Prevention of vessel desiccation and maintenance of normal morphology during endovascular harvesting using humidified warmed gas.
OBJECTIVE
Endoscopic vessel harvesting (EVH) traditionally uses carbon dioxide (CO(2)) gas for insufflation. The CO(2) based on government regulations is bone dry and room temperature. All previous EVH studies use this type of unconditioned  gas. It is hypothesized that by changing the quality of CO(2) gas differences may occur that are attributable to dry gas versus wet gas exposure.


METHODS
A comparison of the effect(s) of traditional dry CO(2) gas compared to humidified exposure was done using  a porcine model and evaluated in a double-blind randomized controlled fashion.


RESULTS
Vessels exposed to traditional dry cold gas had morphologic and structural changes noted on histologic evaluation. This included desiccation changes of the tunica adventitia desiccation and tunica  media collagen and elastin. Vessels exposed to dry gas showed 10% to 12% contraction and constriction with tortuous changes to the intima and endothelial lining that were progressive with increasing volumes of gas exposure. No desiccation or morphologic changes were seen with humidified warmed  gas produced using the VesselGuardian.


CONCLUSIONS
Traditional dry cold CO(2) caused vascular tissue damage extending from the adventitia to intima, changing the vessel in morphologic and structural configuration. With the VesselGuardian humidified warmed, gas maintained  vessel morphology and integrity by preventing desiccation. Changing the quality of CO(2) from dry and cold to wet and warm may offer clinical utility for a better quality conduit for coronary artery bypass graft procedures.
Department of Internal Medicine, School of Medicine, Mercer University, Macon, GA, USA. tculchasuremd@bellsouth.net
Talley F
TF
Culclasure
Tien-Ahn
TA
Tran
Darian
D
Kameh
Whitney
W
Hartz
Peter
P
Herrera
Holly
H
Lyle
D000818:Animals; D001808:Blood Vessels; D002245:Carbon Dioxide; D001026:Coronary Artery Bypass; D003890:Desiccation; D057510:Endovascular Procedures / Q000379:methods*; D006813:Humidity; D013552:Swine; D013696:Temperature; D020858:Tissue and Organ Harvesting / Q000379:methods*
D002245:Carbon Dioxide