No-touch technique of saphenous vein dissection in myocardial revascularization surgery
Keywords:
saphenous vein, saphenous vein graft, coronary artery bypass, myocardial revascularization.Abstract
Introduction: To date, the internal saphenous vein is the most commonly used graft in myocardial revascularization surgery; therefore, the study of the mechanisms related to the occlusion process of these bridges and alternatives to improve their patency is a priority research topic.
Objectives: To describe the mechanisms involved in venous graft disease; to present the "no touch" saphenous vein dissection technique; to compare the results of the conventional and "no touch" technique, according to histological preservation and to describe the long-term results of the "no touch" technique, taking into account graft patency.
Methods: A review of scientific and research articles, available in PubMed databases, was performed regarding the "no touch" technique of dissection of the internal saphenous vein.
Results: Venous graft disease has three stages: early thrombosis, intimal hyperplasia and late development of atherosclerosis. The "no touch" technique allows preservation of perivascular tissue that allows atraumatic manipulation. Histopathological analysis shows preservation with the "no touch" technique and alteration in different degrees with the conventional technique. Graft patency by the "no touch" technique is 83% after 16 years.
Conclusions: The preparation of the saphenous vein by the "no touch" technique allows excellent preservation of histological integrity. The saphenous vein grafts extracted by "no touch" technique have a high long-term patency.
Downloads
References
Raza S, Chang C, Deo SV, Sabik JF. Current role of saphenous vein graft in coronary artery bypass grafting. Indian J Thorac Cardiovasc. 2018 Dec [acceso 30/07/2021];34(3):245-50. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525697/pdf/12055_2018_Article_759.pdf
Guida G, Ward A, Bruno VD, George SJ, Caputo M, Angelini G, et al. Saphenous vein graft disease, pathophysiology, prevention, and treatment. A review of the literature. J Card Surg. 2020 Jun [acceso 22/10/2021];35(6):[aprox. 8p.]. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/jocs.14542
Alcocer-Diéguez J, Albors-Martín J, García-Valentín A, Tébar-Bot Eí. Cirugía coronaria con doble arteria mamaria: nuestra experiencia inicial y resultados a corto plazo. Cir Cardiov. 2017 Sep [acceso 21/01/2022];24(3):142-8. Disponible en: https://daneshyari.com/article/preview/5601275.pdf
Almeida de Oliveira S, Leno Judas G, Praça de Oliveira MA. Revascularização Cirúrgica Do Miocárdio - Análise Crítica Da Evolução E Estado Atual. Rev Soc Cardiol. 2018 Mar [acceso 21/01/2022];28(1):60-5. Disponible en: https://docs.bvsalud.org/biblioref/2021/08/906759/08_revistasocesp_v28_01_ingles.pdf
Kopjar T, Dashwood MR, Dreifaldt M, de Souza DR. No-touch saphenous vein as an important conduit of choice in coronary bypass surgery. J Thorac Dis. 2018 Aug [acceso 04/08/2021];10(26):3292-6. Disponible en: https://jtd.amegroups.com/article/view/23735/pdf
Samano N, Geijer H, Liden M, Fremes S, Bodin L, Souza DS. The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: a randomized trial. Thorac Cardiovasc Surg. 2015 Jul [acceso 18/03/2021];150(4):880-8. Disponible en: https://www.sciencedirect.com/science/article/pii/S0022522315012386
Gao J, Liu Y, Li YM. Review of risk factors, treatment, and prevention of saphenous vein graft disease after coronary artery bypass grafting. J Int Med Res. 2018 Dec [acceso 28/01/2022];46(12):4907-19. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300967/pdf/10.1177_0300060518792445.pdf
Moshkovitz J, Raanan E. The art of saphenous vein grafting and patency maintenance. J Thorac Cardiovasc Surg.2016 Sep [acceso 21/06/2022];151(0):300-02. Disponible en: http://www.nature.com/ijo/journal/v41/n3/pdf/ijo2016222a.pdf.
