| BACKGROUND The Saphenous Vein (SV) is one of the most commonly used autologous homograft in patients undergoing coronary artery bypass grafting (CABG). Saphenous vein has traditionally been harvested using an open saphenous vein harvesting (OSVH) with minimal manipulation of the vein. The OSVH consisted of removing the saphenous vein with perivascular tissue in the traditional open way with "No-touch" technique. However, more and more agencies have adapted to the minimally invasive surgical technique of endoscopic saphenous vein harvest (ESVH) because of patient preference and decreased incidence. ESVH once was found to be a waste of time-technology in patients with a small-caliber SV; it was harder to expose the initial segment by a smaller skin incision, and a lot of avulsed side branches needed to be repaired. Although the long-term results of ESVH for patients undergoing CABG have not yet been reported, SV grafts of less satisfactory quality seem to be associated with additional manipulation of the vein during the endoscopic technology, which may harm the vein graft itself. Similarly, the integrity of the endothelial lining is also affected by many factors during ESVH. We have previously argue that the SV calibers can affect the endothelial viability and function. Although the ESVH procedures utilizing the currently available procedure follow a similar minimally invasive technique, differences still exist due to the unique properties operator. Therefore, we have assumed that a SV with a small caliber is less suit for ESVH and is better harvested by a traditional open procedure.OBJECTIVE To assess the influence of saphenous diameter on the procedure difficulty and result of Endoscopic saphenous vein harvesting (ESVH).METHODS The clinical cases of80patients who were treated with ESVH from2011 to2012were investigated. Excluding the initial12patients to eliminate any effect of inexpertise during the period. All the harvested saphenous veins were used for elective CABG. SV caliber in the above-knee portion was measured using an ultrasound system immediately after anesthesia and before skin incision. Patients were divided into two groups by preoperative ultrasound:group A (SV caliber<3mm, n=19), and group B (SV caliber≥3mm,n=61). Total procedure time and EVSH time, SV characteristics such as the total number of side branches, number of repaired branches, and total graft length were recorded in the operating room, scanning electron microscopy was used to assess the trauma of the epithelium, and the cell apoptosis was detected by TUNEL assay.RESULTS1.Group A had a larger number of side branches (A,12.9±3.2; B,9.3±4.1, P<0.05).2. Graft length (A,28.2±3.9cm; B,27.7±3.1cm) and ratio of repaired side branches relative to total branches per graft (A,20.3±9.1%; B,18.5±8.0%) showed no significant inter-group differences.3. Group A patients required a longer operating time (A,59.5±12.8min; B,41.9±15.4min), Vascular histological injury was statistically significant(P<0.05).4. The cell apoptosis was not significantly increased, the apoptosis indexes were (20.3±5.1)%, and (18.52±6.0)%, respectively P>0.05.CONCLUSIONS SV with a caliber of<3mm prolong the procedure time and injure the quality of SV in comparison with SV measuring≥3mm in caliber. SV with a small caliber is less appropriate for ESVH and is better harvested by a conventional open procedure. |
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