“No-Touch” versus “Endo” Vein Harvest: Early Patency on Symptom-Directed Catheterization and Harvest Site Complications

Objective “No-touch” (NT) saphenous vein harvesting preserves the adventitial vasa vasorum, prevents medial ischemia, and is associated with an improved short-term and long-term vein graft patency. It may also be associated with a higher rate of harvest site complications. Endovascular vein harvesting (endo-vein) has a low rate of harvest site complications but also a tendency toward a lower patency rate. Methods During a 2-year period (2011–2012), we compared the vein graft patency at symptom-directed cardiac catheterization as well as wound complication rates in 210 patients who received either NT (87 patients) or endo-vein (123 patients). Results The recatheterization rate for the two groups was similar: 9 (10.3%) of 87 of the NT patients versus 11 (9.0%) of 123 of the endo-vein patients. There was a significant difference in vein graft patency between the groups: 15 (94%) of 16 NT vein grafts were patent versus 6 (27%) of 22 of endo-veins ( P < 0.02). The endo-vein graft patency during this 2-year period was similar to the total endo-vein patency (37%) during a 4-year period. A comparison between a more experienced and a less experienced harvester revealed no difference in patency rate. Harvest site complications were significantly higher with the NT harvest: 18% of the NT patients requiring vacuum-assisted wound closure or intravenous antibiotics versus 2% of the endo-vein patients ( P < 0.0001). The application of platelet-rich plasma did not significantly lower wound complication rates ( P = 0.27). Conclusions These results suggest that NT vein harvesting may be associated with improved graft patency, but methods should be developed to lower wound complication rates.

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2223Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on vein-graft patency 1 year after coronary artery bypass grafting with or without diabetes: a post-hoc analysis of the DACAB tria

European Heart Journal ◽

10.1093/eurheartj/ehz748.0119 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y P Zhu ◽

H Liu ◽

M L Zhang ◽

J Mei ◽

Q Zhao

Keyword(s):

Coronary Artery ◽

Vein Graft ◽

Patency Rate ◽

Artery Bypass ◽

Graft Patency ◽

Bypass Grafting ◽

Once Daily ◽

Vein Grafts ◽

Significant Difference ◽

Graft Patency Rate

Abstract Introduction The association of diabetes and vein graft patency after coronary artery bypass grafting (CABG) remains controversial. In patients with diabetes, impaired endothelial function in vein grafts and high platelet turnover might result in early vein graft failure. The DACAB trial showed ticagrelor plus aspirin significantly increased 1-year vein graft patency vs. aspirin alone, while no significant difference between ticagrelor alone and aspirin alone. However, whether the results is different between the patients with or without diabetes is unknown. Purpose To assess the effects of ticagrelor with or without aspirin vs. aspirin alone on 1-year vein grafts patency after CABG in patients with or without diabetes. Methods We examined the subgroups of patients with and without diabetes from DACAB trial (NCT02201771), in which 500 patients were randomized to 1 of 3 antiplatelet regimens (ticagrelor 90mg twice daily plus aspirin 100mg once daily, T+A group; ticagrelor 90mg twice daily, T group; or aspirin 100mg once daily, A group) within 24 hours post-CABG. The primary outcome was 1-year vein graft patency (FitzGibbon grade A) assessed by multi-slice computed tomographic angiography or coronary angiography. Results According to the baseline medical history and/or glycated hemoglobin (HbA1c) ≥6.5%, 283 patients with 818 vein grafts were allocated to the non-diabetes subgroup, remaining 217 patients with 642 vein grafts to the diabetes subgroup. By per-graft analysis, no significant difference on 1-year vein graft patency rate was observed between non-diabetes and diabetes subgroup (84.6% [692/881] for non-diabetes vs. 80.2% [515/642] for diabetes, adjusted odds ratio (OR) =1.39, 95% CI: 0.92–2.09, P=0.116). In T+A group, 1-year vein graft patency rates were 91.0% (244/268) for non-diabetes vs. 85.8% (188/219) for diabetes; In T group, 85.0% (221/260) for non-diabetes vs. 80.3% (183/228) for diabetes; In A group, 78.3% (227/290) for non-diabetes vs. 73.9% (144/195) for diabetes. Ticagrelor plus aspirin showed higher vein graft patency rate than aspirin alone in both non-diabetes and diabetes subgroup (non-diabetes: adjusted OR = 0.34, 95% CI: 0.17–0.69, and diabetes: adjusted OR = 0.42, 95% CI: 0.19–0.91, P for interaction = 0.524), whereas ticagrelor alone did not show improvement on vein graft patency compared with aspirin alone in both subgroups (non-diabetes: adjusted OR=0.62, 95% CI: 0.32–1.20, and diabetes: adjusted OR = 0.65, 95% CI: 0.33–1.31, P for interaction = 0.795). Similar results were showed by per-patient analysis. A total 16 major adverse cardiovascular events occurred, 8 (2.8%) for non-diabetes and 8 (3.7%) for diabetes. Conclusion In the DACAB trial, diabetes was not found to be associated with decreased vein graft patency at 1 year after CABG. The effect of ticagrelor plus aspirin on improvement of 1-year vein graft patency, when compared with aspirin alone, is consistent in patients with or without diabetes. Acknowledgement/Funding AstraZeneca

