Pedicled no-touch saphenous vein graft harvest limits vascular smooth muscle cell activation: the PATENT saphenous vein graft study†

Abstract

SVGs harvested using the 'NT' technique exhibit an early molecular and morphological pattern consistent with decreased VSMC activation compared with CON harvesting. Functional leg recovery was similar in both groups at 12 months. Larger studies are required to corroborate these findings.

Conduits Used in Coronary Artery Bypass Grafting: A Review of Morphological Studies

“…This procedure involves harvesting a SV with the perivascular tissue intact without direct contact or manipulation of the vein long-term improvement. 33) The morphological characteristics of the vein, such as the luminal diameter, 31) the collagen in the tunica adventitia, 32) the circular distribution pattern of the smooth muscle cells in the tunica media, 31) and the endothelium in the tunica intima, remain intact. 32) The vasa vasorum and the expression of the nitric oxide synthase in the tunica intima increase, whereas the atherosclerotic process is reduced.…”

“…9) Regarding the morphology of the SV, a Turkish study reported a mean length of 72.42 ± 6.60 cm. 20) The luminal diameter varies in proximal, medial, and distal segment itself, thus avoiding distension prior to anastomosis, 31,32) which can cause intimal and medial hyperplasia, leading to graft failure. 31) When using conventional or manual dilatation technique, the SV is often stripped of its adventitial layer and distended, causing damage to the wall.…”

“…20) The luminal diameter varies in proximal, medial, and distal segment itself, thus avoiding distension prior to anastomosis, 31,32) which can cause intimal and medial hyperplasia, leading to graft failure. 31) When using conventional or manual dilatation technique, the SV is often stripped of its adventitial layer and distended, causing damage to the wall. 33) The luminal diameter of the vein increases, causing the loss of the characteristic folds in the tunica intima, 31) as well as modifications in the tunica media morphology and smooth muscle cell distribution.…”

“…31) When using conventional or manual dilatation technique, the SV is often stripped of its adventitial layer and distended, causing damage to the wall. 33) The luminal diameter of the vein increases, causing the loss of the characteristic folds in the tunica intima, 31) as well as modifications in the tunica media morphology and smooth muscle cell distribution. 31) Also these cells are genetically activated, which lead to an increased and uncontrolled proliferation and migration to the tunica intima, diminishing the graft permeability.…”

“…33) The luminal diameter of the vein increases, causing the loss of the characteristic folds in the tunica intima, 31) as well as modifications in the tunica media morphology and smooth muscle cell distribution. 31) Also these cells are genetically activated, which lead to an increased and uncontrolled proliferation and migration to the tunica intima, diminishing the graft permeability. 31) In contrast, when the "no touch" harvesting technique is used, it provides better structural, functional, and mechanical protection of the vein wall, resulting in a with 5.24 ± 0.62 mm, 3.25 ± 0.51 mm, and 1.67 ± 0.29 mm, respectively.…”