No-touch saphenous vein grafts in coronary artery bypass surgery

2021 ◽  
pp. 243-248
Author(s):  
Ninos Samano ◽  
Domingos Souza
Keyword(s):  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Vasa Vasorum ◽  
Vein Grafts ◽  
Saphenous Vein Grafts ◽  
Ischaemic Damage ◽  
Harvesting Technique

After almost 30 years since the first harvesting of the saphenous vein graft with a pedicle of surrounding tissue (no-touch technique), there is no doubt that this method is superior to the conventional technique in which a denuded vein is harvested. In summary, the no-touch harvesting technique decreases risk of graft spasm and the requirement for manual dilatation, limiting endothelial cell loss and long-term damage. The preservation of the vasa vasorum allows retrograde blood flow from the graft lumen, thereby decreasing transmural ischaemic damage. This also preserves endothelial nitric oxide synthase, known to decrease intimal hyperplasia, atherosclerosis, and long-term graft failure. Furthermore, the perivascular tissue acts as a natural external stent reducing the neointimal and medial thickening of the vein graft and preventing it from kinking, which is especially vital for sequential grafts. Finally, target vessel size, quality, and degree of stenosis have little effect on the patency rates of no-touch saphenous vein grafts, in contrast to arterial grafts.

scholarly journals Saphenous Vein Graft Disease Interventions

2021 ◽  
Vol 06 (03) ◽  
pp. 199-208
Author(s):  
Sarita Rao ◽  
K. Roshan Rao ◽  
Achukatla Kumar
Keyword(s):  
Saphenous Vein ◽  
Vein Graft ◽  
Left Internal Mammary Artery ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Standard Of Care ◽  
Coronary Intervention ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Vein Grafts

AbstractIn the current era, coronary artery bypass grafting (CABG) is being increasingly performed using total arterial revascularization or a hybrid procedure of stenting of non-LAD disease and minimal access left internal mammary artery (LIMA) to LAD grafts, in order to minimize the need for vein grafts. Still, we encounter saphenous vein graft (SVG) disease, and it might require PCI, which often presents with unique challenges. The current favored strategy is to attempt PCI of the native coronary, if feasible, especially in long degenerated SVG disease, as it has shown better short- and long-term outcome. PCI is preferred over repeat CABG for early recurrent symptoms after CABG in patent LIMA graft and amenable anatomy patients. Balloon predilatation is not recommended unless delivery of an EPD or stent is not possible. Distal protection should be considered the standard of care for percutaneous coronary intervention (PCI) in most patients with older vein grafts, as periprocedural myocardial infarction and no reflow are the Achilles heel of SVG PCI. Intragraft vasodilators should be used liberally, even before balloon angioplasty/stenting. Avoid postdilatation, and usage of undersized but a longer stent length to reduce plaque extrusion through stent struts is preferred. Consider thrombectomy in lesions with a heavy thrombus burden. Keep activated clotting time on the higher side than in conventional PCI. Prolonged dual antiplatelet therapy (DAPT) based on the DAPT score is recommended. With all the precautions and care, we still need a fair wind in our favor to sail through the vein grafts disease.

Prevalence and outcomes of intermediate saphenous vein graft lesions: Findings from the stenting of saphenous vein grafts randomized-controlled trial

2013 ◽  
Vol 168 (3) ◽  
pp. 2468-2473 ◽  
Author(s):  
Abdul-rahman R. Abdel-karim ◽  
Monica Da Silva ◽  
Christopher Lichtenwalter ◽  
James A. de Lemos ◽  
Owen Obel ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Controlled Trial ◽  
Vein Grafts ◽  
Randomized Controlled ◽  
Saphenous Vein Grafts

No-Touch Sequential Saphenous Venous Harvesting Technique in Off-Pump Bypass Surgery: A Retrospective Study

2021 ◽  
Author(s):  
Xuejian Hou ◽  
Kui Zhang ◽  
Taoshuai Liu ◽  
Yang Li ◽  
Yang Zhao ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Conventional Technique ◽  
Wound Complications ◽  
Off Pump ◽  
Vein Grafts ◽  
Harvesting Technique ◽  
Significant Difference ◽  
Pump Cabg

Abstract Background In the mid-1990s, the Swedish expert team proposed saphenous vein graft (SVG) harvesting with pedicle tissue. The short-term and long-term patency rates of the great saphenous vein obtained by the no-touch technique (NT) were higher than those obtained by the conventional technique (CON). In the past, NT technology was mainly used in on-pump coronary artery bypass grafting (CABG), and vein grafts were mostly single vein grafts. In this study, we retrospectively analysed the safety and effectiveness of sequential vein grafts using NT technology in off-pump CABG. Methods From 2017 to 2019, a total of 505 patients were included in the study. There were 150 patients in the NT group and 355 patients in the CON group. After applying propensity score matching (1:1 matching), 148 patients were included in each group. Baseline data, graft patency, postoperative complications, leg wound complications and 1-year major adverse cardiac and cerebrovascular events (MACCEs) were compared between the two groups. Results There was no significant difference in the patency rate of sequential venous grafts between the two groups one year after the operation either before (NT: 7.1% (10/141) vs CON: 11.5% (38/331), p = 0.149) or after matching (NT: 7.1% (10/140) vs CON: 7.3% (9/124), p = 0.971). There was no significant difference in the composite clinical endpoint between the two groups either before (NT: 3 (2.3%) vs CON: 9 (2.8%), p = 1.000) or after matching (NT: 3 (2.3%) vs CON: 3 (2.5%), p = 1.000). There were differences in leg wound complications between the two groups both before (NT: 9 (6.9%) vs CON: 6 (1.9%), p = 0.007) and after matching (NT: 9 (6.9%) vs CON: 2 (1.7%), p = 0.043). Conclusions The application of the NT technique in off-pump CABG with sequential vein grafts is safe and effective. Leg wound complications are more common with the NT technique than with the conventional technique.

