Endothelial Function Is Preserved in Veins Harvested by Either Endoscopic or Surgical Techniques

Wheeler, Adam; Kendrick, Daniel E.; Allemang, Matt T.; Gosling, Andre F.; Kim, Ann H.; Hausladen, Alfred; Kashyap, Vikram S.

doi:10.1016/j.avsg.2017.05.002

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…Taken together it was concluded that endothelial function is preserved when using EVH, and that the advantages of minimally invasive vein procurement for lower extremity bypass can be obtained without concern for damaging venous endothelium. While SVs in this study were used as lower extremity grafts, the histological data is in general agreement with similar studies where SVs were used in CABG, suggesting that endothelial integrity is similar whether SVs are harvested by OVH or EVH [ 40 ] .…”

Section: Discussionsupporting

confidence: 85%

“…In the last 30 years, a number of in vitro studies examining the vasoreactivity of conduits used in CABG have been published [ 36 - 38 ] with many recently focusing on the potential role of perivascular fat [ 28 , 29 , 39 ] . While these studies have shown varied effects of perivascular fat on OVH vs. NT SV segments in vitro , as far as we are aware, only one recent study has used segments of SVs removed by EVH [ 40 ] . Here, nitric oxide (NO)-mediated endothelial-dependent relaxation (EDR) in vein segments harvested for lower extremity bypass using open surgical techniques was compared with that with EVH techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Also, it was suspected that PVAT maintains vascular tone by releasing vasoconstrictive factors. However, in both studies by Wheeler et al [ 40 ] and Yamada et al [ 29 ] , patient/SV segment numbers are low, and illustrations of SV histology indicate vascular damage to veins has occurred and are of poor quality.…”

Section: Discussionmentioning

confidence: 99%

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Towards Endoscopic No-Touch Saphenous Vein Graft Harvesting in Coronary Bypass Surgery

Kopjar

Dashwood

2022

Braz J Cardiovasc Surg

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The saphenous vein is the most used conduit for coronary artery bypass surgery. However, the patency rate of this graft is inferior to the internal thoracic artery patency rate, which is the gold standard. Using the conventional technique, the saphenous vein is harvested via a large open incision and excised in such a way that causes both vascular damage and wound healing complications. Consequently, vein graft patency and surgical site infection may be compromised. Graft patency is markedly improved when the saphenous vein is harvested atraumatically with minimal damage and with surrounding cushion of perivascular fat intact. However, despite the improved graft performance, wound healing complications and infection remain a problem. Although wound healing complication is reduced when using endoscopic vein harvesting, there may be a negative impact on graft performance. This is due to vascular damage associated with application of forces to the vein that are usually avoided in open vein harvesting, including traction, adventitial stripping, and venous compression. There is evidence to suggest that improved patency of endoscopically harvested saphenous veins is associated with the surgeon’s experience of the technique. Recently, endoscopic methods of harvesting have been described where the saphenous vein is removed intact and with minimal vascular damage caused. In addition, wound healing complications, infection, and scarring are reduced. While the effect of these techniques on vein graft patency have yet to be reported, the ability to obtain a superior graft with reduced wound complications will be of great benefit to patients undergoing coronary revascularization procedures.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Towards Endoscopic No-Touch Saphenous Vein Graft Harvesting in Coronary Bypass Surgery

Kopjar

Dashwood

2022

Braz J Cardiovasc Surg

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Endoscopic vein harvest: benefits beyond (a) reasonable doubt?

Lucchese¹,

Jarral²

2019

J. Thorac. Dis

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The Role of Endothelial Cells in the Onset, Development and Modulation of Vein Graft Disease

Ladak

McQueen

Layton

et al. 2022

Cells

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Endothelial cells comprise the intimal layer of the vasculature, playing a crucial role in facilitating and regulating aspects such nutrient transport, vascular homeostasis, and inflammatory response. Given the importance of these cells in maintaining a healthy haemodynamic environment, dysfunction of the endothelium is central to a host of vascular diseases and is a key predictor of cardiovascular risk. Of note, endothelial dysfunction is believed to be a key driver for vein graft disease—a pathology in which vein grafts utilised in coronary artery bypass graft surgery develop intimal hyperplasia and accelerated atherosclerosis, resulting in poor long-term patency rates. Activation and denudation of the endothelium following surgical trauma and implantation of the graft encourage a host of immune, inflammatory, and cellular differentiation responses that risk driving the graft to failure. This review aims to provide an overview of the current working knowledge regarding the role of endothelial cells in the onset, development, and modulation of vein graft disease, as well as addressing current surgical and medical management approaches which aim to beneficially modulate endothelial function and improve patient outcomes.

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Endothelial Function Is Preserved in Veins Harvested by Either Endoscopic or Surgical Techniques

Cited by 3 publications

References 31 publications

Towards Endoscopic No-Touch Saphenous Vein Graft Harvesting in Coronary Bypass Surgery

Towards Endoscopic No-Touch Saphenous Vein Graft Harvesting in Coronary Bypass Surgery

Endoscopic vein harvest: benefits beyond (a) reasonable doubt?

The Role of Endothelial Cells in the Onset, Development and Modulation of Vein Graft Disease

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