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The right internal mammary artery and the great saphenous vein used for left anterior descending artery revascularization in patients whose left internal mammal artery cannot be used: a study based on transit-time flow measurement.

10.21203/rs.3.rs-16224/v1 ◽

2020 ◽

Author(s):

Guodong Zhang ◽

Yu Chen ◽

Shenglong Chen ◽

Gang Liu ◽

Zhou Zhao

Keyword(s):

Pulsatility Index ◽

Patency Rate ◽

Flow Measurement ◽

Internal Mammary Artery ◽

Great Saphenous Vein ◽

Graft Patency ◽

Time Flow ◽

Significant Difference ◽

Internal Mammary ◽

Early Graft

Abstract Background: Owing to the high patency, the use of the left internal mammary artery (LIMA) for left anterior descending artery (LAD) grafting has been a cornerstone of coronary artery bypass graft surgery (CABG). However, for some patients whose LIMA cannot be used, surgeons have to choose the other conduit materials to revascularize the LAD. The purpose of this study was to explore the difference of different conduit materials used for LAD in the parameters measured by transit-time flow measurement (TTFM) and the early graft patency detected by computed tomography angiography.Methods: We retrospectively collected the data of 410 patients who undergoing isolated primary OPCAB with intraoperative TTFM data. According to the strategy of the left descending artery (LAD) revascularization, 410 patients were assigned to three groups: a left internal mammal artery (LIMA)group(n=333), a right IMA group (n=34) and a great saphenous vein (SVG) group (n=43). The baseline and perioperative blood parameters were compared for the three groups, as well as the early graft patency rates. Results: Compared with the LIMA-LAD group, the SVG-LAD group had a significantly higher mean graft flow volume(37.15±23.29vs29.71±20.94ml/min, P=0.036),however, a lower pulsatility index (2.07±0.62vs 2.65±1.01,P＜0.001).There was no significant difference between the two groups in DF(P＞0.05).Compared with the RIMA-LAD group, the SVG-LAD group just had a lower pulsatility index(2.07±0.62vs 2.56±0.96,P=0.029).However, there was no significant difference between the two groups in MGF and DF(P＞0.05).Compared with the LIMA-LAD group, the RIMA-LAD group had a bit lower DF(70.76±11.87vs74.06±7.09,P=0.018),while there was no difference in MGF and PI between the two groups(P＞0.05). The patency rate of the LIMA-LAD group was 98.72% (309/313), the RIMA-LAD group was 97.06% (33/34), and the SVG-LAD group was 100%. There was no difference among the three groups in patency rate(P=0.405).Conclusions: We conclude that in patients whose LIMA cannot be used，the in-suit RIMA and the SVG are comparable and even better than the LIMA in the blood flow parameters measured by TTFM. In our study，the early patency before discharge of RIMA-LAD and SVG-LAD are comparable with the LIMA-LAD.

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Analysis of Outcomes in Adolescents and Young Adults With Pilonidal Disease

Frontiers in Surgery ◽

10.3389/fsurg.2021.613605 ◽

2021 ◽

Vol 8 ◽

Author(s):

Mackenzie N. Abraham ◽

Steven L. Raymond ◽

Russell B. Hawkins ◽

Atif Iqbal ◽

Shawn D. Larson ◽

...