scholarly journals Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting

JAMA ◽  
2020 ◽  
Vol 324 (2) ◽  
pp. 179 ◽  
Author(s):  
Mario Gaudino ◽  
Umberto Benedetto ◽  
Stephen Fremes ◽  
Karla Ballman ◽  
Giuseppe Biondi-Zoccai ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Radial Artery Graft ◽  
Artery Graft

Contemporary use of embolic protection devices in saphenous vein graft interventions: Insights from the stenting of saphenous vein grafts trial

2010 ◽  
Vol 76 (2) ◽  
pp. 263-269 ◽  
Author(s):  
Neeraj Badhey ◽  
Christopher Lichtenwalter ◽  
James A. de Lemos ◽  
Michele Roesle ◽  
Owen Obel ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Embolic Protection ◽  
Vein Grafts ◽  
Saphenous Vein Grafts ◽  
Protection Devices

A single sequential snake saphenous vein graft versus separate left and right vein grafts in coronary artery bypass surgery: a population-based cohort study from the SWEDEHEART registry†

2019 ◽  
Vol 56 (3) ◽  
pp. 518-525 ◽  
Author(s):  
Sara Wallgren ◽  
Susanne Nielsen ◽  
Emily Pan ◽  
Aldina Pivodic ◽  
Emma C Hansson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Vein Grafts ◽  
End Point ◽  
Left And Right

Abstract OBJECTIVES Our goal was to compare short- and midterm outcomes after coronary artery bypass grafting (CABG) using 2 different revascularization strategies. METHODS A total of 6895 patients were included who had CABG in Sweden from 2009 to 2015 using the left internal mammary artery to the left anterior descending artery and either a single sequential saphenous vein graft connecting the left and right coronary territories to the aorta (snake graft, n = 2122) or separate vein grafts to both territories (n = 4773). Data were obtained from the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) and the Swedish Patient Registry. The groups were compared using adjusted logistic regression for short-term (30-day) and Cox regression and flexible parametric survival models for midterm outcomes. Primary outcome was a composite of all-cause mortality, myocardial infarction (MI), reangiography and new revascularization. The median follow-up time was 35 months. RESULTS At 30 days, the incidences of the composite end point [odds ratio (OR) 1.31, 95% confidence interval (CI) 1.03–1.68; P = 0.03] and reangiography (OR 1.51, 95% CI 1.07–2.14; P = 0.02) were higher in the snake group. There was also a trend towards higher mortality (OR 1.47, 95% CI 0.97–2.22; P = 0.07). The event rates during the complete follow-up period were 6.5 (5.9–7.2) and 5.7 (5.3–6.1) per 100 person-years for the snake group and the separate vein group, respectively. At the midterm follow-up, no significant difference between the groups could be shown for the composite end point [hazard ratio (HR) 1.08, 95% CI 0.95–1.22; P = 0.24], mortality (HR 0.95, 95% CI 0.79–1.14; P = 0.56), MI (HR 1.11, 95% CI 0.88–1.41; P = 0.39) or new revascularization (HR 1.19, 95% CI 0.94–1.50; P = 0.15), whereas reangiography remained more common in the snake group (HR 1.25, 95% CI 1.05–1.48; P = 0.01). CONCLUSIONS Snake grafts were associated with a higher rate of early postoperative complications, possibly reflecting a more demanding surgical technique, whereas midterm outcomes were comparable. Based on these data, one strategy cannot be recommended over the other.

No-touch saphenous vein graft harvesting technique for coronary artery bypass grafting

2019 ◽  
Vol 68 (3) ◽  
pp. 248-253
Author(s):  
Yu Inaba ◽  
Masataka Yamazaki ◽  
Masatoshi Ohono ◽  
Kentaro Yamashita ◽  
Hiroaki Izumida ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Harvesting Technique

Coagulation Factor V (Arg506 → Gln) Mutation and Early Saphenous Vein Graft Occlusion after Coronary Artery Bypass Grafting

1998 ◽  
Vol 80 (08) ◽  
pp. 220-224 ◽  
Author(s):  
Angela Silveira ◽  
Hooft Ferdinand van’t ◽  
Per Tornvall ◽  
Margareta Blombäck ◽  
Björn Wiman ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Factor V ◽  
Graft Occlusion ◽  
Vein Grafts ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryThe factor V (Arg506→Gln) mutation confers an increased risk of deep vein thrombosis, whereas its role in saphenous vein graft closure after coronary artery bypass grafting (CABG) remains unclear. This study examined the anticoagulant response to activated protein C (APC ratio) in relation to the surgical trauma and the significance of the factor V Leiden mutation in determining postoperative thrombin generation and fibrin formation and the risk of early vein graft occlusion. A total of 108 men undergoing elective CABG for exertional angina pectoris (mean age 61.1 ± 8.7 years) were examined. The patency of saphenous vein grafts was studied at routine reangiography three months after CABG.Of 100 patients who underwent reangiography, 23 had one or more occluded vein grafts at reangiography. Heterozygosity for the factor V (Arg506→Gln) mutation tended to be associated with early saphenous vein graft occlusion (5/11 carriers vs. 18/89 non-carriers with graft occlusion, व2 = 3.52, p = 0.06), whereas pre- and postoperative APC ratios did not. Pre- and postoperative determinations of prothrombin fragment 1+2, thrombin-antithrombin complexes and soluble fibrin levels did not differ between patients with and without the mutation.Early saphenous vein graft occlusion after CABG could tentatively be added to deep vein thrombosis as a vascular complication that can be attributed to the factor V (Arg506→Gln) mutation.

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