Cuerpo G, Muñoz C, López J. Injertos en cirugía coronaria. Revisión «realista» de la bibliografía. Cir Cardiov. 2017 Abr [acceso 11/02/2021];24(3):170-4. Disponible en: https://www.elsevier.es/es-revista-cirugia-cardiovascular-358-pdf-S1134009617300645.
Quiroz Ml, Drolett N, Aguirre P, Cifuentes F, Mancilla E, Pumarino A. Reactividad vascular in vitro y estudio morfométrico en venas safenas utilizadas como bypass coronario: Técnica no touch versus convencional. Rev Chil Cir. 2018 Mar [acceso 16/03/2021];70(5):424-31. Disponible en: https://scielo.conicyt.cl/pdf/rchcir/v70n5/0718-4026-rchcir-70-05-0425.pdf
Woodward LC, Antoniades C, Taggart DP. Intraoperative Vein Graft Preservation: What Is the Solution? Ann Thorac Surg. 2016 Nov [acceso 28/06/2022];102(5):1736-46. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27624295/
López Jaramillo P, Bolívar IC, Rueda-Clausen ChF, Calderón J, Castillo VR, López A, et al. Papel del tejido perivascular en la regulación del tono vascular: repercusión en el uso de puentes aorto-coronarios para revascularización miocárdica. Rev. Colomb. Cardiol. 2007 Mar [acceso 10/03/2021];14(2):[aprox. 25p.]. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-56332007000200006
Papakonstantinou NA, Baikoussis NG, Goudevenos J, Papadopoulos G, Apostolakis E. Novel no touch technique of saphenous vein harvesting: Is great graft patency rate provided. Ann Card Anaesth. 2016 Jul-Sep [acceso 30/07/2021];19(3):481-8. Disponible en: https://www.annals.in/temp/AnnCardAnaesth193481-5050451_140144.pdf
Souza DS, Dashwood MR, Tsui JCS, Filbey D, Bodin L, Johansson B, et al. Improved patency in vein grafts harvested with surrounding tissue: results of a randomized study using three harvesting techniques. Ann Thorac Surg. 2002 Apr [acceso 18/03/2021];73(4):1189-95. Disponible en: https://www.annalsthoracicsurgery.org/article/S0003-4975(02)03425-2.
Souza DS, Arbeus M, Botelho Pinheiro B, Filbey D. The no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting surgery [resumen]. Multimed Man Cardiothorac Surg. 2009 Jan [acceso 10/03/2021];1:[aprox. 4p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/24413611/.
Malinska A, Podemska Z, Perek B, Jemielity M, Buczkowski P, Grzymislawska M, et al. Preoperative factors predicting saphenous vein graft occlusion in coronary artery bypass grafting: a multivariate analysis. Histochem Cell Biol. 2017May [acceso 21/01/2022];148(4):417-24. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602051/pdf/418_2017_Article_1574.pdf
Caliskan E, Sandner S, Misfeld M, Aramendi J, Salzberg SP, Choi YH, et al. A novel endothelial damage inhibitor for the treatment of vascular conduits in coronary artery bypass grafting: protocol and rationale for the European, multicentre, prospective, observational DuraGraft registry. J Cardiothorac Surg. 2019 Oct [acceso 23/01/2022];14(1):174. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794868/pdf/13019_2019_Article_1010.pdf
Hamasaki A, Uchida T, Mizumoto M, Hayashi J, Hirooka S, Kentaro A, et al. Proximal first: a beneficial strategy for no-touch saphenous vein graft. Interactive Cardio Vascular and Thoracic Surgery. 2018 Nov [acceso 30/06/2022];27(5):692-4. Disponible en: https://academic.oup.com/icvts/article/27/5/692/4989317?login=true
McKavanagh P, Yanagawa B Zawadowski G, Cheema A. Management and prevention of saphenous vein graft failure: a review. Cardiol Ther. 2017 Jul [acceso 28/01/2022];6(2):203-23. Disponible en: https://link.springer.com/content/pdf/10.1007/s40119-017-0094-6.pdf
Beijk M, Harskamp R. Treatment of Coronary Artery Bypass Graft Failure. En: Aronow WS (editor). Artery Bypass. London: IntechOpen; 2013 [acceso 04/04/2022]. Disponible en: https://www.intechopen.com/chapters/43498