Keyword(s):

Young Adults ◽

Older Patients ◽

Pilonidal Disease ◽

Wound Complication ◽

Wound Complications ◽

Complication Rates ◽

Recurrence Rates ◽

Significant Difference ◽

Secondary Healing ◽

Age And Sex

Purpose: Numerous definitive surgical techniques exist for the treatment of pilonidal disease with varied recurrence rates and wound complications. Due to the wide array of techniques and lack of consensus on the best approach, we proposed to study our experience treating pilonidal disease in adolescents and young adults.Methods: A retrospective analysis was conducted of patients 10–24 years old treated at a tertiary medical center from 2011 to 2016. Data including demographics, management, and outcomes were collected and analyzed. Primary outcome was recurrence of disease.Results: One hundred and thirty three patients with pilonidal disease underwent operative management. Fifty one percent underwent primary closure and 49% healed by secondary intention with no significant difference in recurrence rates (primary 18%, secondary 11%; p = 0.3245). Secondary healing patients had significantly lower wound complication rates (primary 51%, secondary 23%; p = 0.0012). After accounting for sex, race, weight, and operative technique, age was predictive of disease recurrence with an adjusted odds ratio (OR) of 0.706 (0.560–0.888; p = 0.003). Age and sex were both predictive of wound complications. Older patients had decreased risk of wound complication (adjusted OR 0.806, 95% CI 0.684–0.951; p = 0.0105), and male patients had increased risk of wound complication (adjusted OR 2.902, 95% CI 1.001–8.409; p = 0.0497).Conclusion: In summary, there is no significant difference in the recurrence rates between operative techniques for pilonidal disease. Older patients have decreased risk of recurrence following intervention. Wound complication rates are lower in patients undergoing secondary healing, though this may be better explained by differences in age and sex. Additional research investigating newer, minimally-invasive techniques needs to be pursued.

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Does Concurrent Distal Tibiofibular Joint Arthrodesis Affect the Nonunion and Complication Rates of Tibiotalar Arthrodesis?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00367 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0036

Author(s):

Julie Neumann ◽

Maxwell Weinberg ◽

Chong Zhang ◽

Charles Saltzman ◽

Alexej Barg

Keyword(s):

Wound Complication ◽

Ankle Arthrodesis ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Wound Complications ◽

Complication Rates ◽

Vein Thrombosis ◽

Significant Difference ◽

Tibiotalar Arthrodesis ◽

End Stage

Category: Ankle Introduction/Purpose: Tibiotalar arthrodesis is generally a successful treatment option for patients with end stage ankle arthritis. However, there is a 9% risk of nonunion in patients undergoing primary tibiotalar arthrodesis. To date, it is unclear whether concurrent distal tibio-fibular joint arthrodesis affects this nonunion rate as there have been no studies directly comparing patients with and without arthrodesis of the distal tibio-fibular joint. The purpose of this clinical study is to compare the rate of nonunion in patients with a distal tibio-fibular fusion to those without a distal tibio-fibular fusion in the setting of a primary, open ankle arthrodesis. The hypothesis of this study was that the addition of a distal tibio-fibular fusion would decrease the nonunion rate in patients undergoing open ankle arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. 366 ankles from 354 unique patients met inclusion criteria. All patients underwent primary, open tibiotalar arthrodesis. 250 patients underwent open tibiotalar arthrodesis with a distal tibio-fibular fusion and 116 patients underwent open tibiotalar arthrodesis without a distal tibio-fibular fusion. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was nonunion rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, and rate of development of post-operative deep vein thrombosis (DVT)/Pulmonary embolism (PE). Results: Average age of the patients was 56.2 +/- 14.2 years. Mean follow-up time was 33.8 months. Unions were assessed on routine post-operative radiographs and by clinical examination. If there was a concern for nonunion, computerized tomography scan was utilized for further assessment. Nonunion rate of patients who had the distal tibio-fibular joint included was 19/250 (8%) and nonunion rate of those who did not have the distal tibio-fibular joint fused was 14/116 (12%) (p=0.16). There was no significant difference between those who had the distal tibio-fibular joint included versus who did not in wound complication rate (27% vs 31%, p=0.40), time to union (4.9 weeks versus 5 weeks, p =0.54), and DVT/PE rate (5% vs 3%, p=0.41), respectively [Table 1]. There were no major complications. Conclusion: To our knowledge, this is the first study directly comparing nonunion rates and complication rates in patients who underwent primary, open ankle arthrodesis with and without distal tibio-fibular joint arthrodesis. In this study, inclusion of the distal tibio-fibular joint in tibiotalar arthrodesis does not affect nonunion rate in patients undergoing primary, open ankle arthrodesis. Additionally, inclusion of the distal tibio-fibular joint does not affect rate of wound complication, time to union, and DVT/PE rate.

