Abstract
Coronary artery disease (CAD) is the major cause of mortality in the Western world. Methods for restoring blood supply to the heart have changed over the years and include percutaneous transluminal coronary angioplasty (PTCA), bare metal or drug-eluting stents, with more recent attempts using techniques such as gene targeting and stem cell therapy. Once these techniques have failed, the remaining method for revascularization of the myocardium is coronary artery bypass surgery (CABG) using autologous blood vessel grafts as ‘conduits,’ restoring blood supply to diseased heart muscle. The main vessels used include the internal thoracic artery (ITA), radial artery (RA), and saphenous vein (SV). The success of CABG relies on the long-term patency of the conduit used for revascularization. Originally, SV grafts were used, but the ITA has subsequently become the first conduit of choice since it has superior patency compared with SV grafts [1, 2]. The poor long-term results with SV grafts and the encouraging results with ITA have led to a search for other arterial conduits for CABG. Among arterial grafts, the radial artery (RA) has gained the widest popularity as in many studies it has shown an excellent long-term patency [3] compared to SV grafts. However, recent studies have shown no difference between RA and SV grafts regarding their clinical outcome [4] or patency [5]. There is no doubt that the SV remains an important and the most widely used complementary conduit for patients undergoing CABG, and improvement of its long-term patency has been a major goal.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Lytle BW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC. Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg. 1985;89:248–58.
Cameron A, Davis KB, Green G, Schaff HV. Coronary bypass surgery with internal-thoracic-artery grafts ‒ effects on survival over a 15-year period. N Engl J Med. 1996;334:216–20.
Achouh P, Boutekadjirt R, Toledano D, et al. Long-term (5- to 20-year) patency of the radial artery for coronary bypass grafting. J Thorac Cardiovasc Surg. 2010;140:73–79.e2.
Acar C, Jebara VA, Portoghese M, et al. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg. 1992;54:652–9.
Tatoulis J, Royse AG, Buxton BF, et al. The radial artery in coronary surgery: a 5-year experience–clinical and angiographic results. Ann Thorac Surg. 2002;73:143–8.
Rosenfeldt FL, He GW, Buxton BF, Angus JA. Pharmacology of coronary artery bypass grafts. Ann Thorac Surg. 1999;67(3):878–88.
Tsui JC, Souza DS, Filbey D, Bomfim V, Dashwood MR. Preserved endothelial integrity and nitric oxide synthase in saphenous vein grafts harvested by a ‘no-touch’ technique. Br J Surg. 2001;88:1209–15.
Ahmed SR, Johansson BL, Karlsson MG, Souza DS, Dashwood MR, Loesch A. Human saphenous vein and coronary bypass surgery: ultrastructural aspects of conventional and “no-touch” vein graft preparations. Histol Histopathol. 2004;19(2):421–33.
Vasilakis V, Dashwood MR, Souza DS, Loesch A. Human saphenous vein and coronary bypass surgery: scanning electron microscopy of conventional and “no-touch” vein grafts. Vasc Dis Prev. 2004;1:133–9.
Dashwood MR, Savage K, Tsui JC, Dooley A, Shaw SG, Fernández Alfonso MS, et al. Retaining perivascular tissue of human saphenous vein grafts protects against surgical and distension-induced damage and preserves endothelial nitric oxide synthase and nitric oxide synthase activity. J Thorac Cardiovasc Surg. 2009;138(2):334–40.
Souza D. A new “no-touch” preparation technique. Scand J Thorac Cardiovasc Surg. 1996;30:41–4.
Dashwood MR, Gibbins R, Mehta D, Bashar Izzat M, Angelini GD, Jeremy JY. Neural reorganisation in porcine vein grafts: a potential role for endothelin-1. Atherosclerosis. 2000;150(1):43–53.
Dashwood MR, Angelini GD, Wan S, Yim A, Mehta D, Izzat MB, et al. Does external stenting reduce porcine vein-graft occlusion via an action on vascular nerves? J Card Surg. 2002;17(6):556–60.