Samano N, Pinheiro BB, Souza D. Surgical aspects of no-touch saphenous vein graft harvesting in CABG: clinical and angiographic follow-up at 3 months. Braz J Cardiovasc Surg . 2019 Oct [acceso 16/03/2021];34(1):98-100. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385820/pdf/rbccv-34-01-0098.pdf
Samano N, Souza DS, Botelho PB, Kopjar T, Dashwood M. Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: Structural Observations and Impact on Graft Performance. Braz J Cardiovasc Surg. 2020 Jun [acceso 18/03/2021];35(1):91-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32270965/
Verma S, Lovren F, Pan Y, Yanagawa B, Deb S, Karkhanis R, et al. Pedicled no-touch saphenous vein graft harvest limits vascular smooth muscle cell activation: the PATENT saphenous vein graft study. Eur J Cardiothorac Surg. 2014 Mar [acceso 17/04/2021];45(4):717-25. Disponible en: https://pubmed.ncbi.nlm.nih.gov/24327455/
Samano N, Souza D, Dashwood MR. Saphenous veins in coronary artery bypass grafting need external support. Asian Cardiovascular & Thoracic Annals 710132225. 2020 Jan [acceso 23/01/2022];14(5):1-11 Disponible en: http://www.nature.com/ijo/journal/v41/n3/pdf/ijo2016222a.pdf.
Neuman FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019 Aug [acceso 25/06/2021];40(2):87-165. Disponible en: https://watermark.silverchair.com/ehy394.pdf?token
Deb S, Singh SK, Souza DS, Chu MWA, Whitlock R, Meyer SR, et al. SUPERIOR SVG: no touch saphenous harvesting to improve patency following coronary bypass grafting (a multi-Centre randomized control trial, NCT01047449). Journal of Cardiothoracic Surgery. 2019;14(1):85. DOI: https://doi.org/10.1186/s13019-019-088
Pettersen Q, Haram PM, Winnerkvist A, Karevold A, Wahba A, Stenvik M, et al. Pedicled vein graft in coronary surgery: perioperative data from a randomized trial. Ann Thorac Surg. 2017 Oct [acceso 06/08/2021];104(4):1313-17. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0003497517305489?via%3Dihub
Kim YH, Oh CH, Choi JW, Hwang HY, Kim KBl. No-touch saphenous vein harvesting may improve further the patency of saphenous vein composite graft: early outcomes and 1-year angiographic results. Ann Thorac Surg. 2017 Jan [acceso 23/01/2022];103(5):1489-97. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8818706/pdf/fcvm-08-804739.pdf
Siddiqi MS. Saphenous vein harvest wound complications: risk factors, identification, prevention, and management. Chronic Wound Care Management and Research. 2016 Nov [acceso 04/08/2021];3:147-56. Disponible en: https://www.researchgate.net/publication/310390014_Saphenous_vein_harvest_wound_complications_risk_factors_identification_prevention_and_management
Hayashi I, Kashima I, Yoshikawa E. Use of the No- Touch Saphenous Vein Harvesting Technique via Small Incisions. Innovations. 2020 Jan [acceso 25/01/2022];15(1):81-4. Disponible en: http://www.nature.com/ijo/journal/v41/n3/pdf/ijo2016222a.pdf.
Downloads
Published
How to Cite
Issue
Section
License
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Attribution-NonCommercial 4.0 Internacional (CC BY-NC 4.0) que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista. o admite fines comerciales. Permite copiar, distribuir e incluir el artículo en un trabajo colectivo (por ejemplo, una antología), siempre y cuando no exista una finalidad comercial, no se altere ni modifique el artículo y se cite apropiadamente el trabajo original. El Comité Editorial se reserva el derecho de introducir modificaciones de estilo y/o acotar los textos que lo precisen, comprometiéndose a respectar el contenido original.
- Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
- Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web) antes y durante el proceso de envío, lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada. (Véase El efecto del acceso abierto).
