What is the impact of preserving the endothelium on saphenous vein graft performance? Comments on the ‘NO’ touch harvesting technique
Abstract Saphenous veins used for coronary artery bypass surgery are subjected to considerable vascular trauma when harvested by conventional methods. This vascular damage is responsible, at least in part, for the inferior patency of the saphenous vein when compared with the internal thoracic artery...
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-021-01397-y |
| _version_ | 1818673385611198464 |
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| author | Ninos Samano Andrzej Loesch Michael R. Dashwood |
| author_facet | Ninos Samano Andrzej Loesch Michael R. Dashwood |
| author_sort | Ninos Samano |
| collection | DOAJ |
| description | Abstract Saphenous veins used for coronary artery bypass surgery are subjected to considerable vascular trauma when harvested by conventional methods. This vascular damage is responsible, at least in part, for the inferior patency of the saphenous vein when compared with the internal thoracic artery. The performance of saphenous vein grafts is improved when this conduit is harvested atraumatically using the no-touch technique. There is growing evidence that the success of the no-touch technique is due to the preservation of a number of vascular structures including the endothelium, vasa vasorum and perivascular fat. There is conflicting evidence regarding the degree of endothelial damage to the endothelium of conventional versus no-touch saphenous vein grafts. In general, it has been shown that this single layer of cells lining the lumen exhibits considerable damage associated with a combination of vascular trauma and high pressure intraluminal distension. Increased platelet aggregation and thrombus formation at the exposed subendothelial membrane is due to a local reduction of endothelium-derived factors including nitric oxide. In addition, damage to the vasa vasorum of conventionally-harvested veins will reduce transmural blood flow, a condition shown to promote neointimal hyperplasia and atheroma formation. By stripping off the perivascular fat during conventional harvesting, mechanical support of the graft is reduced and the source of adipocyte-derived factors potentially beneficial for graft patency removed. While most agree that endothelial damage to the saphenous vein affects graft patency, the contribution of other tissue-derived factors affected by vascular damage at harvesting need to be considered. |
| first_indexed | 2024-12-17T07:54:57Z |
| format | Article |
| id | doaj.art-cd33d1f8692c448f87babe8610c77ae1 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-12-17T07:54:57Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-cd33d1f8692c448f87babe8610c77ae12022-12-21T21:57:45ZengBMCJournal of Cardiothoracic Surgery1749-80902021-03-011611510.1186/s13019-021-01397-yWhat is the impact of preserving the endothelium on saphenous vein graft performance? Comments on the ‘NO’ touch harvesting techniqueNinos Samano0Andrzej Loesch1Michael R. Dashwood2Department of Cardiothoracic and Vascular Surgery, Örebro UniversityCentre for Rheumatology, Royal Free Hospital Campus, University College Medical SchoolSurgical and Interventional Sciences, Royal Free Hospital Campus, University College Medical SchoolAbstract Saphenous veins used for coronary artery bypass surgery are subjected to considerable vascular trauma when harvested by conventional methods. This vascular damage is responsible, at least in part, for the inferior patency of the saphenous vein when compared with the internal thoracic artery. The performance of saphenous vein grafts is improved when this conduit is harvested atraumatically using the no-touch technique. There is growing evidence that the success of the no-touch technique is due to the preservation of a number of vascular structures including the endothelium, vasa vasorum and perivascular fat. There is conflicting evidence regarding the degree of endothelial damage to the endothelium of conventional versus no-touch saphenous vein grafts. In general, it has been shown that this single layer of cells lining the lumen exhibits considerable damage associated with a combination of vascular trauma and high pressure intraluminal distension. Increased platelet aggregation and thrombus formation at the exposed subendothelial membrane is due to a local reduction of endothelium-derived factors including nitric oxide. In addition, damage to the vasa vasorum of conventionally-harvested veins will reduce transmural blood flow, a condition shown to promote neointimal hyperplasia and atheroma formation. By stripping off the perivascular fat during conventional harvesting, mechanical support of the graft is reduced and the source of adipocyte-derived factors potentially beneficial for graft patency removed. While most agree that endothelial damage to the saphenous vein affects graft patency, the contribution of other tissue-derived factors affected by vascular damage at harvesting need to be considered.https://doi.org/10.1186/s13019-021-01397-yCoronary artery bypass graftEndotheliumNitric oxidePatencySaphenous veinTissue damage |
| spellingShingle | Ninos Samano Andrzej Loesch Michael R. Dashwood What is the impact of preserving the endothelium on saphenous vein graft performance? Comments on the ‘NO’ touch harvesting technique Journal of Cardiothoracic Surgery Coronary artery bypass graft Endothelium Nitric oxide Patency Saphenous vein Tissue damage |
| title | What is the impact of preserving the endothelium on saphenous vein graft performance? Comments on the ‘NO’ touch harvesting technique |
| title_full | What is the impact of preserving the endothelium on saphenous vein graft performance? Comments on the ‘NO’ touch harvesting technique |
| title_fullStr | What is the impact of preserving the endothelium on saphenous vein graft performance? Comments on the ‘NO’ touch harvesting technique |
| title_full_unstemmed | What is the impact of preserving the endothelium on saphenous vein graft performance? Comments on the ‘NO’ touch harvesting technique |
| title_short | What is the impact of preserving the endothelium on saphenous vein graft performance? Comments on the ‘NO’ touch harvesting technique |
| title_sort | what is the impact of preserving the endothelium on saphenous vein graft performance comments on the no touch harvesting technique |
| topic | Coronary artery bypass graft Endothelium Nitric oxide Patency Saphenous vein Tissue damage |
| url | https://doi.org/10.1186/s13019-021-01397-y |
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