Barker SG, Talbert A, Cottam S, Baskerville PA, Martin JF. Arterial intimal hyperplasia after occlusion of the adventitial vasa vasorum in the pig. Arterioscler Thromb. 1993;13:70–7.
Barker SG, Tilling LC, Miller GC, Beesley JE, Fleetwood G, Stavri GT, et al. The adventitia and atherogenesis: removal initiates intimal proliferation in the rabbit which regresses on generation of a ‘neoadventitia’. Atherosclerosis. 1994;105:131–44.
Scotland RS, Vallance PJ, Ahluwalia A. Endogenous factors involved in regulation of tone of arterial vasa vasorum: implications for conduit vessel physiology. Cardiovasc Res. 2000;46(3):403–11.
Gollasch M, Dubrovska G. Paracrine role for periadventitial adipose tissue in the regulation of arterial tone. Trends Pharmacol Sci. 2004;25(12):647–53.
Maenhaut N, Van de Voorde J. Regulation of vascular tone by adipocytes. BMC Med. 2011;9:25.
Gollasch M. Vasodilator signals from perivascular adipose tissue. Br J Pharmacol. 2012;165(3):633–42.
Dashwood MR, Dooley A, Shi-Wen X, Abraham DJ, Souza DS. Does periadventitial fat-derived nitric oxide play a role in improved saphenous vein graft patency in patients undergoing coronary artery bypass surgery? J Vasc Res. 2007;44(3):175–81.
Malinowski M, Deja MA, Gołba KS, Roleder T, Biernat J, Woś S. Perivascular tissue of internal thoracic artery releases potent nitric oxide and prostacyclin-independent anticontractile factor. Eur J Cardiothorac Surg. 2008;33(2):225–31.
Dashwood MR, Dooley A, Shi-Wen X, Abraham DJ, Dreifaldt M, Souza DS. Perivascular fat-derived leptin: a potential role in improved vein graft performance in coronary artery bypass surgery. Interact Cardiovasc Thorac Surg. 2011;12(2):170–3.
Fésüs G, Dubrovska G, Gorzelniak K, Kluge R, Huang Y, Luft FC, et al. Adiponectin is a novel humoral vasodilator. Cardiovasc Res. 2007;75(4):719–27.
Favaloro RG. Saphenous vein graft in the surgical treatment of coronary artery disease. Operative technique. J Thorac Cardiovasc Surg. 1969;58:178–85.
Tsui JC, Dashwood MR. Recent strategies to reduce vein graft occlusion: a need to limit the effect of vascular damage. Eur J Vasc Endovasc Surg. 2002;23(3):202–8.
Mehta D, Izzat MB, Bryan AJ, Angelini GD. Towards the prevention of vein graft failure. Int J Cardiol. 1997;62 Suppl 1:S55–63.
Gottlob R. The preservation of the venous endothelium by <<dissection without touching>> and by an atraumatic technique of vascular anastomosis. Minerva Chir. 1977;32:693–700.
Angelini GD, Bryan AJ, Hunter S, Newby AC. A surgical technique that preserves human saphenous vein functional integrity. Ann Thorac Surg. 1992;53(5):871–4.
Souza DSR, Arbeus M, Botelho Pinheiro B, Filbey D. The no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting surgery. http://mmcts.ctsnetjournals.org/cgi/content/full/2009/0731/mmcts.2008.003624. Accessed on Jan 1, 2009.
Souza DS, Bomfim V, Skoglund H, Dashwood MR, Borowiec JW, Bodin L, et al. High early patency of saphenous vein graft for coronary artery bypass harvested with surrounding tissue. Ann Thorac Surg. 2001;71(3):797–800.
Souza DS, Dashwood MR, Tsui JC, 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;73(4):1189–95.
Souza DS, Johansson B, Bojö L, Karlsson R, Geijer H, Filbey D, et al. Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial. J Thorac Cardiovasc Surg. 2006;132(2):373–8.
Souza DS, Christofferson RH, Bomfim V, Filbey D. “No-touch” technique using saphenous vein harvested with its surrounding tissue for coronary artery bypass grafting maintains an intact endothelium. Scand Cardiovasc J. 1999;33(6):323–9.
