass variable is possibly endogenous, which would bias the estimators if the problem remains unsolved. Our empirical strategy consists in estimating a per vessel harvest function using panel data, which allows us to control for vessels' unobserved heterogeneity, and episodes of 'El Nino' phenomenon as valid instrumental variable for biomass, which allows us to control for the potential biomass endogeneity. This strategy produces consistent estimates of the biomass coefficient. The results, using a panel of industrial vessels operating in the central-southern region of Chile during the period 1985-2002, show that the endogeneity of the biomass variable biases upwardly the magnitude of its coefficient in a Cobb-Douglas harvest function. In the case of our data, the endogeneity bias even changes the sign of the catch-to-biomass elasticity. A first contribution of the paper is to address the endogeneity of biomass in a harvest function, an issue often underestimated in the empirical literature. A second contribution is related to 'El Nino' effects on the Chilean jack mackerel stock. The results show that an oceanic 'El Nino' episode not only has negative contemporaneous effects on jack mackerel biomass but also negative biomass effects lasting for at least two additional years.

GENETICALLY ENGINEERED MAMMALIAN CELLS COULD IMPROVE THE BIOCOMPATIBILITY OF IMPLANTABLE CARDIOVASCULAR DEVICES

patients’ acceptance and become popular in cardiac surgical practices. Because most centres have limited experiencewith this approach,we summarised the clinical profiles in patients undergoing endoscopic vessel harvest (EVH). Methods. Between March 2001 and October 2005, 1005 patients (705 male, 301 female) with a mean age of 67.2 (range 28–89) underwent EVH of the saphenous vein for coronary artery bypass surgery, peripheral artery reconstruction and miscellaneous conditions. The EVH was performed using the Vasoview system (Guidant, Menlo Park, CA) under the assistance of carbon dioxide (CO2) insufflation. Results. Technical success was achieved in 98% of cases. Two saphenous veins were discarded due to obvious vein injury. The mean harvest time was 45min. The mean harvest times for the first 50 cases and last 200 cases were 68 and 23min, respectively. Ninety-eight percent of patients had only saphenous vein harvested from thighs; only 2% patients had saphenous vein harvested from legs. Postoperative wound complications occurred in 36 patients. There were 19 wound dehiscences or poor healing, 16 wound infections and 1 overlying skin necrosis. Overall, 18 subsequent revisionswere required for these complications. Therewere detectable air embolisms in 143 patients, self-limited wound haematoma in 25 patients, and numbness in the saphenous nerve territory in 169 patients. Methods. To improve the biocompatibility of implantable cardiovascular devices our group investigated cellular linings to modulate biological properties of device surfaces. For this purpose different tissue types were harvested, isolated and expanded in tissue culture. The biological performance of mammalian cells were characterised and assessed. Tissue culture cells were genetically engineered to create an endothelial like cell lining for the blood-contacting surfaces of cardiovascular devices. Cardiovascular devices were coated with a genetically engineered cell lining and their mechanical performance and biological properties were assessed in vitro and in vivo. Data were compared with mathematical models and numerical methods to study diffusion-mediated and stress-induced growth and adhesion of tissue culture cells under normal and sheer stress conditions. Conclusion. Genetically engineered mammalian tissue culture cells have provided an adherent, nonthrombogenic cell lining for implantable cardiovascular devices and were comparable to mathematical modelling. The data gained from this interdisciplinary research project may lead to novel ways of improving the biocompatibility of implantable cardiovascular devices, which in turn may reduce the incidence of complications associated with their use and at last improve the treatment of cardiovascular diseases. Conclusion. EVH of the saphenous vein is a valid alternative to open saphenectomy, providing excellent surgical results, and should be the standard of care for saphenous vein harvest.

Prospective randomized study comparing the Teleflex Medical SaphLITE Retractor to the Ethicon CardioVations Clearglide Endoscopic System

BackgroundSeveral minimally invasive saphenous vein harvesting techniques have been developed to reduce morbidities associated with coronary artery bypass grafting. This prospective, randomized study was designed to compare two commonly used minimally invasive saphenous vein harvesting techniques, the SaphLITE Retractor System (Teleflex Medical) and the Clearglide Endoscopic Vessel Harvesting System (Ethicon CardioVations, Inc.).MethodsBetween January 2003 and March 2004, a total of 200 patients scheduled for primary, nonemergent coronary artery bypass grafting, with or without concomitant procedures were randomized into two groups: SaphLITE (n = 100) and Clearglide (n = 100). Pre-, intra- and postoperative data was collected and subjected to statistical analysis. Randomization provided homogenous groups with respect to preoperative risk factors.ResultsHarvest location for the SaphLITE group was thigh (n = 40), lower leg (n = 5) and both lower leg and thigh (n = 55). The location of harvest for the Clearglide group was thigh (n = 3), lower leg (n = 16) and both lower leg and thigh (n = 81). The mean incision length was 3.6 cm (range, 2–6) in the SaphLITE group versus 2.1 cm (range, 1–4) in the Clearglide group (p < 0.05). The total incision length was 12.9 cm versus 8.9 (p < 0.05) in the SaphLITE and Clearglide groups. Conversion to the open technique occurred in 5 SaphLITE patients and 7 Clearglide patients. Intraoperative leg exploration for bleeding occurred in two of the Clearglide patients and none of the SaphLITE patients. Post-operative complications specifically related to minimally invasive harvesting technique, including a two-week post-discharge visit, were not statistically different between the groups.ConclusionThe saphenous vein can be safely harvested utilizing the SaphLITE and Clearglide systems. While the Clearglide system allows for fewer incisions (number and length) and less harvest time, these benefits may be outweighed by the increased cost of the Clearglide system compared to the SaphLITE retractor.

