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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2001 June;42(3):297-301

lingua: Inglese

Scanning electron microscopic analysis of endoscopic versus open vein harvesting techniques

Lancey R. A., Cuenoud H. *, Nunnari J. J. **

From the Divi­sion of Tho­racic and Car­diac Sur­gery
*Divi­sion of Car­di­o­vas­cular Med­i­cine
**Depart­ment of ­Cell ­Biology
UMass Memo­rial Med­ical ­­Center, ­Worcester, MA, USA


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Back­ground. Endo­scopic ­vein har­vesting tech­niques are increas­ingly ­used for ­obtaining con­duit for cor­o­nary ­artery ­bypass sur­gery. ­Although ­they ­offer advan­tages in ­healing ­over the con­ven­tional ­open tech­nique, con­cern has ­been ­raised ­regarding the poten­tial for ­trauma to the ­vein in the ­form of ­intimal dis­rup­tion ­which ­would theo­ret­i­cally pre­dis­pose to ­early ­graft throm­bosis and/or devel­op­ment of ste­noses. Unfor­tu­nately no ­long ­term ­data is yet avail­able for deter­mining if con­duits har­vested in ­this ­fashion are ­prone to ­such ­events.
­Methods. We ­have exam­ined ­vein seg­ments har­vested by ­both endo­scopic and ­open tech­niques for evi­dence of ­intimal ­injury (­either vis­ible dis­rup­tion of the ­intima and/or pres­ence of ­thrombus) ­using scan­ning elec­tron micros­copy (SEM). ­Those har­vesting the ­vein ­were una­ware ­which ­patients ­were in the ­study, and ­both the SEM tech­ni­cian and car­diac pathol­o­gist who eval­u­ated the ­scans ­were ­blinded to the tech­nique ­used for har­vesting. For ­each ­vein seg­ment exam­ined, ­views ­were ­obtained of ­four dif­ferent sec­tions and ­were ana­lyzed at mag­nifi­ca­tions ­ranging ­from 10× to 100×.
­Results. ­Both ­thrombus for­ma­tion and vis­ible ­intimal dis­rup­tion ­were iden­ti­fied ­quite ­rarely, and ­overall ­were not ­linked sig­nif­i­cantly to the ­type of har­vesting tech­nique ­used.
Con­clu­sions. ­These ­results sug­gest ­that endo­scopic ­vein har­vesting tech­niques do not sub­ject the con­duits to ­more ­trauma ­than ­open tech­niques and there­fore may not pre­dis­pose to the devel­op­ment of ear­lier ste­noses. ­This ­data ­will ­need to be con­firmed by ­both ­other ­methods of iden­ti­fying ­intimal ­injury and by ­long-­term ­follow-up of con­duit ­patency in ­both ­groups.

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