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Hypothesis: A Potential Role for the Vasa Vasorum in the Maintenance of Vein Graft Patency

Angiology ◽

10.1177/000331970405500405 ◽

2004 ◽

Vol 55 (4) ◽

pp. 385-395 ◽

Cited By ~ 33

Author(s):

Michael R. Dashwood ◽

Radhi Anand ◽

Andrzej Loesch ◽

Domingos S.R. Souza

Keyword(s):

Vein Graft ◽

Potential Role ◽

Graft Patency ◽

Vasa Vasorum

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Multiple Skin Bridging for No-Touch Saphenous-Vein Grafts Harvesting Can Reduce Wound Morbidity

The Heart Surgery Forum ◽

10.1532/hsf.3875 ◽

2021 ◽

Vol 24 (3) ◽

pp. E496-E501

Author(s):

Kang Zhou ◽

Xiaoke Qi ◽

Shijie Wei ◽

Xinmin Zhou ◽

Yuan Zhao

Keyword(s):

Saphenous Vein ◽

Patency Rate ◽

Artery Bypass ◽

Bypass Graft ◽

Graft Patency ◽

Subjective Perception ◽

Significant Difference ◽

One Year ◽

Bridging Technique ◽

Graft Length

Background: Reducing the leg wound morbidity is crucial for the patients undergoing coronary artery bypass grafting (CABG) with great saphenous vein (SV) grafts harvested by no-touch (NT) technique. This study was to summarize the experience of skin bridging technique for reducing wound morbidity and the influence of it on one-year bypass graft patency. Methods: According to skin bridging or not, harvesting times, graft length, number of bleeding branches, postoperative subjective perception assessment scale (ASEPSIS) scores and one-year patency rate were analyzed. Results: From June 2018 to February 2019, 60 patients underwent CABG with SV grafts either with open-incision NT or skin bridging NT (30 in each group). There were no significant differences in age (71.4 ± 5.1 years vs. 68.9 ± 5.5 years) or graft length (23.3 ± 1.1 cm vs. 23.9 ± 1.3 cm) between the two groups. The bridging/NT group had a significantly longer harvest time (38.5 ± 4.9 min vs. 18.5 ± 2.6 min; P < 0.001) and a significantly greater number of bleeding branches (1.9 ± 1.2 vs. 0.8 ± 0.8; P < 0.001) than the open NT group. The open NT group had a significantly higher ASEPSIS score (23.8 ± 2.0 vs. 15.7 ± 2.6; P < 0.001). There was no significant difference in patency rate at one-year follow-up. Conclusion: Obtaining the SV by the combined NT/discontinuous skin bridging technique is a satisfactory method for patients who underwent CABG. This method has important clinical significance in reducing wound morbidity in the harvest of NT grafts.

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Platelet-Rich Plasma in the Treatment of Subcutaneous Venous Access Device Scars: A Head-to-Head Patient Survey

BioMed Research International ◽

10.1155/2015/630601 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

C. Eichler ◽

M. Najafpour ◽

A. Sauerwald ◽

J. Puppe ◽

M. Warm

Keyword(s):

Surgical Outcome ◽

Platelet Rich Plasma ◽

Venous Access ◽

Outcome Evaluation ◽

Control Group ◽

Complication Rates ◽

Access Device ◽

Port Area ◽

Significant Difference ◽

Venous Access Device

Introduction. Platelet-rich plasma (PRP) is a product widely used in sports medicine, tissue repair, and general surgery. A recent meta-analysis showed this product to be beneficial when introduced into a wound area, be it intra-articular (i.e., joint-injections) or direct introduction onto the wound surface.Methods. Between the years of 2012 and 2014 a questionnaire evaluating surgical outcome after port (venous access device) removal was answered by 100 patients in the control group and 20 patients in a PRP group, leading to a total of 120 patients in this single center, retrospective, subjective outcome evaluation.Results. No statistical difference was shown in postsurgical complication rates, postsurgical pain, decreased mobility, and overall quality of life. A significant difference was shown in overall patient satisfaction and the desire to further improve port area scarring. Results differed significantly in favor of the PRP group. Interestingly, approximately 40.2% of patients are dissatisfied with the surgical outcome after port removal in the control group. This result, though surprising, may be improved to 10% dissatisfaction when a PRP product is used.Conclusion. PRP products such as Arthrex ACP are safe to use and present an additional option in improving surgical outcome.