Dreifaldt M, Souza DS, Loesch A, Muddle JR, Karlsson MG, Filbey D, et al. The “no-touch” harvesting technique for vein grafts in coronary artery bypass surgery preserves an intact vasa vasorum. J Thorac Cardiovasc Surg. 2011;141(1):145–50.
Dashwood MR, Loesch A. The saphenous vein as a bypass conduit: the potential role of vascular nerves in graft performance. Curr Vasc Pharmacol. 2009;7(1):47–57.
Loesch A, Dashwood MR. On the sympathetic innervation of the human greater saphenous vein: relevance to clinical practice. Curr Vasc Pharmacol. 2009;7(1):58–67.
Johansson BL, Souza DS, Bodin L, Filbey D, Bojö L. No touch vein harvesting technique for CABG improves the long-term clinical outcome. Scand Cardiovasc J. 2009;43(1):63–8.
Johansson BL, Souza DS, Bodin L, Filbey D, Loesch A, Geijer H, et al. Slower progression of atherosclerosis in vein grafts harvested with ‘no touch’ technique compared with conventional harvesting technique in coronary artery bypass grafting: an angiographic and intravascular ultrasound study. Eur J Cardiothorac Surg. 2010;38(4):414–9.
Lemson MS, Tordoir JH, Daemen MJ, Kitslaar PJ. Intimal hyperplasia in vascular grafts. Eur J Var Endovasc Surg. 2000;19:336–50.
Vanhoutte PM. Endothelium and control of vascular function. State of the art lecture. Hypertension. 1989;13(6 Pt 2):658–67.
Dashwood MR, Mehta D, Izzat MB, Timm M, Bryan AJ, Angelini GD, et al. Distribution of endothelin-1 (ET) receptors (ET(A) and ET(B)) and immunoreactive ET-1 in porcine saphenous vein-carotid artery interposition grafts. Atherosclerosis. 1998;137(2):233–42.
Heistad DD, Marcus ML. Role of vasa vasorum in nourishment of the aorta. Blood Vessels. 1979;16(5):225–38.
Iafrati MM. Less-invasive saphenous harvest. Surg Clin North Am. 1999;79(3):623–44.
Rosenthal D, Arous EJ, Friedman SG, Ingegno MD, Johnson BL, Kraiss LW, et al. Endovascular-assisted versus conventional in situ saphenous vein bypass grafting: cumulative patency, limb salvage, and cost results in a 39-month multicenter study. J Vasc Surg. 2000;31(1 Pt 1):60–8.
Narayan P, Yeatman M, Caputo M, Capoun R, Ciulli F, Jeremy JY, et al. Saphenous vein harvest with the Mayo extraluminal dissector: is endothelial function preserved? J Thorac Cardiovasc Surg. 2009;138(2):508–10.
Nowicki M, Buczkowski P, Miskowiak B, Konwerska A, Ostalska-Nowicka D, Dyszkiewicz W. Immunocytochemical study on endothelial integrity of saphenous vein grafts harvested by minimally invasive surgery with the use of vascular Mayo strippers. A randomized controlled trial. Eur J Vasc Endovasc Surg. 2004;27(3):244–50.
Lopes RD, Hafley GE, Allen KB, Ferguson TB, Peterson ED, Harrington RA, et al. Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery. N Engl J Med. 2009;361(3):235–44.
Dashwood MR, Fremes S, Souza DS. Saphenous vein harvest with the Mayo extraluminal dissector: is endothelial function preserved? J Thorac Cardiovasc Surg. 2010;139(1):239–41.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag London
About this chapter
Cite this chapter
Dashwood, M.R., Souza, D.S.R. (2013). Fifteen Years of ‘No-Touch’ Saphenous Vein Harvesting in Patients Undergoing Coronary Artery Bypass Surgery: What Have We Learned?. In: Gabriel, E., Gabriel, S. (eds) Inflammatory Response in Cardiovascular Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-4429-8_34
Download citation
DOI: https://doi.org/10.1007/978-1-4471-4429-8_34
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-4428-1
Online ISBN: 978-1-4471-4429-8
eBook Packages: MedicineMedicine (R0)