Minimally invasive saphenous vein harvesting: endothelial integrity and early clinical results.
BACKGROUND
Endoscopic harvesting of vein grafts may reduce wound complications but the effect on the venous endothelium is unknown. Endothelium-derived vasoactive substances may be important in vein graft disease prevention. We investigated the impact of endoscopic harvesting on the release of these factors and proceeded to evaluate the clinical applicability.


RESULTS
Porcine veins were harvested in either an endoscopic or open fashion. Superfusion bioassay from endoscopic veins had a similar basal secretion as control veins (6.5% +/- 1.5% versus 3.2% +/- 2.2%, respectively; n = 5, p = 0.39). Calcium ionophore A23187 stimulation was similar in both groups (24.6% +/- 5.1% versus 27.3% +/- 9.6%; n = 5, p = 0.68). Light and electron microscopy documented a normal endothelial monolayer in both groups with no endothelial cell or connective tissue loss. Encouraged by these results, 38 patients have subsequently undergone this procedure at our institution. Total operative time for harvesting 35 to 45 cm of saphenous vein was 62.3 +/- 5.3 minutes (range, 35 to 120 minutes). The procurement time in the most recent five patients was 41.6 +/- 3.3 minutes. Patients had little incisional pain, but did have mild ecchymosis.


CONCLUSIONS
Endothelial release of vasoactive substances after endoscopic harvesting is similar to that after the traditional, extended incision technique, and microscopy confirmed similar histology. These laboratory findings support the satisfactory early clinical experience with endoscopic harvesting of saphenous veins.
Cable
D G
DG
Cardiac Surgical Research Center, Division of Laboratory Medicine and Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Dearani
J A
JA
Pfeifer
E A
EA
Daly
R C
RC
Schaff
H V
HV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000001:Calcimycin / Q000494:pharmacology; D002118:Calcium / Q000378:metabolism; D003238:Connective Tissue / Q000187:drug effects / Q000473:pathology; D016861:Cyclooxygenase Inhibitors / Q000494:pharmacology; D004438:Ecchymosis / Q000209:etiology; D004724:Endoscopy; D004730:Endothelium, Vascular / Q000187:drug effects / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000494:pharmacology; D007476:Ionophores / Q000494:pharmacology; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010149:Postoperative Pain / Q000517:prevention & control; D012501:Saphenous Vein / Q000187:drug effects / Q000378:metabolism / Q000473:pathology / Q000601:surgery* / Q000637:transplantation; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000378:metabolism
D016861:Cyclooxygenase Inhibitors; D007476:Ionophores; D014665:Vasodilator Agents; D000001:Calcimycin; D002118:Calcium; D007213:Indomethacin