Novel no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting.
BACKGROUND
Optimization of the saphenous vein for myocardial revascularization.


OBJECTIVE
To present the no-touch technique of the saphenous vein preparation. This technique consists of harvesting the vein with a pedicle of surrounding tissue, which protects the vein from spasms, obviating the need for distension.


METHODS
A prospective, randomized study with 156 patients who underwent artery bypass grafting was performed comparing three saphenous vein harvesting techniques: conventional, intermediate, and no-touch. A morphological study of the endothelium was carried out using scanning microscopy. An angiographic assessment of the vein graft patency was performed at a mean follow-up time of 18 months. Also, an immunohistochemical assessment was carried out to identify the endothelial enzyme nitric oxide synthase (eNOS) in the vein wall


RESULTS
The preservation of the endothelial cell integrity was greater in the no-touch technique than in the other procedures. At angiographic follow-up, the patency for the no-touch group was 95.4%, 88.9% for the grafts of the conventional technique group, and 86.2% for the grafts performed in the intermediate technique group. The immunohistochemical assessment revealed eNOS in all three layers of the vein wall in the no-touch group and reduction of this enzyme in the conventional group.


CONCLUSIONS
The endothelial integrity and eNOS activity were better preserved when using the no-touch technique for vein graft harvesting. The mechanical protection provided by the cushion of surrounding tissue in the no-touch group, the vasorelaxation and thromboresistant activities of nitric oxide may be responsible for the reduction of vasospasms and improved patency rate.
Rueda
Fabio de
Fd
Divisão de Cirurgia Cardiotorácica, Hospital Oswaldo Cruz, Universidade de Pernambuco, Recife, Brazil. fgrueda@yahoo.com.br
Souza
Domingos
D
Lima
Ricardo de Carvalho
Rde C
Menezes
Alexandre
A
Johansson
Benny
B
Dashwood
Michael
M
Thé
Emmanuel
E
Gesteira
Mário
M
Escobar
Mozart
M
Vasconcelos
Frederico
F
D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods*; D004730:Endothelium, Vascular / Q000648:ultrastructure*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular; D006801:Humans; D008297:Male; D008875:Middle Aged; D009252:NADPH Dehydrogenase / Q000378:metabolism; D009569:Nitric Oxide / Q000378:metabolism*; D019001:Nitric Oxide Synthase / Q000378:metabolism; D052250:Nitric Oxide Synthase Type III / Q000378:metabolism; D011446:Prospective Studies; D012501:Saphenous Vein / Q000201:enzymology / Q000637:transplantation*; D018709:Statistics, Nonparametric; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014654:Vascular Patency / Q000502:physiology*
D009569:Nitric Oxide; D019001:Nitric Oxide Synthase; D052250:Nitric Oxide Synthase Type III; D009252:NADPH Dehydrogenase