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Low Risk of Wound Complications with Sinus Tarsi Approach for Treatment of Calcaneus Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00484 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0048

Author(s):

S. Blake Wallace ◽

David O’Neill ◽

Anish Narayanan ◽

George T. Liu ◽

Avneesh Chhabra ◽

...

Keyword(s):

Smoking Status ◽

Case Series ◽

Wound Complication ◽

Wound Complications ◽

Complication Rates ◽

Sinus Tarsi ◽

Radiographic Measurements ◽

Sinus Tarsi Approach ◽

Significant Difference ◽

Calcaneus Fractures

Category: Trauma; Hindfoot Introduction/Purpose: Fractures of the calcaneus are life-changing events with a major socioeconomic impact from lost productivity. Traditional operative treatment with the extensile lateral approach has shown relatively high rates of wound complications. Less invasive approaches can improve fracture alignment and decrease wound healing complications. The purpose of this study is to report our experience with the sinus tarsi approach in treating calcaneus fractures. Methods: We retrospectively identified patients at our institution treated with a limited sinus tarsi approach for calcaneus fractures from 2009-2018. Demographic and radiographic data were collected including: age, sex, mechanism of injury, occupation, presence of diabetes, smoking status, Sanders classification, Bohler and Gissane angles. Postoperatively, we recorded the presence of complications, return-to-work time, and radiographic measurements. Results: Our analysis included 105 fractures in 100 patients: 86% males, 42% smokers, 4% diabetics, with an average body mass index of 26.5. The fractures were: Sanders type 2 (32%), type 3 (48%), type 4 (18%), and 2% were a tongue-type variant. Preoperatively 38% of fractures displayed a negative angle, 50% had an angle 0-20 degrees, and 12% over 20 degrees; postoperatively 13% had an angle 0-20 degrees, and 87% had an angle over 20 degrees. Of patients working prior to the injury, 72% had returned to work by 6 months, and 89% by 12 months. The wound complication rate was 12% (12/100), with only 2% (2/100) requiring additional procedures. There was no significant difference in wound complication rates in smokers versus nonsmokers (11.9% vs 12.2%, p=0.55). Conclusion: The limited sinus tarsi approach for depressed calcaneus fractures allows radiographic restoration of calcaneal height with a low rate of wound complications, even amongst active smokers. To the authors’ best knowledge, this is the largest published case series of calcaneus fractures treated with the sinus tarsi approach. Further follow up is needed to determine the success of this approach in mitigating long term complications.

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Favourable outcomes of coccygectomy for refractory coccygodynia

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13814021676675 ◽

2014 ◽

Vol 96 (2) ◽

pp. 136-139 ◽

Cited By ~ 7

Author(s):

B Haddad ◽

V Prasad ◽

W Khan ◽

M Alam ◽

S Tucker

Keyword(s):

Pain Relief ◽

Wound Complication ◽

Daily Activities ◽

Rank Test ◽

Complication Rates ◽

Significant Difference ◽

Lower Complication ◽

Signed Rank Test ◽

Poor Outcomes

Introduction Coccygodynia is a condition associated with severe discomfort in the region of the coccyx. While traditional procedures had poor outcomes and high complication rates, recent literature suggests better outcomes and lower complication rates with coccygectomy. Methods Data were collected retrospectively from clinical notes. A questionnaire was used to evaluate the outcomes. The outcome measures included pain analogue score (PAS) in sitting and during daily activities as well as patients’ overall pain relief. Overall improvement in pain and complications were documented. Results Between 2000 and 2010, 14 patients underwent total coccygectomy for refractory coccygodynia. All patients were available for follow-up appointments and the follow-up duration ranged from 24 to 132 months (mean: 80 months). The aetiology was traumatic in eight patients and non-traumatic in six. The PAS improved from a median of 9 to 4 for sitting and from 7.5 to 2.5 for daily activities. One patient had mild discharge for more than two weeks. No patients required further surgery. Twelve patients (85.7%) had excellent or good pain relief. Only one patient was unsatisfied. A Wilcoxon signed-rank test revealed significant improvement in pain when sitting (p<0.05) and during activities of daily living (p<0.05) at the final follow-up visit. A Mann–Whitney U test did not show a significant difference in improvement in PAS between the traumatic and non-traumatic groups (p=0.282 and 0.755). Conclusions In our series, total coccygectomy offered satisfactory relief of pain in the majority of patients with a low wound complication rate.

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