Full-Length Ulnar Nerve Harvest by Means of Endoscopy for Contralateral C7 Nerve Root Transfer in the Treatment of Brachial Plexus Injuries

To avoid long scar formation after contralateral C7 transfer for treatment of brachial plexus avulsion injuries, endoscopy was used for full-length harvest of the ulnar nerve. The surgical procedure and its clinical effect are reported here. From July to August of 2001, two patients with total root avulsion were recruited. Three 2- to 3-cm-long incisions were made in the mid upper arm, elbow, and wrist, and the full-length ulnar nerve was harvested using the Endoscope Vessel Harvest System endoscope system. The surgical time was recorded, the vascularity of the dissected ulnar nerves was observed, and the recovery of the injured limb after contralateral C7 nerve root transfer was measured. Compared with the traditional technique, there were no significant differences in surgical time, vascularity of the dissected ulnar nerve, or recovery of the injured limb when the full-length ulnar nerve was harvested with endoscopy (as part of the contralateral C7 nerve root transfer operation), but the degree of scarring after surgery was markedly reduced. Although the same level of curative effect was ensured, the new endoscope-aided method for harvesting the full length of the ulnar nerve for contralateral C7 nerve root transfer was not complicated and caused markedly less scarring.

5-Methyltetrahydrofolate Rapidly Improves Endothelial Function and Decreases Superoxide Production in Human Vessels

The circulating form of folic acid, 5-methyltetrahydrofolate (5-MTHF), may have beneficial effects on endothelial function; however, its mechanisms of action remain uncertain. Decreased nitric oxide (NO) bioavailability and increased vascular superoxide production in vascular disease states are due in part to endothelial NO synthase (eNOS) uncoupling related to deficiency of the eNOS cofactor tetrahydrobiopterin (BH4), but whether this mechanism is important in human atherosclerosis and represents a rational therapeutic target remains unclear. We hypothesized that 5-MTHF would improve endothelial function by decreasing superoxide and peroxynitrite production and by improving eNOS coupling, mediated by BH4 availability. Vascular superoxide/peroxynitrite production and vasomotor responses to acetylcholine and bradykinin were determined in saphenous veins and internal mammary arteries from 117 patients undergoing CABG. The effects of 5-MTHF were examined ex vivo (n = 61) by incubating vessels with 5-MTHF (1 to 100 micromol/L) and in vivo by intravenous infusion of 5-MTHF or placebo before vessel harvest (n = 56). 5-MTHF improved NO-mediated endothelium-dependent vasomotor responses and reduced vascular superoxide, both ex vivo and in vivo. These changes were not explained by direct superoxide scavenging by 5-MTHF in vitro or by changes in plasma total homocysteine in vivo. Rather, 5-MTHF was a strong peroxynitrite scavenger and increased vascular BH4 and the BH4/total biopterin ratio. Furthermore, 5-MTHF reversed eNOS uncoupling, as assessed by NG-nitro-l-arginine methyl ester-inhibitable superoxide production, increased the eNOS dimer:monomer ratio, and enhanced eNOS activity. 5-MTHF has beneficial effects on endothelial function and vascular superoxide production in human atherosclerosis, by preventing peroxynitrite-mediated BH4 oxidation and improving eNOS coupling.

Endoscopic Lesser Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: First Reported Case

Endoscopic vessel harvesting has become a widely used modality for harvesting venous and arterial conduits for coronary artery bypass grafting. Specifically, it has been used to harvest the greater saphenous vein, internal thoracic artery, and the radial artery. A case of endoscopic lesser saphenous vein harvesting for coronary artery bypass grafting is reported.

Endoscopic vessel harvesting in coronary artery bypass graft surgery

Endoscopic vessel harvesting in coronary artery bypass graft surgery

Technique of Endoscopic Robot-Assisted Internal Thoracic Vessel Harvesting for TRAM and Superior Gluteal Flap Breast Reconstruction

Technique of Endoscopic Robot-Assisted Internal Thoracic Vessel Harvesting for TRAM and Superior Gluteal Flap Breast Reconstruction

In vivo and mechanical properties of peritoneum/fascia as a novel arterial substitute

This study evaluates the efficacy of bovine peritoneum/fascia as an arterial substitute. Twelve dogs underwent bilateral femoral artery patch angioplasty with a glutaraldehyde-fixed bovine peritoneal/fascial patch (PFA patch) on one side and polyester patch on the contralateral side. Arteriograms were performed just before vessel harvest at 1 and 6 months, and vessels were evaluated for aneurysms and inflammation. Histologic analysis included intima area, media thickness, and lumen area. Immunofluorescence for CD 34 and Factor VIII was done to evaluate endothelialization and alpha-actin for smooth muscle cell growth. Mechanical strength testing was evaluated in separate PFA patches and compared independently to a commercially available bovine pericardial patch and polyester patch. All vessels examined at both 1 and 6 months were patent with no arteriographic evidence of stenosis. There was no evidence of aneurysm formation in any vessel and no difference between groups in inflammatory reaction. One polyester patch at 1 month developed an infection. Microscopic evaluation of experimental vessels revealed no difference between groups in intima area at 1 month (2.1 +/- 1.2 vs 2.2 +/- 1.2 mm 2 ; P = .5) and at 6 months (1.81 +/- 1.2 vs 1.9 +/- 1.2 mm 2 ; P = .5). There was no difference in media thickness, but the PFA patch group had a greater lumen area at 1 month (8.8 +/- 2.9 vs 9.8 +/- 3.0 mm 2 ; P = .02) and 6 months (10.5 +/- 4.2 vs 11.7 +/- 5.6 mm 2 ; P = .02). Immunofluorescence for CD34 and Factor VIII demonstrated complete re-endothelialization of all patches. The polyester patch had a chronic inflammatory response, but not the PFA patch. Mechanical strength testing demonstrated that compared to pericardium, the PFA patch had superior ( P < .05) failure tension, stiffness, and suture pull-out strength, whereas extensibility, fatigue tension, relax slope, and creep tests were not different. Polyester demonstrated superior suture pull-out, stiffness, relax slope, and failure strain ( P < .05), but it was not different in failure tension and extensibility than the PFA patch. However, the PFA patch had significantly less creep (0.25 +/- 0.25 vs 4.92 +/- 0.84; P < .01). The PFA patch has similar clot-resistant properties to polyester and is superior to the pericardial patch in mechanical strength. It is a promising endothelial alternative for not only arterial patches but other vascular products. The search for an artificial, thromboresistant, and intimal hyperplasia resistant interface between blood and native blood vessels still continues. This study demonstrates the feasibility and proof of concept of the peritoneum's clot-resistant properties. When adding the underlying fascia, it serves as an ideal arterial patch. Other studies are underway evaluating its feasibility as a bypass graft and a "drug coated"-like stent lining.

The Pneumatic Tourniquet Technique for Endoscopic Radial Artery Harvest

Endoscopic vessel harvest is viewed as a safe, reliable, and cost-effective method for greater saphenous vein removal. As the radial artery has more recently become a popular conduit choice in coronary artery revascularization, we describe herein an endoscopic technique for radial artery harvest in our first 50 patients as an alternative to the more traditional open technique. From November 2001 to July 2002, 54 radial arteries were harvested endoscopically in 50 patients utilizing the VasoView Endoscopic Vessel Harvesting System, an Esmark bandage, and a pneumatic cuff tourniquet. No patients experienced symptoms of vascular compromise, or signs of infection in the donor arm. No adjunctive procedures were required during the vessel harvest, i.e., conversion to open technique. All radial arteries were successfully removed with endoscopic technique and 53 of the 54 radial arteries were successfully used as bypass conduits. Although the quality of the radial artery harvested remains subjective, we found less vasospasm than in our experience with the open technique. Thirty-day follow-up revealed no readmissions, no cardiac ischemic complications, no significant complications with the donor arm, and an excellent cosmetic result. Endoscopic harvest of the radial artery with the tourniquet technique may offer advantages over the more traditional open technique.

Endoscopic Saphenous Vein Harvesting for Hemodialysis Vascular Access Creation in the Forearm: A New Approach for Arteriovenous Bridge Graft

When superficial arm veins are not suitable to create a native arteriovenous (AV) fistula, an arterio-venous bridge graft by native and/or prosthetic graft is the next best alternative. However, harvesting a native vein, such as the saphenous vein (SV), is invasive and requires a large incision. We report an endoscopic saphenous vein harvesting (ESVH) technique combined with forearm bridge grafting as a new approach for vascular access (VA). We used the Clearglide, Endoscopic Vessel Harvesting System (Eticon, Inc.) for a less invasive SV harvesting technique. Five patients had a SV graft implant and 10 patients had a polytetrafluoroethylene (PTFE) graft implant in the forearm. The SV was harvested easily in all patients in 46 +/- 2 min. There were no wound complications. All SV and PTFE grafts provided satisfactory access within 1 month; however, two declotting procedures in the SV group and five in the PTFE group were required. The PTFE group had two graft infections. It is possible that a combination of ESVH and SV forearm grafting will be one of the new approaches for hemodialysis (HD) access.